婴儿维生素K缺乏性出血症临床特征分析

Clinical Analysis of 106 Cases of Infant Vitamin K Deficiency Bleeding

目的 探讨反映机体维生素K营养状况的敏感指标，分析维生素K1治疗婴儿维生素K缺乏性出血症（VKDB）的合理剂量。方法 2009年9月至2013年9月，采用前瞻性队列式研究方法，对入院的106例VKDB患儿采静脉血，用酶联免疫吸附试验检测凝血酶原前体蛋白（PIVKA‐Ⅱ），sysmex CA‐1500血凝仪测凝血酶原时间（PT）、部分活化凝血活酶时间（APTT）、凝血酶时间（TT）及纤维蛋白原（FIB），再将患儿分为维生素K12mg和5mg治疗组，在静脉滴注维生素K1后24h，3d、5d三个时间点复查上述凝血指标，比较治疗前及治疗5 d后以上指标的变化及2 mg组与5 mg组PIVKA‐Ⅱ的变化。结果 本研究患儿治疗前后PT、APTT、PIVKA‐Ⅱ异常率（％）比较分别为（72．6∶13．2）、（70．8：32．1）、（98．1：8．5），差异有统计学意义（ P＜0．05）；T T及FIB治疗前后异常率比较，差异无统计学意义（ P＞0．05）。2 mg组和5 mg组静滴维生素K124 h后PIVKA‐Ⅱ水平差异有统计学意义（ P＜0．05）；3 d及5 d PIVKA‐Ⅱ水平差异无统计学意义（ P＞0．05）。结论 VKDB患儿在补充维生素K后，PIVKA‐Ⅱ、PT、APT T异常率及水平有明显改善，PIVKA‐Ⅱ是诊断VKDB及疗效监测最敏感指标；静脉点滴维生素K1每次2 mg ，每日1次，连续5 d ，可有效治疗VKDB。

Objective]To explore the sensitive index indicating organism nutrition of vitamin K ,and to an‐alyze the reasonable dosage of vitamin K for the treatment of infant vitamin K deficiency bleeding （VKDB） .[Methods]Prospective cohort study method was used from Sept .2009 to Sept .2013 .Venous blood of 106 in‐patients with VKDB was collected .Enzyme‐linked immunosorbent assay was used to determine prothrombin precursor protein （PIVKA‐Ⅱ ） . Prothrombin time （PT ） , activated partial thromboplastin time （APTT ） , thrombin time（TT） and fibrinogen（FIB） were examined by using sysmex CA‐1500 coagulation analyzer .Then all pediatric patients were divided into 2mg vitamin K1 treatment group and 5mg vitamin K1 treatment group . The above indicators at 24h ,3d and 5d after intravenous drip of vitamin K1 were examined again .The changes of the above indicators before and 5d after treatment were compared .The change of PIVKA‐Ⅱ between 2mg group and 5mg group was also compared .[Results] There were significant differences in the abnormal rates of PT ,APTT and PIVKA‐ Ⅱ between before and after treatment（72 .6 vs .13 .2 ,70 .8 vs .32 .1 ,98 .1 vs .8 .5 , P 〈0 .05） .There was no significant difference in the abnormal rates of TT and FIB between before and after treatment（ P 〉0 .05） .There was significant difference in PIVKA‐ Ⅱ level between 2mg group and 5mg group 24h after intravenous drip of vitamin K1 （ P 〈0 .05） ,while there was no significant difference 3d and 5d after treatment（ P 〉0 .05） .[Conclusion]After the supplementation of vitamin K for pediatric patients with VKDB , the levels and abnormal rates of PIVKA‐ Ⅱ ,PT and APTT are improved obviously .PIVK‐ Ⅱ is the most sensitive index of the diagnosis and the curative effect monitoring of VKDB .Intravenous drip of vitamin K1 2mg daily for continuous 5 days is effective in the treatment of VKDB .