败血症新生儿血栓调节蛋白和D-二聚体的变化及意义

Changes in plasma thrombomodulin and D-dimer levels and their clinical significance in neonates with sepsis

摘要:

目的：观察败血症新生儿血栓调节蛋白（TM）和D-二聚体（DD）的变化，探讨二者在败血症新生儿病情评估及预后判断中的意义。方法：将56例败血症新生儿进行新生儿危重病例评分，分为极危重组（13例）、危重组（22例）和非危重组（21例），在入院初期及恢复期采空腹静脉血，应用酶联免疫吸附试验测定血浆TM，应用免疫比浊法测定血浆DD。26例健康新生儿作为对照组。比较各组血浆TM和DD的差异及败血症新生儿治疗前后二者的变化。结果：败血症极危重组、危重组、非危重组新生儿血浆TM水平分别为25.5±6.6、17.3±4.7、13.3±2.8 μg/L，较对照组的9.8±2.7 μg/L明显升高（P<0.01）。败血症极危重组、危重组新生儿血浆DD水平分别为744±262、436±147 μg/L，较对照组的205±61 μg/L明显升高（P<0.01）。非危重组、危重组、极危重组3组血浆TM和DD水平依次升高（P<0.05）。治疗后（恢复期）患儿血浆TM和DD水平显著下降，与治疗前比较差异有统计学意义（P<0.01）。血浆TM和DD水平与新生儿危重评分均呈明显负相关（分别r=-0.428、-0.363，P<0.01）。结论：检测败血症新生儿的血浆TM和DD水平有助于评估病情危重程度及预后。

Abstract:

OBCTIVE: To observe changes in plasma thrombomodulin (TM) and D-dimer (DD) levels in neonates with sepsis, and to investigate their significance in evaluating the patients' condition and prognosis. METHOD: Fifty-six neonates with sepsis were classified into extremely critical (n=13), critical (n=22) and non-critical groups (n=21) based on neonatal critical illness score (NCIS). Fasting venous blood samples were collected on admission and in the recovery phase. Plasma TM and D-dimer levels were measured using enzyme-linked immunosorbent assay and immune turbidimetry, respectively. Twenty-six healthy neonates were selected as the control group. Plasma TM and D-dimer levels were compared between groups, and the changes after treatment were determined. RESULTS: Plasma TM levels in the extremely critical, critical and non-critical groups were 25.5±6.6, 17.3±4.7 and 13.3±2.8 μg/L respectively, significantly higher than in the control group (9.8±2.7 μg/L) (P<0.01). Plasma D-dimer levels in the extremely critical and critical groups were 744±262 and 436±147 μg/L respectively, also significantly higher than in the control group (205±61 μg/L) (P<0.01). The extremely critical group had significantly higher plasma TM and DD levels than the critical group (P<0.05), and the critical group had significantly higher plasma TM and DD levels than the non-critical group (P<0.05). All patients showed significant decreases in plasma TM and DD levels in the recovery phase after treatment (P<0.01). Plasma TM and DD levels were significantly negatively correlated with NCIS (r?=?-0.428, P<0.01; r?=?-0.363, P<0.01). CONCLUSIONS: Determination of plasma TM and DD levels may be helpful in evaluating severity and prognosis in neonates with sepsis.