Department of Pulmonology, Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Department of Pediatrics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, China.
Front Cell Infect Microbiol. 2021 Jul 15;11:687391. doi: 10.3389/fcimb.2021.687391. eCollection 2021.
pneumonia (MPP) is an important disease in children. Studies have demonstrated that the levels of D-dimer are elevated in some children with MPP, especially those with thrombotic complications. However, the potential association between MPP and D-dimer remains unclear. In our study, we sought to explore the relationship between the levels of plasma D-dimer and clinical characteristics of MPP patients.
Retrospective analysis was conducted on 356 patients who were hospitalized in our hospital for MPP between January 1, 2017, and December 31, 2019. According to the peak value of D-dimer, patients were divided into three groups: the normal group (D-dimer<0.55 mg/L), the mild-moderately elevated group (D-dimer 0.55-5.5 mg/L) and the severely elevated group (D-dimer >5.5 mg/L). The demographic and clinical information, radiological findings, laboratory data, and treatments of patients were compared among different groups.
106 patients were in the normal group, 204 patients were in the mild-moderately elevated group, and 46 patients were in the severely elevated group. More severe clinical and radiographic manifestations, longer length of fever, hospital stay and antibiotic therapy duration, higher incidences of extra-pulmonary complications, refractory MPP (RMPP), severe MPP (SMPP) were found in the elevated group, when compared with the normal group (<0.01). Meanwhile, we found that the percentage of neutrophil (N%) and CD lymphocyte (CD%), C-reactive protein (CRP), lactate dehydrogenase (LDH), interleukin (IL)-6, IL-10, and interferon-gamma (IFN-γ) trended higher with increasing D-dimer, whereas the percentage of lymphocyte (L%) and prealbumin (PAB) trended lower (<0.01). In addition, the proportions of patients requiring oxygen therapy, glucocorticoid, bronchoscopy, immunoglobulin use, thoracentesis, or ICU admission were significantly higher in the severely elevated group than those in the other two groups (<0.01). Correlation analysis showed that N%, L%, CRP, LDH, IL-10, length of fever, length of stay, and length of antibiotic therapy had strong correlations with the level of D-dimer.
MPP patients with higher levels of D-dimer had more severe clinical manifestations and needed longer duration of treatment, which might be closely related to the severity of lung inflammation after MP infection.
肺炎（MPP）是儿童的一种重要疾病。研究表明，一些患有 MPP 的儿童，尤其是伴有血栓并发症的儿童，其 D-二聚体水平升高。然而，MPP 与 D-二聚体之间的潜在关联尚不清楚。在我们的研究中，我们试图探讨血浆 D-二聚体水平与 MPP 患者临床特征之间的关系。
对 2017 年 1 月 1 日至 2019 年 12 月 31 日期间因 MPP 在我院住院的 356 例患者进行回顾性分析。根据 D-二聚体的峰值，患者被分为三组：正常组（D-二聚体<0.55mg/L）、轻度升高组（D-二聚体 0.55-5.5mg/L）和重度升高组（D-二聚体>5.5mg/L）。比较不同组患者的人口统计学和临床信息、影像学表现、实验室数据和治疗情况。
正常组 106 例，轻度升高组 204 例，重度升高组 46 例。与正常组相比，升高组患者的临床和影像学表现更严重，发热时间更长，住院时间和抗生素治疗时间更长，肺外并发症发生率更高，难治性 MPP（RMPP）和重症 MPP（SMPP）发生率更高（<0.01）。同时，我们发现随着 D-二聚体水平的升高，中性粒细胞（N%）和 CD 淋巴细胞（CD%）、C 反应蛋白（CRP）、乳酸脱氢酶（LDH）、白细胞介素（IL）-6、IL-10 和干扰素-γ（IFN-γ）的百分比呈上升趋势，而淋巴细胞（L%）和前白蛋白（PAB）的百分比呈下降趋势（<0.01）。此外，重度升高组患者需要吸氧、糖皮质激素、支气管镜检查、免疫球蛋白使用、胸腔穿刺术或 ICU 入院治疗的比例明显高于其他两组（<0.01）。相关性分析显示，N%、L%、CRP、LDH、IL-10、发热时间、住院时间和抗生素治疗时间与 D-二聚体水平呈强相关。
D-二聚体水平较高的 MPP 患者临床表现更严重，治疗时间更长，这可能与 MP 感染后肺部炎症的严重程度密切相关。
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