早产儿D-二聚体及凝血功能动态变化的临床意义

Dynamic changes of coagulation function and plasma D-dimer level in premature infant

目的观察不同日龄正常早产儿D-二聚体(DD)、血浆凝血酶原时间(PT)和活化部分凝血时间(APTT)生理水平及其变化的临床意义。方法选取日龄1、5、10d的早产儿各20例及1、5、10d正常足月儿各20例(作对照),检测血浆DD、PT、APTT水平,比较各组间凝血、纤溶活性变化及其日龄变化规律。结果(1)早产儿和足月儿DD在新生儿期较高,尤其是早产儿在生后1周内;DD随日龄增长而降低,早产儿降低较慢。(2)早产儿PT、APTT在第1天与足月儿比较差异有统计学意义(P<0.05),在第5、10天与足月儿比较差异无统计学意义(P>0.05)。(3)早产儿PT、APTT随着日龄增长有下降趋势;足月儿第1天的APTT较长,PT则无明显变化。结论新生儿出生后DD高于正常值,尤其是早产儿DD显著高于正常值,PT及APTT均较高。提示凝血、纤溶活性的增强,对新生儿特别是早产儿临床出现DD高于正常或PT及APTT延长时,应动态观察,诊断DIC要慎重。

Objective To survey the plasma levels of D-dimer（DD）and activated partial thromboplastin time（APTT） ,prothrombin time（PT） and their dynamic changes in different age of premature infants. Methods The plasma levels of DD, APTT and PT were determined respectively in 20 premature infants and 20 full-term infants on 1,5,10d of life. The changes of coagulation state and fibrinolytic activity in premature infants were analyzed. Results Plasma DD levels were significantly higher both in premature and full-term infants in neonatal period, especially premature infants in the first week of life. Plasma DD levels in premature infants decreased slowly by age comparison with full term infants. PT and APTT in premature infant on ld of life was significantly higher than that in full-term infants （P〈0.05）. PT and APTT in premature infant gradually decreased. Conclusion DD may be at high level in normal newborn, but it may not always indicate abnormalities. The rise of DD level in premature infants suggests the activation of the coagulation state and fibrinolytic activity,espeeially premature infants in the first week of life. We can not make diagnosis of DIC with only plasma DD levels.