晚发型维生素K缺乏性颅内出血发病的高危因素

Risk Factors for Intracranial Hemorrhage Caused by Late Vitamin K Deficiency

目的探讨晚发型维生素K缺乏致颅内出血的危险因素,以预防并降低其发病率。方法选择2002年1月-2007年12月北京儿童医院PICU及神经内科收治的晚发型维生素K缺乏性出血(VKDB)致颅内出血90例(Ⅰ组),同期住院的晚发型VKDB无颅内出血23例(Ⅱ组)。入院12h内,查头颅CT,检测血钙水平、肝功能、血钠、血糖、凝血酶原时间、部分凝血活酶时间、纤维蛋白原、血小板。应用非条件Logistic回归分析,对性别、年龄、出生情况、喂养方式、近期腹泻、巨细胞病毒(CMV)感染、低钙血症、血糖异常、低钠血症、肝功能异常10项可能的相关危险因素进行分析。结果经非条件Logistic回归分析,Ⅰ组与Ⅱ组比较,低钙血症、近期腹泻、肝功能异常有显著性差异(Pa<0.01),OR值分别为6.662、8.092、12.895;晚发型VKDB伴低钙血症、肝功能异常、近期腹泻的的患儿颅内出血的风险高,分别是血钙正常、肝功能正常、无腹泻的晚发型VKDB患儿的6.662、8.092、12.895倍。结论低钙血症、肝功能异常、近期腹泻是晚发型VKDB致颅内出血的高危因素;防止低钙血症有利于预防晚发型VKDB致颅内出血。

Objective To explore the risk factors for intraeranial hemorrhage caused by late vitamin K deficiency bleeding （VKDB） ,in order to prevent and reduce the incidence of intracranial hemorrhage caused by late VKDB. Methods A retrospective analysis of the risk factors of late VKDB and intracranial hemorrhage was applied to 2 groups of patients in PICU and department of neurology of Beijing children＇s Hospital from Jan. 2002 to Dec. 2007. In group Ⅰ , there were 90 patients suffering from intracranial hemorrhage caused by late VKDB ; while in group Ⅱ , there were 23 patients of late VKDB without intracranial hemorrhage. Within 12 hours of hospitalization, the following 9 items were checked ： the cranial CT, blood calcium concentration, liver function, serum sodium, blood glucose, prothrombin time, partial thromboplastin time, fibrinogen concentration, and platelet. Ten possible relevant risk factors of gender, age, birth situation, feeding patterns, recent diarrhea, cytomegalovirus （ CMV ） infection, hypocalcemia, dysglycemia, hyponatremia, and abnormal liver function were analyzed by the method of non - conditional Logistic regression analysis. Results Statistically significant difference had been found in the 3 factors of hypocalcaemia, recent diarrhea,abnormal liver function （Pa〈 0. 01 ） between the group Ⅰ and group Ⅱ ; meanwhile, OR values were 6. 662,8. 092, and 12. 895, respectively. The risk of intracranial hemorrhage for children with late VKDB accompanied by hypocalcemia, abnormal liver function,and recent diarrhea were respectively 6. 662,8. 092, and 12. 895 times higher than those of the late VKDB children with normal blood calcium, normal liver function, and no recent diarrhea. Conclusions Hypocalcemia, abnormal liver function, and recent diarrhea are the 3 high risk factors of intracranial hemorrhage caused by late VKDB, and the prevention of hypocalcemia can help prevent intracranial hemorrhage caused by late VKDB.