Jia Haiting,Li Hai,Wang Shifu,et al.The relationship between Staphylococcus aureus infection and coagulation function in children with acute osteomyelitis[J].Journal of Clinical Pediatric Surgery,2026,(07):662-666.[doi:10.3760/cma.j.cn101785-202208011]
金黄色葡萄球菌感染与儿童急性骨髓炎凝血功能的关系
- Title:
- The relationship between Staphylococcus aureus infection and coagulation function in children with acute osteomyelitis
- Keywords:
- Osteomyelitis; Staphylococcus Aureus; Coagulation; Child
- 摘要:
- 目的 通过和脓液培养未培养出细菌的儿童急性骨髓炎对比分析,探讨金黄色葡萄球菌对儿童急性骨髓炎凝血功能的影响。方法 回顾性分析2017年11月至2022年4月治疗的94例急性骨髓炎患儿的病例资料,根据脓液培养结果,将金黄色葡萄球菌感染的69例患儿设为观察组,包括甲氧西林敏感性金黄色葡萄球菌(methicillin-susceptible Staphylococcus aureus,MSSA)45例和耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)24例,其中男38例、女31例,年龄19天至15岁;将脓液培养阴性的25例患儿设为对照组,其中男17例、女8例,年龄4个月至11岁。对两组患儿入院24 h内凝血酶原时间、国际标准化比值、部分凝血活酶时间、凝血酶时间、纤维蛋白原、D-二聚体和血小板进行对比分析,同时在观察组内对比分析甲氧西林敏感性金黄色葡萄球菌和耐甲氧西林金黄色葡萄球菌对凝血功能的影响。结果 观察组和对照组在凝血酶原时间升高比例(7/69比0/25)、国际标准化比值升高比例(8/69比0/25)、部分凝血活酶时间升高比例(7/69比3/25)、凝血酶时间升高比例(2/69比0/25)、D-二聚体升高比例(43/69比10/25)和血小板升高比例(42/69比18/25)上差异无统计学意义(P＞0.05),在纤维蛋白原升高比例(50/69比12/25)上差异有统计学意义(P＜0.05);观察组和对照组纤维蛋白原升高程度分别为(5.61±1.02)g/L和(4.62±0.45)g/L,D-二聚体升高程度分别为(2.73±1.93)mg/L和(1.59±0.48)mg/L,差异均有统计学意义(P＜0.05);观察组中,甲氧西林敏感性金黄色葡萄球菌对凝血功能的影响与耐甲氧西林金黄色葡萄球菌差异无统计学意义(P＞0.05)。结论 本单中心研究结果表明,金黄色葡萄球菌较少引起急性骨髓炎患儿凝血酶原时间、国际标准化比值、部分凝血活酶时间和凝血酶时间的升高,但容易引起血小板、纤维蛋白原和D-二聚体升高,且纤维蛋白原和D-二聚体升高程度相比细菌培养阴性者明显升高;但上述结论需要更进一步的临床研究总结分析。
- Abstract:
- Objective To analyze and compare the effects of Staphylococcus aureus infection on coagulation function in children with acute osteomyelitis against cases with negative bacterial cultures. Methods This study retrospectively analyzed the case data of 94 children with acute osteomyelitis treated at Jinan Children’s Hospital from November 2017 to April 2022. Based on pus culture results,69 children with Staphylococcus aureus infections were assigned to the observation group,including 45 with methicillin-susceptible Staphylococcus aureus (MSSA) and 24 with methicillin-resistant Staphylococcus aureus (MRSA) (38 boys,31 girls,aged 19 days to 15 years).The control group included 25 children with negative bacterial cultures (17 boys,8 girls,aged 4 months to 11 years).Coagulation indicators measured within 24 hours of admission,such as prothrombin time,international normalized ratio,activated partial thromboplastin time,thrombin time,fibrinogen,D-dimer,and platelet count,were compared between groups.The effects of MSSA versus MRSA on coagulation in the observation group were also analyzed.Results There were no statistically significant differences between the observation and control groups regarding elevated prothrombin time (7/69 vs.0/25),international normalized ratio (8/69 vs.0/25),activated partial thromboplastin time (7/69 vs.3/25),thrombin time (2/69 vs.0/25),elevated D-dimer (43/69 vs.10/25),or platelet count (42/69 vs.18/25)(P>0.05).However,there was a statistically significant difference in the proportion of elevated fibrinogen cases (50/69 vs.12/25)(P<0.05).Fibrinogen levels were higher in the observation group (5.61±1.02 g/L vs.4.62±0.45 g/L),as were D-dimer levels (2.73±1.93 mg/L vs.1.59±0.48 mg/L) (P<0.05).There was no statistically significant difference between MSSA and MRSA in their effects on coagulation function within the observation group (P>0.05).Conclusions Staphylococcus aureus infection rarely increases prothrombin time,international normalized ratio,activated partial thromboplastin time,or thrombin time in children with acute osteomyelitis but is associated with elevated platelet count,fibrinogen,and D-dimer levels,with fibrinogen and D-dimer levels significantly higher compared to culture-negative cases.Further clinical and multicenter studies are required for a more comprehensive analysis.
参考文献/References:
[1] Peltola H,P??kk?nen M.Acute osteomyelitis in children[J].N Engl J Med,2014,370(4):352-360.DOI:10.1056/NEJMra1213956.
[2] 宋宝健,王强,冯伟,等.持续冲洗结合负压封闭引流治疗儿童急性血源性骨髓炎[J].临床小儿外科杂志,2017,16(3):238-241.DOI:10.3969/j.issn.1671-6353.2017.03.009. Song BJ,Wang Q,Feng W,et al.Efficacy of continuous douche plus vacuum sealing drainage for pediatric acute hematogenous osteomyelitis[J].J Clin Ped Sur,2017,16(3):238-241.DOI:10.3969/j.issn.1671-6353.2017.03.009.
[3] Gigante A,Coppa V,Marinelli M,et al.Acute osteomyelitis and septic arthritis in children:a systematic review of systematic reviews[J].Eur Rev Med Pharmacol Sci,2019,23(2 Suppl):145-158.DOI:10.26355/eurrev_201904_17484.
[4] Bartkowski S.Clinical and experimental studies on the effects of anticogulant,fibrinolytic and antibacterial treatment of non-specific osteitis[J].Pol Tyg Lek,1975,30(11):479-481.
[5] Citla Sridhar D,Maher OM,Rodriguez NI.Pediatric deep venous thrombosis associated with staphylococcal infections:single institutional experience[J].J Pediatr Hematol Oncol,2018,40(2):e73-e76.DOI:10.1097/MPH.0000000000001040.
[6] Puy C,Tucker EI,Wong ZC,et al.Factor XII promotes blood coagulation Independent of factor XI in the presence of long-chain polyphosphates[J].J Thromb Haemost,2013,11(7):1341-1352.DOI:10.1111/jth.12295.
[7] Yeaman MR.Platelets in defense against bacterial pathogens[J].Cell Mol Life Sci,2010,67(4):525-544.DOI:10.1007/s00018-009-0210-4.
[8] Tang YQ,Yeaman MR,Selsted ME.Antimicrobial peptides from human platelets[J].Infect Immun,2002,70(12):6524-6533.DOI:10.1128/IAI.70.12.6524-6533.2002.
[9] Gonzalez BE,Teruya J,Mahoney DH Jr,et al.Venous thrombosis associated with staphylococcal osteomyelitis in children[J].Pediatrics,2006,117(5):1673-1679.DOI:10.1542/peds.2005-2009.
[10] Shallcross LJ,Fragaszy E,Johnson AM,et al.The role of the Panton-Valentine leucocidin toxin in staphylococcal disease:a systematic review and meta-analysis[J].Lancet Infect Dis,2013,13(1):43-54.DOI:10.1016/S1473-3099(12)70238-4.
[11] Niemann S,Bertling A,Brodde MF,et al.Panton-Valentine leukocidin associated with S.aureus osteomyelitis activates platelets via neutrophil secretion products[J].Sci Rep,2018,8(1):2185.DOI:10.1038/s41598-018-20582-z.
[12] 杜青青,潘芬,王春,等.2016-2021年儿童金黄色葡萄球菌血流感染的分子特征和毒力基因研究[J].中华检验医学杂志,2022,45(6):595-602.DOI:10.3760/cma.j.cn114452-20220216-00074. Du QQ,Pan F,Wang C,et al.Molecular characteristics and virulence genes of Staphylococcus aureus in bloodstream infection from children during 2016-2021[J].Chin J Lab Med,2022,45(6):595-602.DOI:10.3760/cma.j.cn114452-20220216-00074.
[13] McNeil JC,Forbes AR,Vallejo JG,et al.Role of operative or interventional radiology-guided cultures for osteomyelitis[J].Pediatrics,2016,137(5):e20154616.DOI:10.1542/peds.2015-4616.
[14] Bartowski SB,Heczko PB,Lisiewicz J,et al.Combined treatment with antibiotic,heparin and streptokinase-a new approach to the therapy of bacterial osteomyelitis[J].J Craniomaxillofac Surg,1994,22(3):167-176.DOI:10.1016/s1010-5182(05)80384-1.
相似文献/References:
[1]张晓乐,赵国强,赵旭飞.18例儿童手和足骨髓炎诊治分析[J].临床小儿外科杂志,2020,19(10):921.[doi:10.3969/j.issn.1671-6353.2020.10.011]
Zhang Xiaole,Zhao Guoqiang,Zhao Xufei.Analysis of diagnosis and treatment of 18 cases of hand and foot osteomyelitis in children[J].Journal of Clinical Pediatric Surgery,2020,19(07):921.[doi:10.3969/j.issn.1671-6353.2020.10.011]
[2]文玉伟,贾海亭,王春华,等.儿童短管状骨及扁平骨骨髓炎的治疗[J].临床小儿外科杂志,2023,22(02):158.[doi:10.3760/cma.j.cn101785-202202018-012]
Wen Yuwei,Jia Haiting,Wang Chunhua,et al.Treatment of osteomyelitis of short tubular and flat bones in children[J].Journal of Clinical Pediatric Surgery,2023,22(07):158.[doi:10.3760/cma.j.cn101785-202202018-012]
[3]李雅琴,李论,徐涛涛,等.儿童亚急性骨髓炎的研究进展[J].临床小儿外科杂志,2023,22(05):485.[doi:10.3760/cma.j.cn101785-202211063-016]
Li Yaqin,Li Lun,Xu Taotao,et al.Research advances of subacute osteomyelitis in children[J].Journal of Clinical Pediatric Surgery,2023,22(07):485.[doi:10.3760/cma.j.cn101785-202211063-016]
[4]伍江雁,胡雄科,曾凌嵘,等.儿童股骨远端具核梭杆菌感染致亚急性骨骺骨髓炎1例并文献综述[J].临床小儿外科杂志,2023,22(12):1189.[doi:10.3760/cma.j.cn101785-202310052-017]
Wu Jiangyan,Hu Xiongke,Zeng Lingrong,et al.Subacute epiphyseal osteomyelitis caused by Fusobacterium nucleatum in distal femur:one case report with a literature review[J].Journal of Clinical Pediatric Surgery,2023,22(07):1189.[doi:10.3760/cma.j.cn101785-202310052-017]
[5]贾海亭,王玉亭,孙琳,等.耐甲氧西林和甲氧西林敏感性金黄色葡萄球菌致儿童急性骨髓炎的临床特征比较[J].临床小儿外科杂志,2024,23(05):452.[doi:10.3760/cma.j.cn101785-202206023-010]
Jia Haiting,Wang Yuting,Sun Lin,et al.Clinical features of acute osteomyelitis due to methicillin-resistant Staphylococcus aureus in children[J].Journal of Clinical Pediatric Surgery,2024,23(07):452.[doi:10.3760/cma.j.cn101785-202206023-010]
[6]王怀铿,黄少敏,梁龙芳,等.灌洗负压引流在儿童急性血源性骨髓炎开窗减压加病灶清除术中的应用[J].临床小儿外科杂志,2024,23(08):757.[doi:10.3760/cma.j.cn101785-202309018-010]
Wang Huaikeng,Huang Shaomin,Liang Longfang,et al.Application of continuous douche plus vacuum drainage for acute hematogenous osteomyelitis in children with fenestration decompression and lesion clearance[J].Journal of Clinical Pediatric Surgery,2024,23(07):757.[doi:10.3760/cma.j.cn101785-202309018-010]
[7]贾海亭,孙李华,刘涛,等.15月龄以下和18月龄以上累及骨骺的急性干骺端骨髓炎患儿临床特征分析[J].临床小儿外科杂志,2024,23(08):763.[doi:10.3760/cma.j.cn101785-202306036-011]
Jia Haiting,Sun Lihua,Liu Tao,et al.Clinical features of acute metaphyseal osteomyelitis involving epiphysis in children aged below 15 months and over 18 months[J].Journal of Clinical Pediatric Surgery,2024,23(07):763.[doi:10.3760/cma.j.cn101785-202306036-011]
[8]廖嘉丽,李各芳,何波,等.基于机器学习算法的儿童化脓性关节炎金黄色葡萄球菌感染预测模型构建[J].临床小儿外科杂志,2026,(05):477.[doi:10.3760/cma.j.cn101785-202507035]
Liao Jiali,Li Gefang,He Bo,et al.Construction of a machine learning-based prediction model for Staphylococcus aureus infection in children with septic arthritis[J].Journal of Clinical Pediatric Surgery,2026,(07):477.[doi:10.3760/cma.j.cn101785-202507035]
备注/Memo
收稿日期:2022-8-5。
基金项目:山东省儿童健康与疾病临床医学研究中心立项项目(RC006)
通讯作者:王世富,Email:wshfu709@163.com