早产儿纤溶活性的改变及临床意义

Change and clinical significance of fibrinolytic activity in premature infant

目的探讨无并发症早产儿纤溶活性状态及临床意义,分析新生儿出血的原因及风险因素。方法选择健康足月儿35例(胎龄≥37周)和无并发症早产儿35例(胎龄<37周),其中正常体质量儿39例(体质量≥2500g),低出生体质量儿31例(体质量<2500g)。分别检测纤溶酶原活性(Plg)、组织型纤溶酶原激活物活性(t-PA)、纤溶酶原激活物抑制物活性(PAI)、D-二聚体含量(D-dimer),计算PAI/t-PA比值。结果无并发症早产儿Plg活性、PAI/t-PA比值、D-dimer含量均表现出较宽的取值范围。与健康足月儿相比,无并发症早产儿Plg活性和D-dimer含量显著降低(P<0.01),PAI/t-PA比值显著增高(P<0.05)。与正常体质量儿相比,低出生体质量儿Plg活性和D-dimer含量显著降低(P<0.01)。胎龄、体质量和Plg活性、D-dimer含量均呈显著正相关(P<0.01或0.05)。结论早产儿纤溶活性有较大个体差异;无并发症早产儿、低出生体质量儿纤溶活性显著降低,降低纤溶活性对降低新生儿尤其是早产儿出血有重要作用。

Objective It is to discuss the state and clinical significance of fibrinolytic activity in premature infant without complication and analyze the reason and risk factor of neonate bleeding. Methods 35 cases of healthy term infant (conceptus age ≥ 37 weeks) and 35 cases of premature infant without complication (conceptus age < 37 weeks) were chosen. In the 70 cases, there were 39 cases of normal body mass infant (body mass ≥ 2 500 g) and 31 cases of low birth mass infant (body mass < 2 500 g). Plasminogen activity (Plg), tissue type plasminogen activator activity (t-PA), plasminogen activator inhibitor activity (PAI)and D-dimer content were measured respectively and PAI/t-PA was counted. Results Plg activity, PAI/t-PA and D-dimer content in premature infant without complication were all showed wider taking value area. Compared with healthy term infant, Plg activity and D-dimer content were significantly lowered (P<0.01) and PAI/t-PA was significantly risen (P<0.05) in premature infant without complication. Compared with normal body mass infant, Plg activity and D-dimer content were significantly lowered (P<0.01) in low birth mass infant. Conceptus age and body mass were significantly positive correlation with Plg activity and D-dimer content (P<0.01 or 0.05). Conclusion The fibrinolysis activity has larger personal difference in premature infant. The fibrinolytic activity is significantly lowered in premature infant without complication and low birth mass infant. Lowering fibrinolytic activity has important action on neonate bleeding especially to premature infant.