• Коагуляционные нарушения при инфекционных заболеваниях у детей и их диагностика с помощью показателя D-димера

Коагуляционные нарушения при инфекционных заболеваниях у детей и их диагностика с помощью показателя D-димера

SOVREMENNAYA PEDIATRIYA.2018.1(89):90-96; doi 10.15574/SP.2018.89.90

Марков А. И.
Национальный медицинский университет им. А.А. Богомольца, г. Киев, Украина

Инфекционные заболевания традиционно ассоциируются с активацией системы гемостаза и усилением тромбообразования. Для оценки активности системы гемостаза в последние годы широко изучается D-димер, который отражает текущую активность системы гемостаза и является высокочувствительным маркером внутрисосудистого тромбообразования.
Цель — изучение показателей D-димера в сыворотке крови детей с инфекционными заболеваниями различной этиологии для определения степени активации системы гемостаза и оценки его диагностических возможностей.
Материалы и методы. Под наблюдением находились дети в возрасте от 1 месяца до 18 лет, проходившие стационарное лечение по поводу острых инфекционных заболеваний. В комплексном обследовании в течение первых суток проводилось определение D-димера в плазме крови.
Результаты. Было обследовано 23 ребенка в возрасте от 5 месяцев до 17 лет. У 26,0% детей была диагностирована ветряная оспа, в том числе у 13,0% осложненная мозжечковой атаксией; у 56,5% — инфекционный мононуклеоз ЭБВ1этиологии, у 8,7% — менингококковая инфекция (менингококкемия + менингит) и у 8,7% — скарлатина. У всех пациентов уровень D-димера превышал референтный уровень (>0,5 мкг/мл). У пациентов с ветряной оспой он составлял 1,07±0,30 мкг/мл (M±SD), инфекционным мононуклеозом — 1,90±1,14, менингококковой инфекцией — 9,11±0,15 и скарлатиной — 9,12±4,36. Была выявлена достоверная разница между уровнем этого показателя у детей с ветряной оспой и менингококковой инфекцией, ветряной оспой и скарлатиной, инфекционным мононуклеозом и менингококковой инфекцией, инфекционным мононуклеозом и скарлатиной, между группами пациентов с вирусной и бактериальной природе заболевания.
Выводы. Определение уровня D-димера может быть важным для комплексной оценки коагуляционных расстройств, определения тяжести и развития осложнений при острых инфекционных заболеваниях у детей, а также для дифференциальной диагностики заболеваний вирусной и бактериальной этиологии.
Ключевые слова: гемостаз, D-димер, инфекции, дети.

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