窒息新生儿抗凝血酶Ⅲ血管性假血友病因子及D-二聚体测定及其临床意义

A study on antithrombin III,VWF and D-dimer in plasma of asphyxial newborns

目的探讨窒息新生儿血浆中抗凝血酶Ⅲ（AT-Ⅲ）、血管性假血友病因子（VWF）、D-二聚体（D-D）的变化及其意义。方法深圳市人民医院于2002-2004年，采用酶联荧光分析法和发色底物法分别测定39例不同程度窒息新生儿和16名正常新生儿VWF、D-D的水平及AT-Ⅲ的活性，同时检测血小板计数（BPC）、凝血酶原时间（PT）、纤维蛋白原（Fbg）的变化。结果重度窒息组的AT-Ⅲ明显降低；窒息新生儿血浆的VWF、D-D平均值均有不同程度增高，重度窒息组升高更为显著，与正常对照组比较，其差异具有显著性意义（P〈0．05，P〈0．01）。窒息后并发器官功能损害新生儿较无并发症组血浆的VWF、D-D均有不同程度的升高，以颅内出血患儿升高最为明显（P〈0．05，P〈0．01）。结论窒息新生儿表现以高凝状态为主的早期DIC、VWF及D-D的升高与窒息的程度有关，VWF及D-D明显升高者常合并组织器官损害。测定窒息新生儿血浆中AT-Ⅲ、VWF、D-D等指标对窒息后新生儿临床选用抗凝药物治疗及疗效观察、预后判断。均有一定的指导意义。

Objective To observe the changes of antithrombin Ⅲ, VWF and D-dimer in asphyxial newborns and study their clinical significane. Methods From 2002 to 2004 ELISA was used to detect AT-Ⅲ,VWF and D-dimer in 39 cases of asphyxic newborns and 16 normal newborns in Shenzhen People＇s Hospital. Results Anti-thrombin Ⅲ in the newborns with severe asphyxia decreased significantly. VWF and D-dimer in the asphyxic newborns were higher than those in the normal controls,especially for the severe asphyxia （ P 〈0. 05, P 〈0. 01 ）. VWF and D-dimer in the asphyxial newborns complicated with intracranial hemorrhage were higher than those with other complications or without complications （ P 〈 0. 05 ; P 〈 0. 01 ） . Condusion Measurement of enti-thrombin Ⅲ, VWF and D-dimer axe useful in evaluating the severity, therapy and prognosis for asphyxic newborns.