胎龄和体重及缺氧对新生儿纤溶活性的影响

Relationship between fibrinolytic activity and gestational age, birth weight, anoxia in neonate

目的 探讨正常新生儿的纤溶活性状态及胎龄、体重、缺氧对纤溶活性的影响 ,并分析新生儿出血的可能原因及风险因素。方法 对不同胎龄、不同出生体重正常新生儿以及出生窒息足月儿的纤溶酶原活性 (P1g)、组织型纤溶酶原激活物活性 (t PA)、纤溶酶原激活物抑制物活性 (PAI)及D 二聚体含量 (D dimer)进行检测。结果 正常足月新生儿P1g为 (2 84± 0 0 6)IU/ml,t PA为 (0 2 4±0 11)IU/ml,PAI为 (0 64± 0 3 7)AU/ml,PAI/t PA比值为 2 6± 2 0 ,D dimer为 (3 7± 4 7)mg/L ,表现出较宽的取值范围。无合并症早产儿P1g活性为 (2 16± 0 5 2 )IU/ml,D dimer含量为 (1 0± 0 7)mg/L ,PAI/t PA比值为 3 9± 2 6;与正常足月儿相比 ,P1g活性和D dimer含量显著降低 (P <0 0 1) ,PAI/t PA比值显著增高 (P <0 0 5 ) ;窒息足月儿与无合并症早产儿相似 ,P1g活性、D dimer含量为 (1 2 0±0 85 )mg/L ;与足月儿相比 ,P1g活性和D dimer含量亦显著降低 ,而PAI/t PA比值显著增高 ,出生后窒息时间与D dimer含量呈显著正相关 (r=0 5 96,P <0 0 1) ;P1g活性、胎龄、出生体重与D dimer含量均呈显著正相关。结论 正常足月儿纤溶活性有较大个体差异 ;纤溶活性的改变和胎龄、出生体重、缺氧密切相关。

Objective To investigate the status of fibrinolytic system in healthy newborns and the relationship between the fibrinolytic activity and gestational age, birth weight, anoxia, and to analyze the possible reason and risk of bleeding tendency in neonates. Methods Plasminogen activity (P1g), tissue type plasminogen activator activity (t-PA), plasminogen activitor inhibitor activity (PAI), D-dimer were measured in healthy neonates of different gestational ages and birth weight and in stressed term newborns. Results P1g,t-PA,PAI,PAI/t-PA and D-dimer were observed in healthy term neonates [(2.84±0.06)IU/ml,(0.24±0.11)IU/ml,(0.64±0.37)AU/ml,(2.6±2.0)and(3.7±4.7)mg/L, respectively], and showed an extremely large range of values. Compared with healthy term newborns, P1g(2.16±0.52)IU/ml and D-dimer (1.0±0.7)mg/L significantly decreased and, PAI/t-PA(3.9±2.6)enhanced in healthy premature neonates. In stressed term neonates, P1g and D-dimer significantly decreased and, PAI/t-PA enhanced in preterm neonates. P1g and D-dimer showed a good correlation with the gestational age and birth weight (P<0.01 or 0.05). D-dimer represented a significant correlation with the anoxic time (P<0.01). Conclusion There was great diversity in fibrinolytic activity in healthy neonates. Changes of fibrinolytic activity were significantly related to the gestational age, birth weight and anoxia. Changes of fibrinolytic activity might play an important role in the mechanism of neonatal hoemorrhage, especially for the premature and stressed newborn.