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Article(id=1208862366926770404, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208862365714616539, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2021.09.12, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1611763200000, receivedDateStr=2021-01-28, revisedDate=1622390400000, revisedDateStr=2021-05-31, acceptedDate=null, acceptedDateStr=null, onlineDate=1766144847851, onlineDateStr=2025-12-19, pubDate=1632758400000, pubDateStr=2021-09-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766144847851, onlineIssueDateStr=2025-12-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766144847851, creator=13701087609, updateTime=1766144847851, updator=13701087609, issue=Issue{id=1208862365714616539, tenantId=1146029695717560320, journalId=1189873630562394117, year='2021', volume='46', issue='9', pageStart='849', pageEnd='953', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766144847562, creator=13701087609, updateTime=1766144914151, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1208862645055254758, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208862365714616539, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1208862645055254759, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208862365714616539, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=917, endPage=922, ext={EN=ArticleExt(id=1208862367241343217, articleId=1208862366926770404, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Predictive values of erythrocyte and platelet parameters for the severity of sepsis in children, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To evaluate the predictive values of erythrocyte and platelet parameters for the severity of sepsis in children. Methods A total of 213 children with sepsis admitted to Pediatric Intensive Care Unit (PICU) of Hebei Children's Hospital from December 2015 to December 2020 were selected as the research subjects. According to the severity, they were divided into the sepsis group (152 cases) and septic shock group (61 cases). The gender, age, infected site and treatment of the enrolled subjects were recorded. The erythrocyte and platelet parameters were collected within 24 hours after the diagnosis of sepsis. The children were scored according to acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure score (SOFA) within 24 hours after admission to PICU. The median of the red cell volume distribution width (RDW) and platelet distribution width (PDW) and interquartile range were calculated for the child patients using the quartile method, and the 213 child patients were stratified on the basis. The gender, age, length of PICU stay, continuous renal replacement therapy (CRRT), mechanical ventilation, and occurrence of septic shock were compared between the child patients with different RDW and PDW stratifications.Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of erythrocyte and platelet parameters for the severity of children with sepsis. Results The scores of RDW [17.03%(16.17%, 18.72%)], PDW [24.25 fl (23.25 fl, 26.60 fl)],APACHE Ⅱ (19.06±3.78) and SOFA (7.35±2.62) in septic shock group were higher than those [15.28%(14.23%, 16.39%),21.28 fl (18.84 fl, 23.40 fl), 15.73±3.89, 5.68±2.40] in sepsis group, with statistical significance (P<0.05). There was statistically significant difference in the duration of assisted ventilation for RDW stratification (P<0.05), and there was statistically significant difference in the duration of hospitalization in PICU for PDW stratification (P<0.05). There was statistical significance in sepsis severity between RDW stratification and PDW stratification (P<0.05). RDW had the highest predictive value for sepsis severity,while PDW had the highest sensitivity for sepsis severity. Conclusion RDW and PDW are important biomarkers for predicting the severity of sepsis in children.

, correspAuthors=Mei-Xian Xu, authorNote=null, correspAuthorsNote=
*E-mail:
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目的 评估红细胞及血小板参数对儿童脓毒症严重程度的预测价值。方法 选取河北医科大学附属河北省儿童医院重症医学科(PICU)2015年12月—2020年12月收治的213例脓毒症患儿，根据脓毒症严重程度分为脓毒症组(152例)与脓毒性休克组(61例)。比较两组患儿的一般资料、诊断脓毒症24 h内的红细胞及血小板参数、患儿入住PICU 24 h内的急性生理学与慢性健康状况评分Ⅱ(APACHE Ⅱ)及序贯器官衰竭评分(SOFA)。利用四分位法计算患儿红细胞分布宽度(RDW)及血小板分布宽度(PDW)的中位数及四分位间距，并据此将213例患儿进行分层。比较不同RDW、PDW分层患儿的性别、年龄、PICU住院时间、连续性肾脏替代治疗(CRRT)、机械通气情况，以及脓毒性休克发生情况；使用受试者工作特征(ROC)曲线评估RDW及PDW对患儿脓毒症严重程度的预测价值。结果 脓毒性休克组的RDW[17.03%(16.17%，18.72%)]、PDW [24.25 fl(23.25 fl，26.60 fl)]、APACHE Ⅱ评分[(19.06±3.78)分]及SOFA评分[(7.35±2.62)分]均高于脓毒症组[分别为15.28%(14.23%，16.39%)、21.28 fl(18.84 fl，23.40 fl)、(15.73±3.89)分、(5.68±2.40)分]，差异有统计学意义(P<0.05)；不同RDW分层的辅助通气时间差异有统计学意义(P<0.05)，不同PDW分层的PICU住院时间差异有统计学意义(P<0.05)；不同RDW、PDW分层的脓毒症严重程度差异有统计学意义(P<0.05)；RDW评估脓毒症严重程度的临床价值最高，PDW评估脓毒症严重程度的敏感度最高。结论 RDW及PDW可作为评估儿童脓毒症严重程度的重要指标。

, correspAuthors=徐梅先, authorNote=null, correspAuthorsNote=
徐梅先，E-mail：
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白新凤，医学博士，主治医师，主要从事儿童危重症方面的研究

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白新凤，医学博士，主治医师，主要从事儿童危重症方面的研究

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白新凤，医学博士，主治医师，主要从事儿童危重症方面的研究

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RDW. 红细胞分布宽度；PDW. 血小板分布宽度；APACHEⅡ. 急性生理学与慢性健康状况评分Ⅱ；SOFA. 序贯器官衰竭评分

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Comparison of baseline data between the two groups of children with sepsis

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指标脓毒症组(n=152)脓毒性休克组(n=61)t/χ2P
性别(男/女，例)80/7229/320.4510.502
年龄(岁，$\bar{x}±s$)4.3±2.14.5±1.7–0.3700.712
感染部位[例(%)]3.8740.423
 肺部61(40.1)26(42.6)
 腹腔35(23.0)19(31.1)
 泌尿系统33(21.7)10(16.4)
 血流17(11.3)6(9.8)
 其他6(3.9)0(0)
机械通气[例(%)]117(77.0)50(82.0)0.6410.423
机械通气时间(d, $\bar{x}±s$)5.23±1.746.15±2.13–3.0040.003
CRRT[例(%)]66(43.4)34(55.7)2.6510.103
MODS[例(%)]54(35.5)47(77.0)30.102<0.001
28 d内死亡[例(%)]31(20.4)25(41.0)9.5220.002
PICU住院时间(d, $\bar{x}±s$)7.63±2.428.67±2.85–2.6870.008
), ArticleFig(id=1208862372106736021, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862366926770404, language=CN, label=表1, caption=

两组脓毒症患儿一般资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
指标脓毒症组(n=152)脓毒性休克组(n=61)t/χ2P
性别(男/女，例)80/7229/320.4510.502
年龄(岁，$\bar{x}±s$)4.3±2.14.5±1.7–0.3700.712
感染部位[例(%)]3.8740.423
 肺部61(40.1)26(42.6)
 腹腔35(23.0)19(31.1)
 泌尿系统33(21.7)10(16.4)
 血流17(11.3)6(9.8)
 其他6(3.9)0(0)
机械通气[例(%)]117(77.0)50(82.0)0.6410.423
机械通气时间(d, $\bar{x}±s$)5.23±1.746.15±2.13–3.0040.003
CRRT[例(%)]66(43.4)34(55.7)2.6510.103
MODS[例(%)]54(35.5)47(77.0)30.102<0.001
28 d内死亡[例(%)]31(20.4)25(41.0)9.5220.002
PICU住院时间(d, $\bar{x}±s$)7.63±2.428.67±2.85–2.6870.008
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Comparison of erythrocyte and platelet parameters and APACHE Ⅱ, SOFA scores between the two groups of children with sepsis

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指标脓毒症组(n=152)脓毒性休克组(n=61)t/ZP
APACHE Ⅱ评分(分，$\bar{x}±s$)15.73±3.8919.06±3.78–5.692<0.001
SOFA评分(分，$\bar{x}±s$)5.68±2.407.35±2.62–4.463<0.001
红细胞参数[M(Q1, Q3)]
 RBC(×1012/L)3.56(2.76, 4.12)3.60(2.85, 4.60)–1.1440.253
 MCV(fl)98.48(89.12, 103.66)100.48(92.48, 103.67)–1.0720.284
 HCT(L/L)0.29(0.25, 0.43)0.34(0.26, 0.42)–0.4220.673
 RDW(%)15.28(14.23, 16.39)17.03(16.17, 18.72)–6.951<0.001
血小板参数[M(Q1, Q3)]
 PLT(×109/L)293.48(256.17, 336.85)299.21(265.53, 356.84)–1.0400.298
 MPV(fl)8.94(7.65, 10.99)8.93(8.30, 10.99)–0.0380.970
 PCT(%)0.26(0.24, 0.29)0.26(0.24, 0.29)–0.3920.695
 PDW(fl)21.28(18.84, 23.40)24.25(23.25, 26.60)–6.596<0.001
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两组脓毒症患儿红细胞、血小板参数及APACHE Ⅱ、SOFA评分比较

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指标脓毒症组(n=152)脓毒性休克组(n=61)t/ZP
APACHE Ⅱ评分(分，$\bar{x}±s$)15.73±3.8919.06±3.78–5.692<0.001
SOFA评分(分，$\bar{x}±s$)5.68±2.407.35±2.62–4.463<0.001
红细胞参数[M(Q1, Q3)]
 RBC(×1012/L)3.56(2.76, 4.12)3.60(2.85, 4.60)–1.1440.253
 MCV(fl)98.48(89.12, 103.66)100.48(92.48, 103.67)–1.0720.284
 HCT(L/L)0.29(0.25, 0.43)0.34(0.26, 0.42)–0.4220.673
 RDW(%)15.28(14.23, 16.39)17.03(16.17, 18.72)–6.951<0.001
血小板参数[M(Q1, Q3)]
 PLT(×109/L)293.48(256.17, 336.85)299.21(265.53, 356.84)–1.0400.298
 MPV(fl)8.94(7.65, 10.99)8.93(8.30, 10.99)–0.0380.970
 PCT(%)0.26(0.24, 0.29)0.26(0.24, 0.29)–0.3920.695
 PDW(fl)21.28(18.84, 23.40)24.25(23.25, 26.60)–6.596<0.001
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Comparison of clinical features of children with sepsis in different RDW stratification groups

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指标≤15%(n=73)15%~17%(n=87)>17%(n=53)F/χ2P
性别(男/女，例)37/3644/4323/300.8330.659
年龄(岁，$\bar{x}±s$)4.2±1.94.7±1.94.1±1.92.4980.085
PICU住院时间(d, $\bar{x}±s$)8.21±2.687.73±2.577.85±2.490.7270.484
CRRT[例(%)]32(43.8)37(42.5)31(58.5)3.8010.149
机械通气[例(%)]52(71.2)70(80.5)45(84.9)3.7570.153
机械通气时间(d, $\bar{x}±s$)4.96±1.735.84±1.85(1)5.67±2.07(1)4.6960.010
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不同RDW分层组脓毒症患儿临床特征比较

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指标≤15%(n=73)15%~17%(n=87)>17%(n=53)F/χ2P
性别(男/女，例)37/3644/4323/300.8330.659
年龄(岁，$\bar{x}±s$)4.2±1.94.7±1.94.1±1.92.4980.085
PICU住院时间(d, $\bar{x}±s$)8.21±2.687.73±2.577.85±2.490.7270.484
CRRT[例(%)]32(43.8)37(42.5)31(58.5)3.8010.149
机械通气[例(%)]52(71.2)70(80.5)45(84.9)3.7570.153
机械通气时间(d, $\bar{x}±s$)4.96±1.735.84±1.85(1)5.67±2.07(1)4.6960.010
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Comparison of clinical features of children with sepsis in different PDW stratification groups

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指标≤20 fl(n=59)20~25 fl(n=106)>25 fl(n=48)F/χ2P
性别(男/女，例)26/3356/5022/261.3870.500
年龄(岁，$\bar{x}±s$)4.1±2.04.5±1.84.5±2.21.1420.321
PICU住院时间(d, $\bar{x}±s$)7.22±1.947.90±2.71(1)8.86±2.75(1)5.5730.004
CRRT[例(%)]24(40.7)51(48.1)25(52.1)1.4970.473
机械通气[例(%)]47(79.7)83(78.3)37(77.1)0.1050.949
机械通气时间(d, $\bar{x}±s$)5.67±1.735.47±1.905.34±2.110.4050.667
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不同PDW分层组脓毒症患儿临床特征比较

, figureFileSmall=null, figureFileBig=null, tableContent=
指标≤20 fl(n=59)20~25 fl(n=106)>25 fl(n=48)F/χ2P
性别(男/女，例)26/3356/5022/261.3870.500
年龄(岁，$\bar{x}±s$)4.1±2.04.5±1.84.5±2.21.1420.321
PICU住院时间(d, $\bar{x}±s$)7.22±1.947.90±2.71(1)8.86±2.75(1)5.5730.004
CRRT[例(%)]24(40.7)51(48.1)25(52.1)1.4970.473
机械通气[例(%)]47(79.7)83(78.3)37(77.1)0.1050.949
机械通气时间(d, $\bar{x}±s$)5.67±1.735.47±1.905.34±2.110.4050.667
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Comparison of the incidence of septic shock in children in different RDW and PDW stratification groups [n(%)]

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指标脓毒症(n=152)脓毒性休克(n=61)
RDW分层
 ≤15% (n=73)67(91.8)6(8.2)
 15%~17% (n=87)63(72.4)24(27.6)(1)
 >17% (n=53)22(41.5)31(58.5)(1)(2)
 χ238.051
 P<0.001
PDW分层
 ≤20 fl(n=59)55(93.2)4(6.8)
 20~25 fl(n=106)76(71.7)30(28.3)(3)
 >25 fl(n=48)21(43.8)27(56.2)(3)(4)
 χ231.706
 P<0.001
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不同RDW、PDW分层组患儿脓毒性休克发生率比较[例(%)]

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指标脓毒症(n=152)脓毒性休克(n=61)
RDW分层
 ≤15% (n=73)67(91.8)6(8.2)
 15%~17% (n=87)63(72.4)24(27.6)(1)
 >17% (n=53)22(41.5)31(58.5)(1)(2)
 χ238.051
 P<0.001
PDW分层
 ≤20 fl(n=59)55(93.2)4(6.8)
 20~25 fl(n=106)76(71.7)30(28.3)(3)
 >25 fl(n=48)21(43.8)27(56.2)(3)(4)
 χ231.706
 P<0.001
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Predictive value of erythrocyte and platelet parameters and scores for septic shock

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指标AUC(95%CI)P最佳临界值敏感度特异度
RDW0.805(0.741, 0.869)<0.00115.990.8360.684
PDW0.789(0.725, 0.854)<0.00122.130.8850.664
APACHE Ⅱ评分0.751(0.680, 0.823)<0.00116.040.8030.612
SOFA评分0.687(0.604, 0.770)<0.0017.5750.5570.789
RDW分层0.748(0.676, 0.820)<0.0012.50.5080.855
PDW分层0.725(0.652, 0.798)<0.0012.50.4430.862
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红细胞、血小板参数及脓毒症评分对脓毒性休克的预测价值

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指标AUC(95%CI)P最佳临界值敏感度特异度
RDW0.805(0.741, 0.869)<0.00115.990.8360.684
PDW0.789(0.725, 0.854)<0.00122.130.8850.664
APACHE Ⅱ评分0.751(0.680, 0.823)<0.00116.040.8030.612
SOFA评分0.687(0.604, 0.770)<0.0017.5750.5570.789
RDW分层0.748(0.676, 0.820)<0.0012.50.5080.855
PDW分层0.725(0.652, 0.798)<0.0012.50.4430.862
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红细胞及血小板参数对儿童脓毒症严重程度的预测价值
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白新凤 1 , 徐梅先 1, * , 郭芳 2 , 康磊 1 , 张会芬 1 , 程彩云 1
解放军医学杂志 | 临床研究 2021,46(9): 917-922
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解放军医学杂志 | 临床研究 2021, 46(9): 917-922
红细胞及血小板参数对儿童脓毒症严重程度的预测价值
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白新凤1, 徐梅先1, * , 郭芳2, 康磊1, 张会芬1, 程彩云1
作者信息
  • 1河北省儿童医院重症医学科，石家庄 050031
  • 2河北省儿童医院感染科，石家庄 050031

    • 白新凤，医学博士，主治医师，主要从事儿童危重症方面的研究

通讯作者:

徐梅先，E-mail：
Predictive values of erythrocyte and platelet parameters for the severity of sepsis in children
Xin-Feng Bai1, Mei-Xian Xu1, * , Fang Guo2, Lei Kang1, Hui-Fen Zhang1, Cai-Yun Cheng1
Affiliations
  • 1Department of Intensive Care Unit, Shijiazhuang 050031, China
  • 2Department of Infection, Hebei Children's Hospital, Shijiazhuang 050031, China
出版时间: 2021-09-28 doi: 10.11855/j.issn.0577-7402.2021.09.12
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摘要
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目的 评估红细胞及血小板参数对儿童脓毒症严重程度的预测价值。方法 选取河北医科大学附属河北省儿童医院重症医学科(PICU)2015年12月—2020年12月收治的213例脓毒症患儿，根据脓毒症严重程度分为脓毒症组(152例)与脓毒性休克组(61例)。比较两组患儿的一般资料、诊断脓毒症24 h内的红细胞及血小板参数、患儿入住PICU 24 h内的急性生理学与慢性健康状况评分Ⅱ(APACHE Ⅱ)及序贯器官衰竭评分(SOFA)。利用四分位法计算患儿红细胞分布宽度(RDW)及血小板分布宽度(PDW)的中位数及四分位间距，并据此将213例患儿进行分层。比较不同RDW、PDW分层患儿的性别、年龄、PICU住院时间、连续性肾脏替代治疗(CRRT)、机械通气情况，以及脓毒性休克发生情况；使用受试者工作特征(ROC)曲线评估RDW及PDW对患儿脓毒症严重程度的预测价值。结果 脓毒性休克组的RDW[17.03%(16.17%，18.72%)]、PDW [24.25 fl(23.25 fl，26.60 fl)]、APACHE Ⅱ评分[(19.06±3.78)分]及SOFA评分[(7.35±2.62)分]均高于脓毒症组[分别为15.28%(14.23%，16.39%)、21.28 fl(18.84 fl，23.40 fl)、(15.73±3.89)分、(5.68±2.40)分]，差异有统计学意义(P<0.05)；不同RDW分层的辅助通气时间差异有统计学意义(P<0.05)，不同PDW分层的PICU住院时间差异有统计学意义(P<0.05)；不同RDW、PDW分层的脓毒症严重程度差异有统计学意义(P<0.05)；RDW评估脓毒症严重程度的临床价值最高，PDW评估脓毒症严重程度的敏感度最高。结论 RDW及PDW可作为评估儿童脓毒症严重程度的重要指标。

脓毒症  /  红细胞参数  /  血小板参数  /  儿童

Objective To evaluate the predictive values of erythrocyte and platelet parameters for the severity of sepsis in children. Methods A total of 213 children with sepsis admitted to Pediatric Intensive Care Unit (PICU) of Hebei Children's Hospital from December 2015 to December 2020 were selected as the research subjects. According to the severity, they were divided into the sepsis group (152 cases) and septic shock group (61 cases). The gender, age, infected site and treatment of the enrolled subjects were recorded. The erythrocyte and platelet parameters were collected within 24 hours after the diagnosis of sepsis. The children were scored according to acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure score (SOFA) within 24 hours after admission to PICU. The median of the red cell volume distribution width (RDW) and platelet distribution width (PDW) and interquartile range were calculated for the child patients using the quartile method, and the 213 child patients were stratified on the basis. The gender, age, length of PICU stay, continuous renal replacement therapy (CRRT), mechanical ventilation, and occurrence of septic shock were compared between the child patients with different RDW and PDW stratifications.Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of erythrocyte and platelet parameters for the severity of children with sepsis. Results The scores of RDW [17.03%(16.17%, 18.72%)], PDW [24.25 fl (23.25 fl, 26.60 fl)],APACHE Ⅱ (19.06±3.78) and SOFA (7.35±2.62) in septic shock group were higher than those [15.28%(14.23%, 16.39%),21.28 fl (18.84 fl, 23.40 fl), 15.73±3.89, 5.68±2.40] in sepsis group, with statistical significance (P<0.05). There was statistically significant difference in the duration of assisted ventilation for RDW stratification (P<0.05), and there was statistically significant difference in the duration of hospitalization in PICU for PDW stratification (P<0.05). There was statistical significance in sepsis severity between RDW stratification and PDW stratification (P<0.05). RDW had the highest predictive value for sepsis severity,while PDW had the highest sensitivity for sepsis severity. Conclusion RDW and PDW are important biomarkers for predicting the severity of sepsis in children.

sepsis  /  erythrocyte parameters  /  platelet parameters  /  children
白新凤, 徐梅先, 郭芳, 康磊, 张会芬, 程彩云. 红细胞及血小板参数对儿童脓毒症严重程度的预测价值. 解放军医学杂志, 2021 , 46 (9) : 917 -922 . DOI: 10.11855/j.issn.0577-7402.2021.09.12
Xin-Feng Bai, Mei-Xian Xu, Fang Guo, Lei Kang, Hui-Fen Zhang, Cai-Yun Cheng. Predictive values of erythrocyte and platelet parameters for the severity of sepsis in children[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (9) : 917 -922 . DOI: 10.11855/j.issn.0577-7402.2021.09.12
正文
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脓毒症是宿主对感染反应失调引起的危及生命的器官功能障碍，也是导致儿童死亡的主要原因[1-2]。脓毒症患儿病死率从1%到20%不等，取决于疾病的严重程度、危险因素及病灶位置[3-5]。红细胞发生代谢及结构损伤，可损害氧气传递并影响预后，宿主对感染反应的失调在红细胞参数中表现尤为明显[6]。血小板作为宿主对感染反应的关键要素，在脓毒症的免疫应答及炎症反应过程中起着重要作用[7]。血常规是各级医院均开展的常规检查，红细胞参数及血小板参数较易获得，对红细胞参数及血小板参数进行分析，可以提高其预测儿童脓毒症严重程度的敏感度及特异度。本文回顾性研究红细胞参数及血小板参数与儿童脓毒症严重程度的相关性，以期为儿童脓毒症的早期识别、早期治疗及病情评估提供依据。
1 资料与方法
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1.1 研究对象
回顾性收集2015年12月—2020年12月河北医科大学附属河北省儿童医院重症医学科(PICU)收治的213例脓毒症患儿。纳入标准：(1)出生日龄>28 d、纠正胎龄>41周，且不超过18岁；(2)符合我国“儿童脓毒性休克(感染性休克)诊治专家共识(2015版)”中的诊断标准[8]。排除有基础疾病的患儿。根据脓毒症严重程度，将本组213例患儿分为脓毒症组(n=152)与脓毒性休克组(n=61)。其中脓毒性休克是指脓毒症导致的组织低灌注及心血管功能障碍。
1.2 临床资料收集
回顾性收集患儿的年龄、性别、感染部位、治疗等临床数据；记录患儿诊断脓毒症24 h内的实验室检查指标，包括红细胞计数(red blood count，RBC)、平均红细胞体积(mean corpuscular volume，MCV)、血细胞比容(hematocrit，HCT)、红细胞分布宽度(red blood cell distribution width，RDW)、血小板计数(platelet count，PLT)、血小板平均体积(mean platelet volume，MPV)、血小板比容(platelet crit，PCT)、血小板分布宽度(platelet distribution width，PDW)。记录患儿入住PICU 24 h内的急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluation Ⅱ，APACHE Ⅱ)及序贯器官衰竭评分(sequential organ failure score，SOFA)。
1.3 临床资料分析
比较脓毒症组与脓毒性休克组红细胞参数、血小板参数及APACHE Ⅱ评分、SOFA评分；比较不同RDW、PDW分层组脓毒症患儿的临床特征及脓毒症严重程度；分析脓毒症评分及RDW、PDW分层对脓毒性休克的预测价值。
1.4 统计学处理
采用SPSS 25.0软件对数据进行统计分析。对所有计量数据进行正态与方差齐性检验，符合正态分布且方差齐者以$\bar{x}±s$表示，多组比较采用方差分析，两组比较采用t检验；不符合正态分布者以M(Q1，Q3)表示，两组比较采用秩和检验。计数资料以例(%)表示，比较采用卡方检验。采用受试者工作特征(ROC)曲线分析红细胞、血小板参数及APACHE Ⅱ评分、SOFA评分对患儿脓毒症严重程度诊断的价值。P<0.05为差异有统计学意义。
2 结果
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2.1 两组一般资料比较
两组性别、年龄、感染部位、机械通气比例、连续性肾脏替代治疗(CRRT)比例差异均无统计学意义(P>0.05)；脓毒性休克组的机械通气时间、多器官功能障碍综合征(MODS)比例、28 d后死亡患者比例及PICU住院天数大于脓毒症组，差异有统计学意义(P<0.05，表1)。
2.2 两组红细胞参数、血小板参数及APACHEⅡ评分、SOFA评分比较
脓毒性休克组RDW、PDW及APACHE Ⅱ评分、SOFA评分均高于脓毒症组，差异有统计学意义(P<0.05)；两组RBC、MCV、HCT、PLT、MPV、PCT差异无统计学意义(P>0.05，表2)。
2.3 不同RDW、PDW分层组脓毒症患儿临床特征比较
患儿RDW值[M(Q1，Q3)]为[15.74%(14.61%，17.00%)]，并据此将213例患儿分为3层，即≤15%(73例)，15%~17%(87例)，>17%(53例)。患儿PDW[M(Q1，Q3)]为[22.08(19.71，24.56)] fl，并据此将213例患儿分为3层，即≤20 fl(59例)，20~25 fl(106例)，>25 fl(48例)。
不同RDW分层组年龄、性别、PICU住院时间、CRRT比例、机械通气比例等差异无统计学意义(P>0.05)；RDW≤15%组的机械通气时间小于另外两组，差异有统计学意义(P<0.05，表3)。
不同PDW分层组年龄、性别、CRRT比例、机械通气比例、机械通气时间等差异无统计学意义(P>0.05)；PDW≤20 fl组的PICU住院时间短于另外两组，差异有统计学意义(P<0.05，表4)。
2.4 不同RDW、PDW分层组患儿脓毒症严重程度比较
不同RDW、PDW分层组的脓毒性休克发生率差异有统计学意义(P<0.001)。RDW、PDW越大，发生脓毒性休克的发生率越高，差异有统计学意义(P<0.05，表5)。
2.5 脓毒症评分及RDW、PDW分层对脓毒性休克的预测价值
ROC曲线分析结果显示，RDW预测脓毒性休克的AUC最大，为0.805，PDW次之，但后者敏感度最高。RDW及PDW分层预测脓毒性休克的AUC均较小，且敏感度均较低。具体参见表6、图1。
3 讨论
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APACHE Ⅱ及SOFA评分是被广泛用于评估危重症患者严重程度的简单而有效的指标。本研究ROC曲线分析发现，RDW、PDW的AUC高于APACHE Ⅱ及SOFA评分，对脓毒性休克的预测效能较好。此外，本研究发现，不同RDW、PDW分层也可能是预测儿童脓毒症严重程度的有用指标。RDW、PDW层数越大，脓毒性休克发生率越高。
RDW是一种重复性高的常规临床实验室检测项目，反映了外周血红细胞大小的变异性(即红细胞大小不等)，传统上用于研究贫血[9]。一般认为RDW的增加通过影响红细胞的产生及存活而导致红细胞稳态的严重失调[10]。既往研究发现，脓毒症患者入住ICU时的RDW与病死率相关[11]，但这种关联在不同脓毒症严重程度患者中的报道较少。之前有学者发现，RDW是重症监护病房中脓毒症患者住院时间的预测因子[12]。本研究结果显示，脓毒症患者的PDW值越高，PICU住院时间越长；RDW值越高，机械通气时间越长。
RDW可能反映了炎症反应的存在。炎症反应对骨髓功能、铁代谢及红细胞稳态产生负面影响，进而导致红细胞生成迟缓或红细胞大小不等，在许多人类疾病的起病及进展中发挥重要作用，也可能对脓毒症产生负面影响[13]。炎症还能抑制红细胞生成素的产生，诱导对红细胞生成素的抗性，降低铁的生物利用度，直接抑制骨髓中的红细胞前体，激活红细胞凋亡及外周吞噬[14]。高氧化应激是脓毒症的病理生理特征之一[15]，可促进大的不成熟的红细胞进入外周循环，直接导致RDW升高。脓毒症可改变红细胞膜糖蛋白和离子通道，从而导致红细胞形态的改变[16]。提示RDW升高可能是对各种有害病理过程的综合反映，包括氧化应激、炎症反应、肾功能不全、营养不良，这些可能在脓毒症中同时发生。因此，RDW具有评估脓毒症严重程度的能力，类似于APACHE Ⅱ及SOFA等疾病严重程度评分，但RDW更容易且能更快地获得。
PDW是一个可以直接反映血小板大小变异性的参数，其值较高表明网状血小板的产生增加，也表明血小板活性增高[17]。血小板活化引起血小板形态的改变，包括球形及伪足的形成，血小板假足数量及大小的增加会影响PDW值[18-19]。有学者研究发现，入院时PDW值升高与住院期间机械通气相关，建议将入院时较高的PDW作为疾病严重程度的标志[20]。之前有学者研究发现，较高的PDW与器官衰竭相关，入院时的PDW是持续性器官衰竭的独立预测因子[21]。
PDW比PLT及MPV更能反映血小板的新生、活化及机体的炎症反应状态，即PDW对病情严重程度的判断更敏感。PDW增加可能是脓毒症病情加重的原因，但也很可能是脓毒症病情加重的结果。最近有大量临床研究表明，PDW水平与危重症的发病相关[22-23]。也有研究报道，血小板功能及大小的变化与全身炎症相关，PDW在预测某些疾病预后方面有重要价值[24]。本研究ROC曲线分析结果显示，PDW的AUC稍低于RDW，但也具有高度敏感性，这对高危婴幼儿的管理具有重要意义。
综上所述，RDW、PDW可以预测脓毒症的严重程度，其预测效能超出了APACHE Ⅱ及SOFA评分。但本研究为回顾性研究，未评估入院期间RDW、PDW的变化，未来可进一步行前瞻性队列研究来验证本研究的发现。RDW、PDW作为全血细胞计数的常规参数，其测量不涉及额外的成本，且可以提高经典严重程度评分预测脓毒性休克的效能，因此在未来开发新的评分系统时可考虑将其纳入。
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  • 2019 Medical Science Research Project of Hebei Province(20190824)
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2021年第46卷第9期
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doi: 10.11855/j.issn.0577-7402.2021.09.12
  • 接收时间：2021-01-28
  • 首发时间：2025-12-19
  • 出版时间：2021-09-28
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  • 收稿日期：2021-01-28
  • 修回日期：2021-05-31
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2019 Medical Science Research Project of Hebei Province(20190824)
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    1河北省儿童医院重症医学科，石家庄 050031
    2河北省儿童医院感染科，石家庄 050031

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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