凝血6项联合血小板相关指标在儿童初发原发性肾病综合征中的诊断价值  

Diagnostic value of six coagulation and platelet related indexes in children with primary nephrotic syndrome

作　　者：符利梅 盛哲 杨丹[1] 徐锦[1] 吴梓文[1] FU Limei;SHENG Zhe;YANG Dan;XU Jin;WU Ziwen(Clinical Laboratory Center,The Children′s Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院临床医学检验中心,上海201102

出　　处：《检验医学与临床》2023年第8期1086-1089,共4页Laboratory Medicine and Clinic

摘　　要：目的分析儿童初发原发性肾病综合征(PNS)的凝血及血小板相关指标,探讨其在PNS中的诊断价值。方法选取2019年1月至2021年12月在该院就诊且首次诊断为PNS的63例患儿作为病例组,另选取同期45例健康儿童作为健康对照组,分析两组血小板计数(PLT)、平均血小板体积(MPV)、血小板体积分布宽度(PDW)、血小板压积(PCT)、凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血浆纤维蛋白原(FIB)、纤维蛋白降解产物(FDP)和D-二聚体(D-D)的差异,并采用受试者工作特征曲线(ROC曲线)分析其对PNS的诊断价值。结果病例组和健康对照组MPV、PDW和PT比较,差异均无统计学意义(P>0.05);病例组PLT、PCT、TT、FIB、FDP、D-D水平均高于健康对照组,APTT低于健康对照组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,D-D诊断PNS的AUC为0.957,最佳截断值为0.59 mg/L时,灵敏度为93.7%,特异度为95.6%;FIB诊断PNS的AUC为0.942,最佳截断值为4.03 g/L时,灵敏度为88.9%,特异为97.8%;TT诊断PNS的AUC为0.887,最佳截断值为19.20 s时,灵敏度为84.1%,特异度为84.4%。结论初发PNS患儿早期已出现高凝状态,D-D、FIB、TT在PNS诊断中具有良好的辅助价值。Objective To analyze the coagulation and platelet related indicators in children with primary nephrotic syndrome(PNS)and explore their clinical value in the diagnosis of PNS.Methods Sixty-three children who were first diagnosed with PNS at our hospital between January 2019 and December 2021 were chosen as the case group,and 45 healthy children were chosen as the healthy control group during the same time period.The differences in platelet count(PLT),mean platelet volume(MPV),platelet volume distribution width(PDW),plateletcrit(PCT),Thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),fibrin degradation products(FDP)and D-dimer(D-D)were analyzed between the two groups of children.And their diagnostic value for PNS was analyzed by receiver operating characteristic(ROC)curves.Results The differences in MPV,PDW and PT between the two groups were not statistically significant(P>0.05),but PLT,PCT,TT,FIB,FDP and D-D were higher in the case group than in the healthy group,and APTT was lower than in the healthy group,with statistically significant differences(P<0.05).The AUC for diagnosis of D-D was 0.957,cutoff value was 0.59 mg/L,sensitivity was 93.7%and specificity was 95.6%.The AUC for diagnosis of FIB was 0.942,cutoff value was 4.03 g/L,sensitivity was 88.9%and specificity was 97.8%.The AUC for diagnosis of TT was 0.887,cutoff value was 19.20 s,sensitivity was 84.1%and specificity was 84.4%.Conclusion In the early stage of PNS,the hypercoagulable state has been found in the children.D-D,FIB and TT have good auxiliary diagnostic value in the diagnosis of PNS.

关 键 词：原发性肾病综合征 血小板相关指标 凝血功能 儿童 

分 类 号：R446.1[医药卫生—诊断学] R692.9[医药卫生—临床医学]