危重型手足口病患儿血浆D-二聚体动态变化及预后评估价值

Dynamic changes in plasma D-dimer level and its prognostic value in children with severe hand-foot-mouth disease

摘要:

目的 探讨危重型手足口病患儿血浆D-二聚体水平的动态变化及在预后评估中的价值。方法 选取2010年5月至2012年9月95例手足口病患儿，包括危重型65例（观察组），普通型30例（对照组）。对观察组第1、2、3、4、5天与对照组入院第1天血浆D-二聚体水平进行比较及观察组第1、2、3、4、5天之间血浆D-二聚体水平进行比较，并通过受试者工作特征曲线（ROC曲线）分析血浆D-二聚体在手足口病预后评估中的价值。结果 观察组65例患儿中，死亡15例，存活50例；对照组30例均存活。观察组第1、2、3、4、5天血浆D-二聚体水平均明显高于对照组（P<0.05）。观察组第1、2、3、4、5天间血浆D-二聚体水平差异有统计学意义（P<0.01），其中入院第1天最高，第2天次之。观察组中死亡患者入院第1天血浆D-二聚体水平明显高于存活者（P<0.05）。以观察组发病第1天血浆D-二聚体水平预测病死率的ROC曲线下面积为0.877，95%可信区间为0.785~0.969，最佳界值为582.10 μg/L（敏感性80%、特异性78%）。结论 危重型手足口病患儿血浆D-二聚体水平明显升高，且与病情严重程度相关，可作为预测病情严重程度及预后评估的重要参考指标之一。

Abstract:

Objective To study the dynamic changes in plasma D-dimer and its prognostic value in children with severe hand-foot-mouth disease (HFMD). Methods A total of 95 children who suffered from HFMD between May 2010 and September 2012, including 65 cases of severe HFMD (observation group) and 30 cases of non-severe HFMD (control group), were enrolled in the study. Plasma D-dimer levels of the observation group on days 1, 2, 3, 4 and 5 were compared with plasma D-dimer levels of the control group on day 1 after admission. In the observation group, plasma D-dimer levels on days 1, 2, 3, 4 and 5 were compared. The prognostic value of plasma D-dimer was analyzed using the receiver operating characteristic (ROC) curve. Results Of the 65 cases in the observation group, 15 died, and 50 survived. All the 30 cases in the control group survived. Plasma D-dimer levels in the observation group on days 1, 2, 3, 4 and 5 were significantly higher than in the control group on day 1 after admission (P<0.05). In the observation group, there were significant differences between plasma D-dimer levels on days 1, 2, 3, 4 and 5 (P<0.01), and plasma D-dimer level was the highest on day 1 after admission and second highest on the next day. Of the patients in the observation group, those who died had significantly higher plasma D-dimer levels on day 1 after admission than those who survived (P<0.05). In the observation group, plasma D-dimer levels on day 1 after onset had an area under the ROC curve of 0.877 (95% confidence interval: 0.785-0.969) and an optimal cut-off value of 582.10 μg/L (80% sensitivity and 78% specificity) for predicting mortality. Conclusions Children with severe HFMD have significantly increased plasma D-dimer levels, and the severer the condition, the higher the value. Plasma D-dimer levels can be used as one of the important indices for assessing the severity and prognosis of severe HFMD.