支气管肺炎伴血小板增多患儿的临床特征及炎症因子变化情况(1)
[摘要] 目的 观察支气管肺炎伴血小板增多患儿的临床特征和炎症因子的变化情况，为支气管肺炎严重程度监测提供支持。 方法 将河北省秦皇岛市第一医院儿科2015年1～6月收治的198例支气管肺炎患儿根据血小板数量分为研究组和对照组，对两组患儿的血小板计数、炎症因子水平、临床症状和重症肺炎发生率进行观察。 结果 两组发热发生率比较，差异无统计学意义(P=0.271)；研究组喘息、呼吸困难发生率高于对照组，差异有高度统计学意义(P=0.001、0.000)。研究組C-反应蛋白、白细胞介素-6、肿瘤坏死因子-α水平高于对照组，差异有统计学意义(P=0.031、0.005、0.003)。研究组重症肺炎发生率为36.46%，对照组为18.63%，差异有高度统计学意义(P=0.005)。研究组平均住院天数为(10.52±2.49)d，明显长于对照组的(6.86±2.18)d，差异有统计学意义(P=0.036)。 结论 血小板增多的支气管肺炎患儿炎性反应更重，血小板增多可作为监测支气管肺炎严重程度的指标。
[关键词] 支气管肺炎；血小板增多；炎症因子；临床特征
[中图分类号] R563.1 [文献标识码] A [文章编号] 1673-7210(2016)11(b)-0101-04
[Abstract] Objective To observe clinical characteristics and changes in inflammatory factors of children with bronchopneumonia combined with thrombocytosis in order to provide support for bronchial pneumonia severity monitoring. Methods 198 children with bronchopneumonia of Pediatrics Department in the First Hospital of Qinhuangdao City， Hebei Province from January to June 2015 were divided into study group and control group according to their platelets counts. Platelet counts， levels of inflammatory factors， clinical symptoms and the incidence rate of severe pneumonia between two groups were observed. Results The incidence rate of fever between two groups was compared， with no statistical difference (P=0.271). The incidence rates of breathing， difficulty breathing in study group were higher than those in control group， the differences were highly statistically significant (P=0.001， 0.000). Levels of C-reaction protein， interleukin-6 and tumor necrosis factor-α in study group were higher than those in control group， the differences were statistically significant (P=0.031， 0.005， 0.003). The incidence rate of severe pneumonia in study group was 36.46%， the incidence rate of severe pneumonia in control group was 18.63%， the difference was highly statistically significant (P=0.005). The average hospital stay of study group was (10.52±2.49) d， significantly longer than that of control group [(6.86±2.18) d]， the difference was statistically significant (P=0.036). Conclusion Children with bronchopneumonia combined with thrombocytosis have more severe inflammatory responses. Thrombocytosis can be used as an indicator to monitor the severity of bronchopneumonia.
[Key words] Bronchopneumonia； Thrombocytosis； Inflammatory factor； Clinical feature
小儿支气管肺炎是儿科的常见病和多发病，多种病原微生物感染均可诱发，儿科住院的患儿中因支气管肺炎住院的比例在24.5%～65.2%[1]。在重症肺炎时，因严重感染导致机体释放大量细胞因子和炎症介质，形成全身炎性反应综合征(systemic inflammatory response syndrome，SIRS)，甚至发生多器官功能障碍综合征(multiple organ dysfunctions syndrome，MODS)[2-3]，是导致儿童死亡的主要原因之一[4-6]，近年来，细菌耐药的现象日趋严重，进一步增加了重症肺炎的治疗难度，临床上常使用的病原学检测手段存在假阳性率高，检测周期长等缺点，因此，如能早期判断患儿支气管肺炎的严重程度，预防并发症，对改善患儿预后和降低支气管肺炎相关死亡率有积极的意义[7]。研究发现，外周血血小板升高的下呼吸道感染儿童病情重，平均住院时间延长[8]。国内研究也提示，血小板升高的重症感染患儿发展出现弥漫性血管内凝血(disseminated or diffuse intravascular coagulation，DIC)的概率增高[9]。Hsu等[10]的研究显示，白细胞介素-6(interleukin-6，IL-6)、肿瘤坏死因子-α(tumor necrosis factor-alpha，TNF-α)等炎症因子的增高和血小板的升高有关，血小板升高的程度可间接反映机体炎性反应程度和组织损伤的程度。目前国内对支气管肺炎患儿血小板增多和炎性反应程度的研究较少，因此笔者设计了此项研究，通过对血小板增多支气管肺炎患儿和血小板正常支气管肺炎患儿的对照分析，探讨血小板增多患儿的临床特征及与炎症因子水平的关系，以探讨血小板能否作为评判支气管肺炎患儿病情轻重程度的监测指标。, http://www.100md.com(李宝琪 苏颖)
[关键词] 支气管肺炎；血小板增多；炎症因子；临床特征
[中图分类号] R563.1 [文献标识码] A [文章编号] 1673-7210(2016)11(b)-0101-04
[Abstract] Objective To observe clinical characteristics and changes in inflammatory factors of children with bronchopneumonia combined with thrombocytosis in order to provide support for bronchial pneumonia severity monitoring. Methods 198 children with bronchopneumonia of Pediatrics Department in the First Hospital of Qinhuangdao City， Hebei Province from January to June 2015 were divided into study group and control group according to their platelets counts. Platelet counts， levels of inflammatory factors， clinical symptoms and the incidence rate of severe pneumonia between two groups were observed. Results The incidence rate of fever between two groups was compared， with no statistical difference (P=0.271). The incidence rates of breathing， difficulty breathing in study group were higher than those in control group， the differences were highly statistically significant (P=0.001， 0.000). Levels of C-reaction protein， interleukin-6 and tumor necrosis factor-α in study group were higher than those in control group， the differences were statistically significant (P=0.031， 0.005， 0.003). The incidence rate of severe pneumonia in study group was 36.46%， the incidence rate of severe pneumonia in control group was 18.63%， the difference was highly statistically significant (P=0.005). The average hospital stay of study group was (10.52±2.49) d， significantly longer than that of control group [(6.86±2.18) d]， the difference was statistically significant (P=0.036). Conclusion Children with bronchopneumonia combined with thrombocytosis have more severe inflammatory responses. Thrombocytosis can be used as an indicator to monitor the severity of bronchopneumonia.
[Key words] Bronchopneumonia； Thrombocytosis； Inflammatory factor； Clinical feature
小儿支气管肺炎是儿科的常见病和多发病，多种病原微生物感染均可诱发，儿科住院的患儿中因支气管肺炎住院的比例在24.5%～65.2%[1]。在重症肺炎时，因严重感染导致机体释放大量细胞因子和炎症介质，形成全身炎性反应综合征(systemic inflammatory response syndrome，SIRS)，甚至发生多器官功能障碍综合征(multiple organ dysfunctions syndrome，MODS)[2-3]，是导致儿童死亡的主要原因之一[4-6]，近年来，细菌耐药的现象日趋严重，进一步增加了重症肺炎的治疗难度，临床上常使用的病原学检测手段存在假阳性率高，检测周期长等缺点，因此，如能早期判断患儿支气管肺炎的严重程度，预防并发症，对改善患儿预后和降低支气管肺炎相关死亡率有积极的意义[7]。研究发现，外周血血小板升高的下呼吸道感染儿童病情重，平均住院时间延长[8]。国内研究也提示，血小板升高的重症感染患儿发展出现弥漫性血管内凝血(disseminated or diffuse intravascular coagulation，DIC)的概率增高[9]。Hsu等[10]的研究显示，白细胞介素-6(interleukin-6，IL-6)、肿瘤坏死因子-α(tumor necrosis factor-alpha，TNF-α)等炎症因子的增高和血小板的升高有关，血小板升高的程度可间接反映机体炎性反应程度和组织损伤的程度。目前国内对支气管肺炎患儿血小板增多和炎性反应程度的研究较少，因此笔者设计了此项研究，通过对血小板增多支气管肺炎患儿和血小板正常支气管肺炎患儿的对照分析，探讨血小板增多患儿的临床特征及与炎症因子水平的关系，以探讨血小板能否作为评判支气管肺炎患儿病情轻重程度的监测指标。, http://www.100md.com(李宝琪 苏颖)