Abstract: Objective To explore the association between platelet parameters at birth and the risk of moderate/severe bronchopulmonary dysplasia (BPD) in a cohort of extremely preterm infants. Methods The data of premature infants with gestational age ≤28 weeks and birth weight<1 500 g admitted to the Neonatal Intensive Care Unit, Dalian Maternal and Child Health Care Hospital of Dalian Medical University from September 2014 to December 2019 were retrospectively collected.The preterm infants were divided into non-BPD, mild BPD and moderate/severe BPD groups.The differences in platelet parameters in 24 hours after birth among the three groups were compared, including platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW) and platelet mass.Receiver operating characteristic (ROC) curve was used to evaluate the early predictive value of platelet parameters for moderate/severe BPD. Results A total of 147 premature infants were enrolled, including 71 non-BPD infants,35 mild BPD infants and 41 infants with moderate/severe BPD.The value of MPV in 24 hours after birth was significantly higher in moderate/severe BPD group than that in non-BPD group and mild BPD group(F=8.048,P<0.001).But there were no significant differences in PLT, PDW and platelet mass among the three groups (P>0.05).Multivariate Logistic regression analysis indicated that with the increase of gestational age, the risk of moderate/severe BPD decreased (OR=0.466, 95%CI:0.247-0.880).The increasing MPV(OR=2.522, 95%CI:1.313-4.847), higher number of blood transfusions(OR=2.177, 95%CI:1.135-4.177), and longer duration of mechanical ventilation(OR=3.296, 95%CI:1.071-10.144).ROC curve analysis showed that the best diagnostic cut-off value of MPV was 10.55 fl,and the sensitivity and specificity of early prediction of moderate/severe BPD was about 62.2% and 76.8%, respectively. Conclusions A higher level of MPV in the first 24 hours of life may increase the risk of moderate/severe BPD after extremely premature birth.The change of MPV is likely to be related to the onset of BPD in preterm infants.

Key words: bronchopulmonary dysplasia, blood platelet, mean platelet volume, preterm infants

摘要： 目的 探索血小板参数与中重度支气管肺发育不良的关系。方法 回顾性分析2014年9月-2019年12月大连市妇幼保健院新生儿科收治的胎龄≤28周,出生体重<1 500 g的早产儿,根据支气管肺发育不良(BPD)的发病情况,分为无BPD组、轻度BPD组和中重度BPD组,比较各组间早产儿出生后24 h内血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)和血小板质量的差异,并采用Logistic回归分析发生中重度BPD的危险因素,采用受试者工作特征(ROC)曲线分析相关指标对中重度BPD的早期预测价值。结果 共纳入无BPD早产儿71例、轻度BPD早产儿35例、中重度BPD早产儿41例。中重度BPD组生后24 h内MPV高于无BPD组和轻度BPD组(F=8.048,P<0.001),而三组患儿PLT、PDW和血小板质量差异无统计学意义(P>0.05)。多因素Logistic回归分析显示随着胎龄的增大,中重度BPD的发生风险降低(OR=0.466, 95%CI:0.247~0.880)。MPV增大(OR=2.522, 95%CI:1.313~4.847)、输血次数多(OR=2.177, 95%CI:1.135~4.177)、机械通气时间长(OR=3.296, 95%CI:1.071~10.144)是发生中重度BPD的独立危险因素。ROC曲线分析显示MPV的诊断界值为10.55fl时,预测中重度BPD的敏感度为62.2％,特异度为76.8％。结论 早产儿出生后24 h内较高水平的MPV是发生中重度BPD的独立危险因素。MPV的变化可能与早产儿中重度BPD的发生有关。

关键词: 支气管肺发育不良, 血小板, 平均血小板体积, 早产儿