不同胎龄新生儿凝血功能的临床研究

A clinical study on the changes of blood coagulation in newborns of different gestational age

目的探讨不同胎龄新生儿凝血功能指标差异。方法共纳入足月新生儿(37～42周)293例,晚期早产儿(34～36+6周)118例,早期早产儿(26～33+6周)115例,入院时的一般情况(时龄、性别、胎产次、分娩方式、孕母妊娠并发症、生后Apgar评分、羊水污染、胎膜早破)组间比较差异无统计学意义(P>0.05),纳入条件相同,生后6h内检测血浆凝血功能指标活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、纤维蛋白降解产物(FDP)及D-二聚体。结果早期早产儿APTT、PT、FDP及D-二聚体均高于晚期早产儿和足月新生儿(P<0.01),FIB低于晚期早产儿和足月新生儿(P<0.01),晚期早产儿除D-二聚体较足月儿升高外(P<0.01),其余指标与足月儿比较差异无统计学意义(P>0.05)。结论凝血初筛指标和D-二聚体有胎龄差异,在早期早产儿期这种差异更为明显。D-二聚体是凝血功能紊乱的早期灵敏指标,对于新生儿尤其是早产儿出现D-二聚体升高或PT、APTT延长,应引起重视并及时干预。

Objective To compare the components of coagulation and fibrinolytic system in newborns of different gestational age.Methods 293 full-term neonates（37~42 weeks）,118 late preterm neonates（34~36＋6weeks）,and 115 early preterm neonates（26~33＋6weeks） were recruited in this study.The activated partial thromboplastin time（APTT）,prothrombin time（PT）,the level of fibrinogen（FIB）,fibrin degradation product（FDP）,and D-Dimer in neonates were detected within 6 h after birth.There was no statistically difference in postnatal age,gender,number of previous pregnancies and deliveries,mode of delivery,motherhood pregnancy complications,Apgar score,amniotic fluid contamination and premature rupture of membrane among the groups.Results Compared with late preterm neonates and full-term neonates respectively APTT,PT,FDP and D-Dimer were higher and FIB was lower in early preterm neonates（P＆lt;0.01）.However,no significant differences in coagulation system components were observed between late preterm neonates and full-term neonates,except that D-Dimer was higher in late preterm neonates（P＆lt;0.01）.Conclusion Coagulation parameters and D-Dimer are sensitive to gestational age-related changes in haemostatic proteins,especially in the cases of early preterm neonates.The D-Dimer is a candidate maker for neonates with coagulation disorders,appropriate intervention should be taken in time for infants especially preterm infants when the level of D-Dimer increases or PT and APTT prolonged.