凝血功能障碍对儿童金黄色葡萄球菌脓毒症预后的影响  

Influence of coagulation dysfunction on prognosis of Staphylococcus aureus sepsis in children

作　　者：易茜 李媛媛[1] 吴毅 李沁原[1,2] 罗斯颖 唐源 王智利 张光莉[1] 田小银 罗征秀[1] YI Qian;LI Yuanyuan;WU Yi;LI Qinyuan;LUO Siying;TANG Yuan;Wang Zhili;ZHANG Guangli;TIAN Xiaoyin;LUO Zhengxiu(Department of Respiratory,Children's Hospital of Chongqing Medical University;Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation base of Child Development and Critical Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院呼吸科 [2]儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆400014

出　　处：《临床儿科杂志》2020年第1期44-48,52,共6页Journal of Clinical Pediatrics

基　　金：国家临床重点专科建设项目(No.2011-873)

摘　　要：目的探讨凝血功能障碍对儿童金黄色葡萄球菌脓毒症预后的影响。方法回顾分析2014年1月至2018年2月收治的130例金黄色葡萄球菌脓毒症患儿的临床资料,并按其病情转归分为存活组和死亡组,行单因素及多元logistic回归分析,并对相关凝血功能指标行ROC分析。结果130例患儿男68例、女62例,中位年龄54.0个月(10.7~129.8月),死亡34例,病死率26.2%。死亡组的耐甲氧西林金黄色葡萄球菌检出率、降钙素原、C反应蛋白、血小板分布宽度、活化部分凝血活酶时间、凝血酶时间、D-二聚体水平,凝血酶原时间≥17 s比例均显著高于存活组,血小板计数、纤维蛋白原水平低于存活组,差异有统计学意义(P<0.05)。多元logistic回归分析显示,原发血流感染、耐甲氧西林金黄色葡萄球菌感染凝血酶原时间延长、D-二聚体升高、血小板减少为死亡的独立危险因素(P<0.05)。PT为17 s、D-二聚体为5.9 mg/L、血小板为50×10^9/L时,ROC曲线下面积(AUC)分别为0.853、0.870、0.889,预测的死亡灵敏度分别为88.24%、88.24%、52.94%,特异度分别为83.33%、83.33%、97.92%。联合上述三项凝血功能指标行ROC分析,预测死亡的灵敏度、特异度分别为85.29%、94.79%,AUC为0.936。结论凝血酶原时间≥17 s、D-二聚体≥5.9 mg/L、血小板≤50×10^9/L时,金黄色葡萄球菌脓毒症患儿死亡的风险增加,联合三种指标预测患儿死亡分析的价值更高。Objective To explore the effect of coagulation dysfunction on the prognosis of Staphylococcus aureus sepsis in children.Methods The clinical data of Staphylococcus aureus sepsis in 130 children from January 2014 to February 2018 were analyzed retrospectively.According to the outcome,the patients were divided into survival group and death group.Univariate and multivariate logistic regression analysis were carried out,and ROC analysis was performed for related indicators of coagulation function.Results In the 130 patients(68 boys;62 girls)with a median age of 54.0 months(10.7~129.8 months),34 died and case fatality rate was 26.2%.The detection rate of methicillin-resistant Staphylococcus aureus,procalcitonin,C-reactive protein,platelet distribution width,activated partial thromboplastin time,thrombin time,D-dimer level,the proportion of prothrombin time≥17s in the death group were significantly higher than those in the survival group,and the platelet count and fibrinogen were significantly lower than those in the survival group(all P<0.05).Multivariate logistic regression analysis showed that primary blood flow infection,methicillin-resistant Staphylococcus aureus infection,prothrombin time(PT)extension,increased D-dimer and thrombocytopenia were independent risk factors for death(all P<0.05).When PT was 17s,D-dimer was 5.9 mg/L and platelet was 50×10^9/L,area under the ROC curve(AUC)was 0.853,0.870 and 0.889,respectively.The sensitivity of predicting death was 88.24%,88.24%and 52.94%,and the specificity was 83.33%,83.33%and 97.92%,respectively.When combined the above three indicators of coagulation function,the ROC analysis showed that the sensitivity and specificity of predicting death were 85.29%and 94.79%,respectively,and the AUC was 0.936.Conclusions When prothrombin time≥17s,D-dimer≥5.9 mg/L,platelets≤50×10^9/L,the risk of death in children with Staphylococcus aureus sepsis increased,and the value of combination of three indicators to predict the death of children was higher.

关 键 词：金黄色葡萄球菌 脓毒症 凝血功能 危险因素 儿童 

分 类 号：R720.597[医药卫生—急诊医学]