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

doi:10.11958/20230564

Abstract

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

CLC Number:

R446.1

Figures/Tables 8

References 16

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组别	n	胎龄/周	男性	出生体质量/kg	低Apgar 评分	出生窒息	RDS	IVH	血管瘤	积水	脓毒症	PIH	PA
对照组	50	37.6±4.4	29（58.0）	3.3±0.7	5（10.0）	7（14.0）	10（20.0）	2（4.0）	0（0）	1（2.0）	2（4.0）	4（8.0）	0（0）
观察组	87	36.2±4.6	49（56.3）	3.1±0.8	25（28.7）	32（36.8）	22（25.3）	15（17.2）	3（3.4）	8（9.2）	18（20.7）	20（23.0）	4（4.6）
t、χ²或P		1.744	0.036	1.406	6.517^＊	8.093^＊＊	0.496	5.122^＊	0.300^▲	2.678	7.094^＊＊	4.937^＊	0.296^▲

组别	n	胎龄/周	男性	出生体质量/kg	低Apgar 评分	出生窒息	RDS	IVH	血管瘤	积水	脓毒症	PIH	PA
对照组	50	37.6±4.4	29（58.0）	3.3±0.7	5（10.0）	7（14.0）	10（20.0）	2（4.0）	0（0）	1（2.0）	2（4.0）	4（8.0）	0（0）
观察组	87	36.2±4.6	49（56.3）	3.1±0.8	25（28.7）	32（36.8）	22（25.3）	15（17.2）	3（3.4）	8（9.2）	18（20.7）	20（23.0）	4（4.6）
t、χ²或P		1.744	0.036	1.406	6.517^＊	8.093^＊＊	0.496	5.122^＊	0.300^▲	2.678	7.094^＊＊	4.937^＊	0.296^▲

变量	β	SE	Wald χ²	P	OR	OR 95%CI
低Apgar 评分	1.498	0.573	6.832	0.009	4.471	1.454~13.742
出生窒息	1.405	0.506	7.718	0.005	4.076	1.513~10.984
IVH	1.122	0.829	1.833	0.176	3.072	0.605~15.597
脓毒症	1.721	0.810	4.521	0.033	5.591	1.144~27.324
PIH	1.640	0.622	6.947	0.008	5.153	1.523~17.439
常数项	-0.588	0.279	4.441	0.035	0.556

变量	β	SE	Wald χ²	P	OR	OR 95%CI
低Apgar 评分	1.498	0.573	6.832	0.009	4.471	1.454~13.742
出生窒息	1.405	0.506	7.718	0.005	4.076	1.513~10.984
IVH	1.122	0.829	1.833	0.176	3.072	0.605~15.597
脓毒症	1.721	0.810	4.521	0.033	5.591	1.144~27.324
PIH	1.640	0.622	6.947	0.008	5.153	1.523~17.439
常数项	-0.588	0.279	4.441	0.035	0.556

组别	n	TM/（TU/mL）	TAT/（μg/L）	PIC/（mg/L）	t-PAIC/ （μg/L）
对照组	50	11.43±4.95	10.86±4.61	2.10±1.15	9.16±3.73
观察组	87	19.07±7.10	19.46±8.46	2.82±1.42	11.61±4.45
t		6.720^＊＊	7.693^＊＊	3.070^＊＊	3.288^＊＊