D-二聚体水平变化对肺炎支原体肺炎患儿的临床意义

Clinical significance of D-dimer level in children with mycoplasma pneumoniae pneumonia

摘要:

目的 探讨D-二聚体水平变化对肺炎支原体肺炎（MPP）病情严重程度的意义。方法 回顾性分析2016年1月—2019年12月首都医科大学附属北京儿童医院357例MPP住院患儿的临床资料，根据不同血浆D-二聚体水平将患儿分为3组。比较3组患儿的乳酸脱氢酶（LDH）、红细胞沉降率（ESR）、C反应蛋白（CRP）、白细胞（WBC）、血小板（PLT）、凝血酶原时间（PT）、纤维蛋白原定量（FIB）、部分凝血活酶时间（APTT）及抗凝酶Ⅲ活性（AT-Ⅲ）；比较有无肺内并发症患儿的D-二聚体水平；研究D-二聚体水平与炎症指标、凝血功能及肺内并发症之间的关系。结果 MPP患儿中，D-二聚体<0.729 mg/L 142例，D-二聚体为0.729～1.458 mg/L 97例，D-二聚体>1.458 mg/L 118例。MPP患儿血浆D-二聚体水平与CRP、LDH、是否伴有胸腔积液呈正相关（P <0.05），与APTT、AT-Ⅲ呈负相关（P <0.05）。MPP患儿D-二聚体>0.729 mg/L高度提示SMPP的可能性；D-二聚体水平越高，合并肺内并发症概率越高。结论 血浆D-二聚体可作为早期SMPP的判断指标之一，能够反映MPP的严重程度，为临床治疗和监测提供依据。

Abstract:

Objective To explore the significance of D-dimer level changes on the severity of Mycoplasma pneumoniae pneumonia (MPP).Methods Retrospective analysis of 357 hospitalized children with MPP from January 2016 to December 2019 in Beijing Children's Hospital, Capital Medical University was performed. According to the level of plasma D-dimer, the children were divided into three groups to study the relationship of the level of plasma D-dimer and inflammation index, coagulation function, and pulmonary complications with children with MPP.Results Among 357 cases of MPP, D-dimer of 142 cases were < 0.729 mg/L, 97 cases were 0.729 to 1.458 mg/L, 118 cases were > 1.458 mg/L. Plasma D-dimer level was positively correlated with CRP, LDH, and pleural effusion (P < 0.05), and negatively correlated with APTT and AT-Ⅲ (P < 0.05). D-dimer > 0.729 mg/L in MPP children highly suggested the possibility of SMPP; the higher the level of D-dimer, the higher the probability of pulmonary complications.Conclusion Plasma D-dimer can be used as one of the early indicators of SMPP, which can reflect the severity of MPP and provide the basis for clinical treatment and monitoring.