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中华妇幼临床医学杂志(电子版) ›› 2025, Vol. 21 ›› Issue (06) : 681 -688. doi: 10.3877/cma.j.issn.1673-5250.2025.06.011

论著

支气管肺发育不良超早产儿生后早期血小板参数联合血清粒细胞集落刺激因子水平对预测其首次拔管后72 h内撤机失败的临床价值
郑倩, 朱荣平†()   
  1. 常州市妇幼保健院新生儿科，常州　213000
  • 收稿日期:2025-02-14 修回日期:2025-11-06 出版日期:2025-12-01
  • 通信作者: 朱荣平

Value of early platelet parameters combined with serum granulocyte colony-stimulating factor in predicting withdrawal failure within 72 hours after first extubation in extremely preterm infants with broncho-pulmonary dysplasia

Qian Zheng, Rongping Zhu†()   

  1. Department of Neonatology, Changzhou Maternal and Child Health Care Hospital, Changzhou 213000, Jiangsu Province, China
  • Received:2025-02-14 Revised:2025-11-06 Published:2025-12-01
  • Corresponding author: Rongping Zhu
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引用本文：

郑倩, 朱荣平. 支气管肺发育不良超早产儿生后早期血小板参数联合血清粒细胞集落刺激因子水平对预测其首次拔管后72 h内撤机失败的临床价值[J/OL]. 中华妇幼临床医学杂志(电子版), 2025, 21(06): 681-688.

Qian Zheng, Rongping Zhu. Value of early platelet parameters combined with serum granulocyte colony-stimulating factor in predicting withdrawal failure within 72 hours after first extubation in extremely preterm infants with broncho-pulmonary dysplasia[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2025, 21(06): 681-688.

目的

探讨支气管肺发育不良(BPD)超早产儿生后早期(出生后24 h内)血小板参数联合血清粒细胞集落刺激因子(G-CSF)水平，对预测其首次拔管后72 h内撤机失败的临床价值。

方法

选择2020年7月至2023年7月于常州市妇幼保健院接受机械通气治疗的106例BPD超早产儿为研究对象。根据其首次拔管后72 h内撤机结局，将其分为失败组(n＝32，首次拔管后72 h内因呼吸衰竭等原因需再插管者)与成功组(n＝74，首次拔管后72 h内无需再插管者)。采用前瞻性研究方法，收集2组患儿出生后24 h内的血小板参数[血小板计数(PLT)、血小板体积分布宽度(PDW)与平均血小板体积(MPV)]及血清G-CSF水平，以及围产期资料等临床资料，并分别采用成组t检验、χ2检验进行比较。采用多因素非条件logistic回归分析法，对BPD超早产儿首次拔管后72 h内撤机失败的独立影响因素进行分析。采用受试者工作特征(ROC)曲线，评估BPD超早产儿生后早期血小板参数与血清G-CSF水平对预测其首次拔管后72 h内撤机失败的价值。本研究遵循的程序符合常州市妇幼保健院医学伦理委员会标准，并获得该伦理委员会审批(审批文号：202070)。

结果

①本研究进行机械通气的106例BPD超早产儿中，撤机后再插管者为32例，失败率为30.2%。②失败组患儿宫内感染率、首次拔管前机械通气时间、生后早期MPV及血清G-CSF水平，均高于、长于或大于成功组，并且差异均有统计学意义(χ2＝4.66、P＝0.031，t＝3.66、P＝0.001，t＝4.43、P＝0.001，t＝2.07、P＝0.041)。③多因素非条件logistic回归分析结果显示，首次拔管前机械通气时间(OR＝4.495，95%CI：2.588~7.806)，生后早期MPV(OR＝3.086，95%CI：1.777~5.359)，以及生后早期血清G-CSF水平(OR＝3.747，95%CI：2.158~6.507)，均为BPD超早产儿首次拔管后72 h内撤机失败的独立影响因素(P<0.05)。④ROC曲线分析结果显示，生后早期MPV、血清G-CSF水平单一及联合预测BPD超早产儿首次拔管后72 h内撤机失败的敏感度分别为73.9%(95%CI：64.2%~85.2%)、75.1%(95%CI：67.1%~89.4%)、84.2%(95%CI：75.6%~93.5%)，特异度分别为77.4%(95%CI：69.1%~86.3%)、68.2%(95%CI：60.2%~76.5%)、83.9%(95%CI：74.2%~91.3%)，曲线下面积(AUC)分别为0.737、0.712、0.879。

结论

生后早期MPV、血清G-CSF水平与BPD超早产儿首次拔管后72 h内撤机失败有关，可用于辅助预测该病患儿首次拔管后72 h内撤机失败风险。

关键词: 支气管肺发育不良, 呼吸，人工, 血小板参数, 平均血小板体积, 粒细胞集落刺激因子, 机械通气, 撤机失败, 婴儿，极度早产
Objective

To explore the value of early (within 24 hours after birth) platelet parameters combined with serum granulocyte colony-stimulating factor (G-CSF) level in predicting 72 hours withdrawal failure in extremely preterm infants with broncho-pulmonary dysplasia (BPD).

Methods

A total of 106 cases of extremely preterm infants with BPD who received invasive mechanical ventilation treatment at Changzhou Maternal and Child Health Care Hospital from July 2020 to July 2023 were selected as research subjects. Based on the weaning outcome within 72 hours after the first extubation, the infants were divided into failure group (n=32, those who needed reintubation within 72 hours after the first extubation due to respiratory failure or other reasons) and success group (n=74, those who did not need reintubation within 72 hours after the first extubation). The platelet parameters [platelet count (PLT), platelet distribution width (PDW), and mean platelet volume (MPV)] and serum G-CSF level within 24 hours after birth, as well as perinatal and general information of infants in two groups were collected by prospective study method and were compared using independent-samples t tests and chi-square test. Multivariate unconditional logistic regression analysis was used to analyze the influencing factors of weaning failure within 72 hours after the first extubation in extremely preterm infants with BPD. Receiver operating characteristic (ROC) curve was used to assess the predictive value of early platelet parameters and serum G-CSF level for weaning failure within 72 hours after the first extubation in extremely preterm infants with BPD. The procedures followed in this study complied with the standards of the Medical Ethics Committee of Changzhou Maternal and Child Health Care Hospital and were approved by the committee (Approval No. 202070).

Results

①Among 106 extremely premature infants with BPD who underwent invasive mechanical ventilation, 32 cases required reintubation within 72 hours after after first extubation, and the failure rate was 30.2%. ②The intrauterine infection rate was higher in failure group than that in success group, and the duration of invasive mechanical ventilation before the first extubation was longer than that in success group, and the early MPV and serum G-CSF were higher than those in success group, and all the differences were statistically significant (χ2=4.66, P=0.031; t=3.66, P=0.001; t=4.43, P=0.001; t=2.07, P=0.041). ③Multivariate unconditional logistic regression analysis showed that the duration of invasive mechanical ventilation before the first extubation (OR=4.495, 95%CI: 2.588-7.806), early MPV (OR=3.086, 95%CI: 1.777-5.359), and early serum G-CSF level (OR=3.747, 95%CI: 2.158-6.507) were all independent factors influencing weaning failure within 72 hours after the first extubation in extremely preterm infants with BPD (P<0.05). ④ROC curve analysis showed that the sensitivities of early MPV and serum G-CSF level alone and in combination for predicting weaning failure within 72 hours after the first extubation in extremely preterm infants with BPD were 73.9% (95%CI: 64.2%-85.2%), 75.1% (95%CI: 67.1%-89.4%), and 84.2% (95%CI: 75.6%-93.5%), respectively; the specificities were 77.4% (95%CI: 69.1%-86.3%), 68.2% (95%CI: 60.2%-76.5%), and 83.9% (95%CI: 74.2%-91.3%), respectively; and the area under the curve (AUC) were 0.737, 0.712, and 0.879, respectively.

Conclusions

Early MPV and serum G-CSF level are associated with weaning failure within 72 hours after the first extubation in extremely preterm infants with BPD, and can be used to assist in predicting the risk of weaning failure within 72 hours after the first extubation in these infants.

Key words: Bronchopulmonary dysplasia, Respiration, artificial, Platelet parameters, Mean platelet volume, Granulocyte colony-stimulating factor, Mechanical ventilation, Weaning failed, Infant, extremely premature
表1 2组BPD超早产儿围产期资料比较[例数(%)]
组别 例数 娩出方式 孕母妊娠期糖尿病 孕母妊娠期高血压疾病 产前使用地塞米松 宫内感染
顺产 剖宫产
失败组 32 19(59.4) 13(40.6) 5(15.6) 9(28.1) 15(46.9) 6(18.8)
成功组 74 52(70.3) 22(29.7) 9(12.2) 18(24.3) 44(59.5) 4(5.4)
χ2值   1.20 0.23 0.17 1.43 4.66
P值   0.274 0.629 0.680 0.231 0.031
表2 2组BPD超早产儿一般资料比较
组别 例数 性别[例数(%)] 出生胎龄(周，±s) 出生体重(g，±s) 生后5 min Apgar评分(分，±s) 首次拔管前机械通气时间(h，±s) 使用PS[例数(%)]
男 女
失败组 32 15(46.9) 17(53.1) 27.6±2.0 1 056.3±170.3 4.2±1.3 79.0±10.1 32(100.0)
成功组 74 34(45.9) 40(54.1) 27.3±1.3 1 007.9±152.1 4.8±1.4 72.2±8.3 74(100.0)
统计量   χ2＝0.01 t＝0.85 t＝1.45 t＝1.77 t＝3.66 —a
P值   0.930 0.397 0.150 0.080 0.001 1.000
表3 2组BPD超早产儿生后早期血小板参数及血清G-CSF水平比较(±s)
组别 例数 PLT(×109/L) PDW(%) MPV(fL) 血清G-CSF水平(pg/mL)
失败组 32 209.5±31.3 16.3±1.3 10.7±0.9 112.3±36.1
成功组 74 217.6±26.8 16.7±1.0 10.0±0.7 98.2±30.4
t值   1.35 1.48 4.43 2.07
P值   0.180 0.142 0.001 0.041
表4 影响BPD超早产儿首次拔管后72 h内撤机失败独立危险因素的多因素非条件逐步logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
首次拔管前机械通气时间(连续变量) 1.503 0.724 4.310 0.013 4.495 2.588~7.806
生后早期MPV(连续变量) 1.127 0.526 4.591 0.012 3.086 1.777~5.359
生后早期血清G-CSF水平(连续变量) 1.321 0.658 4.030 0.014 3.747 2.158~6.507
图1 生后早期MPV及血清G-CSF水平预测BPD超早产儿首次拔管后72 h内撤机失败的ROC曲线图注：MPV为平均血小板体积，G-CSF为粒细胞集落刺激因子，BPD为支气管肺发育不良，ROC曲线为受试者工作特征曲线
表5 生后早期MPV与血清G-CSF水平预测BPD超早产儿首次拔管后72 h内撤机失败的效能分析
指标 ROC曲线 最佳临界值 敏感度及其95%CI(%) 特异度及其95%CI(%)
AUC(95%CI) P值
生后早期MPV 0.737(0.609~0.861) <0.001 10.39 fL 73.9(64.2~85.2) 77.4(69.1~86.3)
生后早期血清G-CSF水平 0.712(0.591~0.843) <0.001 105.32 pg/mL 75.1(67.1~89.4) 68.2(60.2~76.5)
二者联合 0.879(0.785~0.972) <0.001 － 84.2(75.6~93.5) 83.9(74.2~91.3)
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