Right Ventricular Function Index And Platelet Parameters For Early Prediction Value Of Bronchopulmonary Dysplasia

Background: Bronchopulmonary dysplasia(BPD)is the most common chronic respiratory disease in premature infants.Abnormal development and injury of alveoli and pulmonary vessels are important characteristics of BPD.Pulmonary hypertension(PH)is a serious manifestation of BPD.With the progress of the disease,right ventricular hypertrophy,dilation and dysfunction can further occur,which is an important reason for poor survival of children with BPD.The PH of premature infants in the early postnatal period is related to the occurrence of BPD,but it is sometimes difficult to detect PH only by conventional ultrasound indicators such as tricuspid regurgitation jet velocity(TRJV).At present,more sensitive and reliable indicators are needed to detect PH earlier.Tricuspid annular plane systolic excursion(TAPSE)and right ventricular index of myocardial performance(RIMP,also known as Tei index)are two effective indicators of right ventricular function to reflect pulmonary artery pressure and evaluate right ventricular function.Platelets participate in the development of pulmonary vessels and are related to the occurrence of BPD.At present,there is no study on the combination of right ventricular function index and platelet parameters to predict BPD at home and abroad.Objective: To dynamically observe and compare the changes of right ventricular function index TAPSE and Tei index between BPD group and non-BPD group after birth,compare the differences of clinical indexes and platelet parameters between the two groups,analyze the independent risk factors of BPD,and explore the early predictive value of right ventricular function index combined with platelet parameters for BPD.Methods: A retrospective study was conducted on 220 premature infants with gestational age(GA)<32 weeks admitted to the neonatal intensive care unit(NICU)of our Hospital from January 2019 to April 2022.According to whether BPD occurs,it is divided into BPD group(n=85)and non-BPD group(n=135).Compare the difference of clinical data between BPD group and non-BPD group.The detection rates of TVRJ,ventricular septal flattening,pulmonary artery widening,right ventricular dilation,right atrial enlargement and other conventional ultrasound indicators reflecting PH in the two groups on 7 day of life(DOL7)were statistically analyzed.Compare the difference of TAPSE and Tei index between the two groups on 1 day of life(DOL1),DOL 7,and on day 14 of life(DOL14).The dynamic changes of right ventricular function indexes were compared between the two groups.Compare the differences of platelet parameters in DOL 1 between the two groups,including platelet count(PLT),mean platelet volume(MPV),plateletcrit(PCT),and platelet distribution width(PDW).Logistic regression was used to analyze the independent risk factors of BPD using the single factor analysis.The receiver operating characteristic(ROC)curve was used to compare the predictive value of right ventricular function index alone and combined platelet parameters on BPD.Results:(1)GA and birth weight(BW)in BPD group were significantly lower than those in non-BPD group(P<0.05);The proportion of using pulmonary surfactant(PS)and invasive mechanical ventilation time≥7 days in BPD group was significantly higher than that in non-BPD group(P<0.05).(2)There was no statistically significant difference between the two groups in the rate of TVRJ measured on DOL 7,the incidence of ventricular septal flattening,pulmonary artery widening,right ventricular dilation,and right atrial enlargement(P>0.05).(3)With the increase of age after birth,TAPSE gradually increased and Tei index gradually decreased in both groups,but from DOL 7 to DOL 14,the increase trend of TAPSE in BPD group was slower than that in non-BPD group,and the decrease trend of Tei index in BPD group was slower than that in non-BPD group.The TAPSE measured on DOL 14 in BPD group was significantly lower than that in non-BPD group,and the Tei index was significantly higher than that in non-BPD group(P<0.05).(3)The PLT on DOL 1 of BPD group was lower than that of non-BPD group,and the MPV was higher than that of non-BPD group,the difference was statistically significant(P<0.05).(4)Logistic regression analysis showed that GA(OR=1.97,95% CI: 1.0573.682),invasive mechanical ventilation time 7 days(OR=0.35,95% CI: 0.171 0.715),PLT of DOL 1(OR=1.46,95% CI: 1.077 1.979),MPV of DOL 1(OR=1.02,95% CI: 1.007 1.034),TAPSE of DOL 14(OR=1.59,95% CI: 1.03 2.300)The Tei index of DOL 14(OR=1.67,95% CI: 1.242 2.243)is an independent risk factor for BPD(P<0.05).(5)ROC curve analysis of the predictive value of right ventricular function index combined with platelet parameters on BPD found that the combination of the two can enhance the predictive ability of BPD(AUC: 0.846,95CI: 0.794～0.899).Conclusion:TAPSE and Tei index can evaluate the changes of pulmonary hemodynamics and right heart function of premature infants after birth,which is helpful for early recognition of PH and detection of premature infants at risk of BPD.In clinical work,combining PLT and MPV can further improve the prediction ability of BPD.