凝血指标和降钙素原及前白蛋白在儿童重症肺炎中的评估价值分析
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摘要
目的探讨D-二聚体(DD)、抗凝血Ⅲ(AT-Ⅲ)等凝血指标、降钙素原(PCT)及前白蛋白(PA)在重症肺炎患儿中的临床诊断价值。方法选取2014年3月至2017年3月收治的重症肺炎患儿42例(重症肺炎组)、普通肺炎患儿96例(普通肺炎组)及健康体检儿童80例(对照组)为研究对象,重症肺炎组根据PCT水平分为低于2. 00 ng/ml和高于2. 00 ng/ml 2个亚组。比较不同组别儿童PCT、CRP、PA、DD、AT-Ⅲ、PLT、PT、TT及APTT等指标的水平。结果重症肺炎组PCT、CRP及PA水平均显著高于普通肺炎组和对照组,普通肺炎组PCT、CRP及PA水平均显著高于对照组,重度肺炎组DD、PT、TT、APTT水平均显著高于对照组和普通肺炎组(P <0. 05)。重度肺炎组AT-Ⅲ、PLT水平均显著低于对照组和普通肺炎组(P <0. 05)。普通肺炎组DD、PT、APTT水平均显著高于对照组,普通肺炎组AT-Ⅲ水平显著低于对照组(P <0. 05)。PCT≥2. 00 ng/ml的患儿DD水平显著高于PCT <2. 00 ng/ml的患儿,PCT≥2. 00 ng/ml的患儿AT-Ⅲ水平显著低于PCT <2. 00 ng/ml的患儿(P <0. 05)。结论 DD、AT-Ⅲ等凝血指标、降钙素原(PCT)及前白蛋白(PA)对于重症肺炎患儿的诊断、病情监测、预后判断具有重要的临床意义。
Objecitve To investigate the clinical diagnostic value of DD,AT-Ⅲ and other coagulation indexes,procalcitonin( PCT) and prealbumin( PA) in children patients with severe pneumonia. Methods A total of 42 children patients with severe pneumonia( severe pneumonia group) and 96 children with common pneumonia( common pneumonia group) who were treated in our hospital from March 2017 to March 2014 were enrolled in the study,at the same time,the other80 healthy children were enrolled as control group. Moreover the severe pneumonia group was redivided into two subgroups according to the levels of PCT,one group was lower than 2. 00 ng/ml and the other one was higher than 2. 00 ng/ml. The levels of PCT,CRP,PA,DD,AT-Ⅲ,PLT,PT,TT and APTT were observed and compared among different groups. Results The levels of PCT,CRP and PA in severe pneumonia group were significantly higher than those in common pneumonia group and control group,moreover,the levels of PCT,CRP and PA in common pneumonia group were significantly higher than those in control group. The levels of DD,PT,TT and APTT in severe pneumonia group were significantly higher than those in control group and common pneumonia group( P < 0. 05). The levels of DD,PT and APTT in common pneumonia group were significantly higher than those in control group,and the levels of AT-Ⅲ in common pneumonia group were significantly lower than those in control group( P < 0. 05). The DD level in patients with PCT≥2. 00 ng/ml were significantly higher than those with PCT < 2. 00 ng/ml. The AT-Ⅲ levels in patients with PCT≥ 2. 00 ng/ml were significantly lower than those of patients with PCT < 2. 00 ng/ml( P < 0. 05). Conclusion The DD,AT-Ⅲ and other coagulation indexes,PCT and PA have important clinical significance in the diagnosis,monitoring and prognosis of children patients with severe pneumonia.
Objecitve To investigate the clinical diagnostic value of DD,AT-Ⅲ and other coagulation indexes,procalcitonin( PCT) and prealbumin( PA) in children patients with severe pneumonia. Methods A total of 42 children patients with severe pneumonia( severe pneumonia group) and 96 children with common pneumonia( common pneumonia group) who were treated in our hospital from March 2017 to March 2014 were enrolled in the study,at the same time,the other80 healthy children were enrolled as control group. Moreover the severe pneumonia group was redivided into two subgroups according to the levels of PCT,one group was lower than 2. 00 ng/ml and the other one was higher than 2. 00 ng/ml. The levels of PCT,CRP,PA,DD,AT-Ⅲ,PLT,PT,TT and APTT were observed and compared among different groups. Results The levels of PCT,CRP and PA in severe pneumonia group were significantly higher than those in common pneumonia group and control group,moreover,the levels of PCT,CRP and PA in common pneumonia group were significantly higher than those in control group. The levels of DD,PT,TT and APTT in severe pneumonia group were significantly higher than those in control group and common pneumonia group( P < 0. 05). The levels of DD,PT and APTT in common pneumonia group were significantly higher than those in control group,and the levels of AT-Ⅲ in common pneumonia group were significantly lower than those in control group( P < 0. 05). The DD level in patients with PCT≥2. 00 ng/ml were significantly higher than those with PCT < 2. 00 ng/ml. The AT-Ⅲ levels in patients with PCT≥ 2. 00 ng/ml were significantly lower than those of patients with PCT < 2. 00 ng/ml( P < 0. 05). Conclusion The DD,AT-Ⅲ and other coagulation indexes,PCT and PA have important clinical significance in the diagnosis,monitoring and prognosis of children patients with severe pneumonia.
引文
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2 ScHuurmans J,Goslings JC,Schepers T. Operative management versus non-operative management of rib fractures in flail chest injuries:a systematic review. Eur J Trauma Emerg Surg,2017,43:163-168.
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4 许燕京,朱然,孙旖旎,等.抗凝血酶Ⅲ对脓毒症DIC的早期诊断价值:附445例患者的回顾性分析.中华危重病急救医学,2017,29:127-132.
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7 郭先锋,时雨,苏爱芳,等.降钙素原抗凝血酶Ⅲ和D-二聚体在新生儿重症肺炎诊治中的价值.安徽医学,2015,36:1216-1219.
8 张芳芳,尹占良,邱建凯,等.重症肺炎患儿降钙素原与凝血纤溶指标的临床意义.热带医学杂志,2016,16:1423-1425.
9 Torres A,Sibila O,Ferrer M,et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response:a randomized clinical trial.JAMA,2015,17:677-686.
10 李晓燕,邢丽华,高景.重症肺炎患者血清胆碱酯酶、降钙素原、D-二聚体与预后.中国实用医刊,2016,43:23-26.
11 郭先锋,时雨,苏爱芳,等.降钙素原抗凝血酶Ⅲ和D-二聚体在新生儿重症肺炎诊治中的价值.安徽医学,2015,36:1216-1219.
2 ScHuurmans J,Goslings JC,Schepers T. Operative management versus non-operative management of rib fractures in flail chest injuries:a systematic review. Eur J Trauma Emerg Surg,2017,43:163-168.
3 陈贤楠.重症患儿肺炎的定义和诊断标准.中华实用儿科临床杂志,2006,21:1118-1120.
4 许燕京,朱然,孙旖旎,等.抗凝血酶Ⅲ对脓毒症DIC的早期诊断价值:附445例患者的回顾性分析.中华危重病急救医学,2017,29:127-132.
5 Walker CF,Rudan I,Liu L,et al. Global burden of childhood pneumonia and diarrhoea. Lancet,2013,381:1405-1416.
6 黄彩芝,莫丽亚,李爱国,等.儿童重症肺炎凝血指标与降钙素原变化及分析.临床儿科杂志,2015,33:20-22.
7 郭先锋,时雨,苏爱芳,等.降钙素原抗凝血酶Ⅲ和D-二聚体在新生儿重症肺炎诊治中的价值.安徽医学,2015,36:1216-1219.
8 张芳芳,尹占良,邱建凯,等.重症肺炎患儿降钙素原与凝血纤溶指标的临床意义.热带医学杂志,2016,16:1423-1425.
9 Torres A,Sibila O,Ferrer M,et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response:a randomized clinical trial.JAMA,2015,17:677-686.
10 李晓燕,邢丽华,高景.重症肺炎患者血清胆碱酯酶、降钙素原、D-二聚体与预后.中国实用医刊,2016,43:23-26.
11 郭先锋,时雨,苏爱芳,等.降钙素原抗凝血酶Ⅲ和D-二聚体在新生儿重症肺炎诊治中的价值.安徽医学,2015,36:1216-1219.