新生儿溶血病患儿血浆t-PA和PAI-1变化的研究

Changes of plasma t-PA and PAI-1 of newborns with hemolytic disease

目的探讨新生儿ABO血型不合溶血病患儿血浆纤溶酶原激活物（t-PA）、纤溶酶原激活物抑制物（PAI-1）以及t-PA／PAI-1水平的变化。方法选择我院儿科病房收治的新生儿溶血病（HDN）患儿28例、非溶血性非感染性高胆红素血症患儿26例、健康新生儿30例，分别检测3组的血浆t-PA、PAI-1、总胆红素以及血小板数量（PLT）。结果HDN组患儿t-PA、PAI-1以及t-PA／PAI-1水平显著高于非溶血性非感染性高胆红素血症组和健康对照组儿童，其中t-PA升高更明显，有统计学意义（t值分别为5．48、4．98、5．59、5．43，均P〈0．05）。重度溶血病组儿童t-PA、PAI-1以及t-PA／PAI-1水平显著高于轻度溶血病组（t=3．93、4．01、3．77，P〈0．05）；而非溶血性非感染性高胆红素血症组和健康对照组相比，无统计学意义（t值分别为0．83、0．2l、0．17，均P〉0．05）。重度溶血病组患儿PLT水平显著低于轻度溶血病组（t=4．56，P〈0．05）。结论HDN患儿体内纤溶与抗纤溶平衡失调，溶血程度越重失调越明显；HDN患儿存在血管内皮损伤的发病机制；HDN患儿凝血功能方面，检测t-PA、PAI-1水平变化较PLT敏感性更高。

Objective To explore the changes of plasma tissue plasminogen activator （t-PA）, plasminogen antivator inhibition 1 （PAI-1） and t-PA/PAl-1 levels of newborns with ABO hemolytic disease. Methods Twenty-eight newborns with hemolytic disease, 26 newborns with non-hemolytic non-infectious hyperbilirubinemia （NHNIH） and 30 healthy newborns admitted in pediatrics department of Zhenjiang First People＇ s Hospital of Jiangsu Province were recruited in the study. The levels of t-PA, PAI-1, total bilirubin （STB） and platelet count （PLT） of them were tested. Results T-PA, PAI-1 and t-PA/PAI-1 levels of hemolytic disease of the newborn （HDN） group were obviously higher than those of NHNIH group and healthy group, and t-PA level rose more significantly （ t value was 5.48, 4.98, 5.59 and 5.43, respectively, all P 〈 0.05 ）. The levels of t-PA, PAI-1 and t-PA/PAI-1 of severe HDN group were significantly higher than those of mild HDN group （t value was 3.93, 4.01 and 3.77, respectively, all P 〈 0.05 ）. There was no significant difference in them between NHNIH group and healthy group （t value was 0.83, 0.21 and 0.17, respectively, all P 〉 0.05 ）. PLT level of severe HDN group was obviously lower than that of mild HDN group （ t = 4. 56, P 〈 0.05 ）. Conclusion Fibrinolysis and antifibrinolysis of newborns with hemolytic disease are imbalance, and the heavier hemolysis degree, the more obvious the phenomenon. The pathogenesis of vascular endothelial injury exists in newborns with HDN. Detection of t-PA and PAI-1 level changes is more sensitive than PLT in view of the blood coagulation function of newborns with HDN.