天津医药

天津医药 ›› 2024, Vol. 52 ›› Issue (2): 206-209.doi: 10.11958/20230564

• 临床研究 • 上一篇    下一篇

新凝血标志物在新生儿弥漫性血管内凝血诊断及预后评估中的价值

张世杰1(), 孟宪春1,△(), 孙萍萍1, 杨静静1, 吴静2   

  1. 1.郑州大学第一附属医院检验科（邮编450052），2.小儿内科
  • 收稿日期:2023-04-23 修回日期:2023-05-11 出版日期:2024-02-15 发布日期:2024-01-26
  • 通讯作者: △ E-mail：mengchun0712@163.com
  • 作者简介:张世杰（1979），男，副主任技师，主要从事临床检验方面研究。E-mail：zsj03@zzu.edu.cn
  • 基金资助:
    河南省高等学校重点科研项目(20A320067)

The value of new coagulation markers in the diagnosis and prognosis evaluation of neonatal disseminated intravascular coagulation

ZHANG Shijie1(), MENG Xianchun1,△(), SUN Pingping1, YANG Jingjing1, WU Jing2   

  1. 1. Department of Clinical Laboratory, 2. Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
  • Received:2023-04-23 Revised:2023-05-11 Published:2024-02-15 Online:2024-01-26
  • Contact: △ E-mail: mengchun0712@163.com

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摘要：

目的 探讨新凝血标志物血栓调节蛋白（TM）、凝血酶-抗凝血酶复合物（TAT）、纤溶酶-α2抗纤溶酶复合物（PIC）和组织型纤溶酶原激活剂-纤溶酶原激活剂抑制剂-1复合物（t-PAIC）在新生儿弥漫性血管内凝血（DIC）诊断及预后评估中的价值。方法 纳入87例DIC患儿（观察组），根据其出院时的转归情况分为存活组（66例）和死亡组（21例），另外以同期出生的50例健康新生儿作为对照组。收集新生儿的临床资料，采用Logistic回归分析新生儿发生DIC的危险因素。分析不同组别TM、TAT、PIC和t-PAIC水平差异。采用受试者工作特征（ROC）曲线分析TM、TAT、PIC和t-PAIC在新生儿DIC诊断和预后评估中的价值。结果 观察组低Apgar评分、出生窒息、IVH、脓毒症和PIH的发生率高于对照组（P<0.05）。多因素Logistic回归分析显示，低Apgar评分、出生窒息、脓毒症和PIH是新生儿发生DIC的独立危险因素。观察组TM、TAT、PIC和t-PAIC水平均高于对照组（P<0.05）。ROC曲线显示，TM、TAT、PIC和t-PAIC联合诊断新生儿DIC的价值优于单独诊断。死亡组TM、TAT水平高于存活组（P<0.05），2组PIC、t-PAIC差异无统计学意义；多因素Logistic回归分析显示，TAT水平升高是影响新生儿DIC预后的独立危险因素。ROC曲线显示，当TAT为21.72 μg/L时，其预测新生儿DIC预后的曲线下面积为0.772（95%CI：0.666~0.878），敏感度和特异度分别为76.2%和71.2%。结论 TM、TAT、PIC和t-PAIC联合应用对新生儿DIC诊断和预后评估具有重要的临床价值。

关键词: 婴儿, 新生, 疾病, 弥漫性血管内凝血, 血栓调节蛋白, 凝血酶-抗凝血酶复合物, 纤溶酶-α2抗纤溶酶复合物, 组织型纤溶酶原激活剂-纤溶酶原激活剂抑制剂-1复合物

Abstract:

Objective To investigate the value of thrombomodulin (TM), thrombin-antithrombin complex (TAT), α2 plasmin inhibitor-plasmin complex (PIC) and tissue plasminogen activator-inhibitor complex (t-PAIC) in the diagnosis and prognosis of neonatal disseminated intravascular coagulation (DIC). Methods Eighty-seven DIC neonates (the observation group) were included and divided into the survival group (66 cases) and the death group (21 cases) based on their outcomes at discharge. And 50 healthy newborns born in the same period were selected as the control group. The clinical data of neonates were collected, and risk factors of neonatal DIC were analyzed by Logistic regression. The differences of TM, TAT, PIC and t-PAIC levels in different groups were analyzed. The receiver operating characteristic (ROC) curve was used to analyze values of TM, TAT, PIC and t-PAIC in the diagnosis and prognosis of neonatal DIC. Results The incidence of low Apgar score, birth asphyxia, IVH, sepsis and maternal pregnancy induced hypertension syndrome (PIH) were higher in the observation group than those in the control group (P<0.05). Multivariate Logistic regression analysis showed that low Apgar score, birth asphyxia, sepsis and PIH were independent risk factors for neonatal DIC. TM, TAT, PIC and t-PAIC levels were higher in the observation group than those in the control group (P<0.05). ROC curve showed that the combined diagnosis value of TM, TAT, PIC and t-PAIC was better than that of single diagnosis of neonatal DIC. TM and TAT levels were higher in the death group than those in the survival group (P<0.05), and there were no significant differences in PIC and t-PAIC levels between the two groups. Multivariate Logistic regression analysis showed that elevated TAT level was an independent risk factor for neonatal DIC prognosis. ROC curve showed that when TAT was 21.72 μg/L, the area under the curve for predicting neonatal DIC prognosis was 0.772 (95%CI: 0.666-0.878), and the sensitivity and specificity were 76.2% and 71.2%, respectively. Conclusion The combined application of TM, TAT, PIC and t-PAIC has important clinical value in diagnosis and prognosis evaluation of neonatal DIC.

Key words: infant, newborn, diseases, disseminated intravascular coagulation, thrombomodulin, thrombin-antithrombin complex, α2-plasmin inhibitor-plasmin complex, tissue plasminogen activator-inhibitor complex

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