摘要
目的 探讨危重新生儿凝血、纤维蛋白溶解（纤溶）活性变化及临床意义。方法 对19例极危重、22例危重、21例非危重疾病和10例正常新生儿作前瞻性研究，检测血浆D-二聚体（D-D）、血浆凝血酶原时间（PT）、凝血酶原时间国际正常化比率（PT-INR）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（Fib），计数外周血血小板（PLT），比较各组间凝血、纤溶活性变化，及其与疾病严重程度的关系。结果 血浆D-D、PT水平极危重、危重疾病组明显高于正常新生儿，极危重高于非危重疾病组，差异均有显著性（P〈0．05）；APTT极危重疾病组高于正常新生儿，差异有显著性（P〈0．05）。正常新生儿D-D超过参考值范围占70％。疾病严重程度与D．D水平呈高度正相关（r=0．828，P〈0．01），与PT、APTT水平呈中度正相关（r=0．375、0．440，P均〈0．01）。结论 新生儿D-D水平可能处于较高水平，并不一定代表异常。但危重、极危重病患儿D-D水平明显升高，存在凝血系统被激活和继发纤溶亢进，凝血、纤溶活性与疾病严重程度相关。
Objective To investigate the changes of coagulation state and fibrinolytic activity in critical full-term neonates and study their relationship with disease severity. Methods This prospective study was performed from June 2003 to August 2006. The study population consisted of 19 extremely serious, 22 serious, 21 non-serious neonates and 10 normal full-term neonates. The levels of activated partial thromboplastin time （APTT）, prothrombin time （PT）, PT international normalized ratio （ PT- INR）, thromhin time （TT）, fibrinogen（Fib） and D-dimer（DD） in plasma were measured with commercial kits, and platelet in peripheral blood was counted using automatic complete blood cell counter. The relationship between coagulation-fibrinolysis activities and disease severity was analyzed. Results Plasma DD and PT levels in extremely serious newborns and serious ones were significantly higher than those in normal controls（ P 〈 0.05 ） ; extremely serious newborns also showed markedly higher DD and PT levels as compared with non-serious ones （P 〈 0.05 ）. In addition, APTT in extremely serious neonates was significantly higher than that in normal controls（P 〈 0.05 ）. The level of DD in 70 % normal newborns was above reference value. DD value had highly positive correlation with disease severity（ r = 0. 828, P 〈 0.01 ）, while PT and APTT showed significant positive correlation （r = 0. 375 and 0. 440, P 〈 0.01）. Conclusion DD may be at high level in normal newborn, but it may not always indicate abnormalities. The rise of DD level in extremely serious and serious newborns suggests the activa- tion of the coagulation state and fibrinolytic activity. The activity of coagulation and fibrinolysis is correlated to the disease severity.
出处
《中国小儿急救医学》
CAS
2007年第2期115-118,共4页
Chinese Pediatric Emergency Medicine
基金
中山市卫生局立项课题（A2003030）
关键词
婴儿
新生
危重症
D-二聚体
凝血
纤维蛋白溶解
Infant, newborn
Critical illness
D-dimer
Blood coagulation
Fibrinolysis
