新生儿脑损害时血小板参数的变化及其临床意义

Change of platelet parameters and its clinical significance in neonates with cerebral damage

目的:探讨新生儿脑损害时血小板参数的变化及其临床意义。方法:新生儿缺氧缺血性脑病(HIE)及颅内出血(ICH)患儿66例,分别测定急性期(<3d)及恢复期(7d)血小板数(PLT)、平均血小板体积(MPV)及血小板分布宽度(PDW),同时测定未合并脑损害的30例新生儿窒息患儿(无脑损害组)及40例健康新生儿(对照组)出生3d内的PLT、PDW、MPV并进行比较。比较脑损害患儿中有及无ICH者的PLT、PDW、MPV。HIE患儿根据病情轻重分为3组并比较PLT、PDW、MPV。结果:(1)脑损害组急性期PLT明显低于无脑损害组及对照组,而PDW、MPV明显高于无脑损害组及对照组,差异均具有显著性(P<0.01),恢复期3组间PLT、PDW、MPV值差异无显著性(P>0.05)。(2)脑损害患儿中ICH组急性期PLT明显低于无ICH组,而PDW、MPV明显高于无ICH组,差异均具显著性(P<0.01,P<0.05)。(3)HIE患儿随病情加重PLT逐渐降低,而MPV、PDW逐渐增大(P<0.01,P<0.05)。结论:血小板参数的动态观察可作为判断新生儿是否合并脑损害及其严重程度的指标,以及早期颅内出血倾向的一项指标。

Objective To explore the change of platelet parameters and its clinical significance in neonates with cerebral damage, Methods 66 neonates with hypoxic-ischemic encephalopathy （HIE） or intracranial hemorrhage （ICH） were included in the study. Their platelet total （PLT）, mean platelet volume （MPV） and platelet distribution width （PDW） were detected in the acute stage （under three days after birth） and recovery stage （seven days after birth）. The data were compared with those from 30 cases of neonatal asphyxia without cerebral damage and 40 healthy neonates born in 3 days. The data from the neonates with ICH （ n = 24） were also compared with those from the neonates with HIE （ n = 42）. 42 cases of HIE were then divided into three groups based on their clinical severity and the data from these three groups were similarly compared. Results （1）PLT in the neonates with cerebral damage during the acute stage was obviously lower than those in the neonatal asphyxia without cerebral damage and the healthy neonates （ P 〈 0. 01 ） whereas MPV and PDW were obviously higher （ P 〈 0. 01 ）, There was no significantly difference of PLT, MPV and PDW among the neonates with cerebral damage during the recovery stage, the neonatal asphyxia without cerebral damage and the healthy neonate （P 〉 0. 05）. （2）PLT in the neonates with ICH during the acute stage was markedly lower than that in the neonates with HIE （ P 〈 0. 01 ） but MPV and PDW were obviously higher （ P 〈 0.01）. （3）PLT decreased with the severity of HIE （ P 〈 0. 01 and P 〈 0. 05） while MPV and PDW increased with the severity of HIE （ P 〈 0.01 and P 〈 0.05）. Conclusion Dynamic observation of the platelet parameters can be of value to diagnose neonates with cerebral damage and to determine the severity of the damage and the platelet parameters may be used to predict the early intracranial hemorrhage.