目的 探讨PICU重症社区获得性肺炎（SCAP）患儿血小板（PLT）计数、平均血小板体积（MPV）动态变化趋势及其与预后的相关性。 方法 回顾性分析2016年1月至2019年12月，因SCAP入住首都医科大学附属北京儿童医院PICU的215例患儿，根据病情转归分为好转组（n=184）与未愈组（n=31），观察两组患儿入院时，住院第2天、第3天、第7天及出院前PLT及MPV变化趋势，并分析PLT变化与不良预后之间的关系。 结果 入院时,住院第2天、第3天、第7天及出院时，好转组PLT（328±159，329±137，362±159，439±168，510±171）×109/L均明显高于未愈组（210±142，207±152，267±143，260±162，343±159）×109/L（P＜0.05）；尽管入院时好转组MPV［（10.9±1.9）fL］明显低于未愈组［（12.7±2.5）fL］（P＜0.05），但两组在住院第2天、第3天、第7天及出院时的MPV值未见明显差异（P＞0.05）。此外，相比于入院时，好转组患儿住院第7天及出院前PLT明显升高（P＜0.05），但未愈组无明显变化（P＞0.05）。相较于入院时出现PLT减少（＜100×109/L）的SCAP患儿（n=22），住院第7天出现PLT减少（n=10）的患儿未愈率显著升高（27.2% 比90.0%）（P＜0.05）。 结论 SCAP患儿入院时、住院7 d后发生PLT减少与不良预后相关，住院7 d后PLT若无明显升高或出现降低，常提示预后不良。动态监测PLT参数变化可能有助于临床医生更好地判断重症肺炎的预后。 Objective To investigate the dynamic trend of platelet（PLT）count and mean platelet volume（MPV）in children with severe community-acquired pneumonia（SCAP）in PICU and their correlation with prognosis. Methods A retrospective study was conducted in 215 SCAP children who were admitted to the PICU of Beijing Children's Hospital Affiliated to Capital Medical University from January 2016 to December 2019.According to the disease outcome，the patients were divided into improvement group (n=184) and unrecovered group (n=31).The changes of PLT count and MPV at admission，on the 2nd，3rd，and 7th days of hospitalization and before discharge were observed，and the relationship between changes in PLT parameters and poor prognosis was analyzed. Meanwhile，the correlation between thrombocytopenia on admission and on the 7th day of hospitalization and prognosis was further explored. Results The PLT count of improvement group at admission，on the 2nd，3rd，and 7th days of hospitalization and at discharge[(328±159, 329±137, 362±159, 439±168, 510±171)×109/L] were significantly higher than those of unrecovered group [(210±142, 207±152, 267±143, 260±162, 343±159)×109/L]（P＜0.05）.Although the MPV of improvement group [(10.9±1.9)fL] on admission was significantly lower than that of the unrecovered group[(12.7±2.5) fL]（P＜0.05），there was no significant difference in MPV between two groups on the 2nd，3rd，7th days of hospitalization and discharge（P＞0.05）.In addition，compared with the admission，children in improvement group had significantly higher PLT count on the 7th day of hospitalization and before discharge（P＜0.05），but there was no significant change in unrecovered group（P＞0.05）.Compared with SCAP patients with thrombocytopenia at admission (PLT＜100×109/L)(n=22),those with thrombocytopenia on 7th day of hospitalization had a significant higher rate of non recovery(P＜0.05). Conclusion The occurrence of thrombocytopenia on admission and after 7 days of hospitalization in children with SCAP is associated with poor prognosis.No significant increase or decrease in PLT count after 7 days of hospitalization is often indicative of poor prognosis.Dynamic monitoring of PLT parameter changes may help to better judge the prognosis of severe pneumonia.
Abstract
Objective To investigate the dynamic trend of platelet（PLT）count and mean platelet volume（MPV）in children with severe community-acquired pneumonia（SCAP）in PICU and their correlation with prognosis. Methods A retrospective study was conducted in 215 SCAP children who were admitted to the PICU of Beijing Children's Hospital Affiliated to Capital Medical University from January 2016 to December 2019.According to the disease outcome，the patients were divided into improvement group (n=184) and unrecovered group (n=31).The changes of PLT count and MPV at admission，on the 2nd，3rd，and 7th days of hospitalization and before discharge were observed，and the relationship between changes in PLT parameters and poor prognosis was analyzed. Meanwhile，the correlation between thrombocytopenia on admission and on the 7th day of hospitalization and prognosis was further explored. Results The PLT count of improvement group at admission，on the 2nd，3rd，and 7th days of hospitalization and at discharge[(328±159, 329±137, 362±159, 439±168, 510±171)×109/L] were significantly higher than those of unrecovered group [(210±142, 207±152, 267±143, 260±162, 343±159)×109/L]（P＜0.05）.Although the MPV of improvement group [(10.9±1.9)fL] on admission was significantly lower than that of the unrecovered group[(12.7±2.5) fL]（P＜0.05），there was no significant difference in MPV between two groups on the 2nd，3rd，7th days of hospitalization and discharge（P＞0.05）.In addition，compared with the admission，children in improvement group had significantly higher PLT count on the 7th day of hospitalization and before discharge（P＜0.05），but there was no significant change in unrecovered group（P＞0.05）.Compared with SCAP patients with thrombocytopenia at admission (PLT＜100×109/L)(n=22),those with thrombocytopenia on 7th day of hospitalization had a significant higher rate of non recovery(P＜0.05). Conclusion The occurrence of thrombocytopenia on admission and after 7 days of hospitalization in children with SCAP is associated with poor prognosis.No significant increase or decrease in PLT count after 7 days of hospitalization is often indicative of poor prognosis.Dynamic monitoring of PLT parameter changes may help to better judge the prognosis of severe pneumonia.
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