重症肺炎患儿血浆纤维蛋白单体与D-二聚体水平分析

目的 探讨重症肺炎患儿血浆纤维蛋白单体(FM)与D-二聚体(DD)水平变化及其临床价值。 方法 选取重症肺炎患儿81例,根据是否合并弥散性血管内凝血(DIC)将患儿分为重症肺炎未合并DIC组(55例)与重症肺炎合并DIC组(26例),另选择30例健康儿童作为正常对照组。检测并比较各组的血浆FM和DD水平。 结果 三组间FM和DD水平差异均有统计学意义(P=0.000)。重症肺炎未合并DIC组与重症肺炎合并DIC组的FM和DD水平均高于正常对照组(P<0.001);重症肺炎合并DIC组血浆FM和DD水平更高于重症肺炎未合并DIC组,差异均有统计学意义(P<0.001)。重症肺炎患儿中,合并DIC组的FM和DD异常率均明显高于未合并DIC组,差异有统计学意义(P=0.025、0.000);重症肺炎未合并DIC组患儿中,FM异常率明显高于DD异常率,差异有统计学意义(P=0.000),而重症肺炎合并DIC组患儿中,FM异常率与DD异常率比较差异无统计学意义(P=0.234)。重症肺炎患儿的血浆FM和DD水平呈正相关(r=0.48,P=0.000)。 结论 重症肺炎患儿体内存在高凝状态与继发性纤溶亢进,纤维蛋白单体和D-二聚体可作为早期诊断重症肺炎患儿高凝状态及DIC的敏感指标。

Plasma fibrin monomer and D-dimer levels in children with severe pneumonia

Objective To study the changes of plasma fibrin monomer (FM) and D-dimer (DD) levels and their clinical values in children with severe pneumonia. Methods Eighty-one children with severe pneumonia were divided into disseminated intravascular coagulation (DIC) group and non-DIC group according to the occurrence of DIC, and 30 healthy children served as the control group. Plasma FM and DD levels were detected, and then compared among the groups. Results There were statistically significant differences in the plasma FM and DD levels among the three groups (P=0.000). The plasma FM and DD levels were significantly higher in the DIC group and non-DIC group than in the control group (P<0.001), higher in the DIC group than in the non-DIC group (P<0.001). Among the children with severe pneumonia, the abnormal rates of FM and DD were significantly higher in the DIC group than in the non-DIC group(P=0.025 and P=0.000 respectively). Among the children with severe pneumonia in the non-DIC group, the abnormal rate of FM was significantly higher than that of DD (P=0.000), while among those in the DIC group, no statistically significant difference was found(P=0.234). Plasma FM level was positively correlated with the plasma DD level in the children with severe pneumonia (r=0.48, P=0.000). Conclusions There exist hypercoagulation and secondary hyperfibrinolysis in children with severe pneumonia. Fibrin monomer and D-dimer could be considered as the sensitive indicators in the early diagnosis of hypercoagulation and DIC in children with severe pneumonia