右心室功能指标和血小板参数对支气管肺发育不良的早期预测价值：一项回顾性研究。
Right ventricular function indices and platelet parameters for early prediction value of bronchopulmonary dysplasia: a retrospective study.
机构信息
Department of Ultrasound, Shenzhen Children's Hospital of China Medical University, Shenzhen, Guangdong, China.
Department of neonatology, Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen, Guangdong, China.
出版信息
BMC Pediatr. 2024 Jun 12;24(1):391. doi: 10.1186/s12887-024-04868-y.
BACKGROUND
To examine the value of early echocardiographic indices for the right ventricular function combined with platelet(PLT) parameters for predicting bronchopulmonary dysplasia (BPD) in preterm infants.
METHODS
This retrospective study included infants with gestational age (GA) below 32 weeks, who were admitted to the neonatal intensive care unit(NICU). The detection rate of tricuspid regurgitation jet velocity (TRVJ), ventricular septal flattening, pulmonary artery widening, right ventricular dilation, and right atrial enlargement on the 7th day of life (DOL 7) were compared between BPD and non-BPD infants. Echocardiographic indices of the right ventricular function including tricuspid annular plane systolic excursion (TAPSE) and right ventricular index of myocardial performance (RIMP) were measured on 1 day of life (DOL 1)、on DOL 7 and on 14 day of life (DOL 14) respectively. The PLT parameters including the PLT count, mean platelet volume (MPV), platelet hematocrit (PCT) level, and platelet distribution width (PDW) were measured on the DOL 1,DOL 7, and DOL 14. Multivariate logistic regression was used to analyze the relationship between these parameters and BPD. Receiver operating characteristic curve analysis was performed to assess the predictive value of the right ventricular function indices and PLT parameters for BPD.
RESULTS
A total of 220 preterm infants were included in this study, and of these, 85 infants developed BPD among them. The RIMP of the BPD group on DOL 14 was higher than that of the non-BPD group (P < 0.05). The TAPSE of the BPD group on DOL 14 was lower than that of the non-BPD group (P < 0.05). The PLT count of the BPD group on DOL 1 was lower than that of the non-BPD group (P < 0.05), and the MPV of the BPD group on DOL 1 was higher than that of the non-BPD group (P < 0.05). Using multivariate logistic regression, GA、invasive mechanical ventilation duration ≥ 7 days、 PLT、 MPV、 TAPSE and RIMP were found to be independent risk factors for BPD. The area under the receiver operating characteristic curve was 0.846 (95CI: 0.794∼0.899), which improved when using right ventricular function indices combined with platelet parameters.
CONCLUSION
TAPSE and RIMP combined with PLT count and MPV can help identify preterm infants at an increased risk of developing BPD.
背景
探讨超声心动图右心功能早期指标联合血小板（PLT）参数对预测早产儿支气管肺发育不良（BPD）的价值。
方法
本回顾性研究纳入胎龄（GA）＜32 周、入住新生儿重症监护病房（NICU）的患儿。比较 BPD 组与非 BPD 组患儿第 7 天（DOL 7）三尖瓣反流射流速度（TRVJ）、室间隔变平、肺动脉增宽、右心室扩张、右心房扩大的检出率。分别于生后第 1 天（DOL 1）、DOL 7 和第 14 天（DOL 14）测量右心功能超声心动图指标三尖瓣环平面收缩期位移（TAPSE）和右心室心肌做功指数（RIMP）。于 DOL 1、DOL 7 和 DOL 14 检测 PLT 参数，包括血小板计数、平均血小板体积（MPV）、血小板压积（PCT）水平和血小板分布宽度（PDW）。采用多因素 logistic 回归分析这些参数与 BPD 的关系。采用受试者工作特征曲线分析右心功能指标和 PLT 参数对 BPD 的预测价值。
结果
本研究共纳入 220 例早产儿，其中 85 例发生 BPD。BPD 组患儿 DOL 14 时 RIMP 高于非 BPD 组（P＜0.05），TAPSE 低于非 BPD 组（P＜0.05）。BPD 组患儿 DOL 1 时 PLT 计数低于非 BPD 组（P＜0.05），MPV 高于非 BPD 组（P＜0.05）。多因素 logistic 回归分析显示，GA、有创机械通气时间≥7 天、PLT、MPV、TAPSE 和 RIMP 是 BPD 的独立危险因素。受试者工作特征曲线下面积为 0.846（95%CI：0.794～0.899），联合右心功能指标和 PLT 参数后面积增大。
结论
TAPSE 和 RIMP 联合 PLT 计数和 MPV 有助于识别发生 BPD 风险增加的早产儿。
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