坏死性小肠结肠炎新生儿血小板减少症的临床意义。

The clinical significance of thrombocytopenia in neonates with necrotizing enterocolitis.

作者信息

Ververidis M, Kiely E M, Spitz L, Drake D P, Eaton S, Pierro A

机构信息

Department of Paediatric Surgery, The Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London, England, UK.

出版信息

J Pediatr Surg. 2001 May;36(5):799-803. doi: 10.1053/jpsu.2001.22964.

DOI:10.1053/jpsu.2001.22964

PMID:11329593

Abstract

PURPOSE

The aim of this study was to evaluate the clinical significance of low platelet count in the surgical management of neonates with necrotizing enterocolitis (NEC).

METHODS

The clinical course of 58 consecutive neonates with advanced NEC (Bell's stages II or III) treated in the authors' hospital between 1995 and 1998 was reviewed. NEC in neonates who required operation was classified as isolated, multifocal, or pan-intestinal. Severe thrombocytopenia was defined as platelet count less than 100 x 10(9)/L. Rapid fall in platelet count was defined as fall greater than 150 x 10(9)/L within 24 hours to a level less than 100 x 10(9)/L.

RESULTS

Median birth weight was 1,564 g (range, 550 to 4,270) and gestational age was 31 weeks (range 23 to 41). Twenty-two neonates (38%) were below 1,000 g. Age at the onset of the disease was 13 days (range, 1 to 62). NEC was treated medically in 7 neonates (12%). Indications for operation included pneumoperitoneum in 23 neonates (45%), clinical deterioration in 19 (37%), and intestinal obstruction in 9 (18%). The nadir platelet count (lowest level during the course of disease) was lower in patients with stage III disease than in patients with stage II disease (P <.05). The greater the extent of the disease, the lower the platelet count (P =.012). The nadir platelet count was lower in infants who died than in survivors (P <.05). None of the patients with platelet count greater than 100 x 10(9)/L died. In predicting intestinal gangrene, severe thrombocytopenia has a sensitivity of 69%, specificity of 60%, and positive predictive value of 89%; rapid fall in platelet count has a sensitivity of 32%, specificity of 89%, and positive predictive value of 92%.

CONCLUSIONS

(1) A platelet count less than 100 x 10(9)/L or a rapid fall in platelet count represent poor prognostic factors. (2) Monitoring the platelet count during the course of NEC is useful; however, it cannot be used in isolation to predict the extent of the disease or survival rate.

摘要

目的

本研究旨在评估血小板计数降低在坏死性小肠结肠炎（NEC）新生儿外科治疗中的临床意义。

方法

回顾了1995年至1998年间在作者所在医院接受治疗的58例连续性晚期NEC（贝尔分期II或III期）新生儿的临床病程。需要手术治疗的新生儿NEC被分为孤立性、多灶性或全肠道性。严重血小板减少症定义为血小板计数低于100×10⁹/L。血小板计数快速下降定义为24小时内下降超过150×10⁹/L至低于100×10⁹/L。

结果

中位出生体重为1564g（范围550至4270g），胎龄为31周（范围23至41周）。22例新生儿（38%）体重低于1000g。发病年龄为13天（范围1至62天）。7例新生儿（12%）接受内科治疗。手术指征包括23例新生儿（45%）出现气腹、19例（37%）临床恶化和9例（18%）肠梗阻。III期疾病患者的最低点血小板计数（疾病过程中的最低水平）低于II期疾病患者（P<.05）。疾病范围越大，血小板计数越低（P=.012）。死亡婴儿的最低点血小板计数低于存活婴儿（P<.05）。血小板计数大于100×10⁹/L的患者均未死亡。在预测肠坏疽方面，严重血小板减少症的敏感性为69%，特异性为60%，阳性预测值为89%；血小板计数快速下降的敏感性为32%，特异性为89%，阳性预测值为92%。