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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。
Objective To investigate the changes and clinical value of plasma fibrin monomer (D-dimer) and DD in children with severe pneumonia. Methods Totally 81 children with severe pneumonia were divided into severe pneumonia without DIC group (55 cases) and severe pneumonia with DIC group (26 cases) according to whether they had disseminated intravascular coagulation (DIC). Another 30 patients Healthy children served as normal control group. The levels of plasma FM and DD in each group were detected and compared. Results The differences of FM and DD between the three groups were statistically significant (P = 0.000). The levels of FM and DD in patients with severe pneumonia without DIC and severe pneumonia with DIC were significantly higher than those in controls (P <0.001). The levels of plasma FM and DD in severe pneumonia with DIC were higher than those without DIC with severe pneumonia All were statistically significant (P <0.001). Severe pneumonia in children with combined DIC group FM and DD abnormalities were significantly higher than those without DIC group, the difference was statistically significant (P = 0.025,0.000); severe pneumonia in children without DIC FM abnormalities Which was significantly higher than that of DD (P = 0.000). However, there was no significant difference in abnormal rate of FM between patients with severe pneumonia and DIC (P = 0.234). Plasma FM and DD levels in children with severe pneumonia were positively correlated (r = 0.48, P = 0.000). Conclusions There is hypercoagulable state and secondary hyperfibrinolysis in children with severe pneumonia. Fibrin monomer and D-dimer may be used as sensitive indicators for early diagnosis of hypercoagulable state and DIC in children with severe pneumonia.