新生儿凝血功能及出血性疾病的危险因素分析

Analysis of neonatal blood coagulation function and risk factors of bleeding diseases

目的研究新生儿凝血系统的发育情况,探讨新生儿出血性疾病可能的危险因素。方法收集该院2019年1月至2020年6月分娩的新生儿相关临床基本资料和出生2 h及1、2、3、4、5、7、14 d时的凝血功能指标[凝血酶原时间(PT)、凝血酶原时间-国际标准化比值(PT-INR)、活化部分凝血活酶时间(APTT)、APTT测定值比率(APTT-ratio)、凝血酶时间(TT)、纤维蛋白原(FIB)]检测结果,将符合研究条件的新生儿分为健康新生儿(A组)611例和出血性疾病新生儿(B组)124例,比较2组凝血功能指标的差异,分析新生儿出血性疾病的危险因素。结果A组出生后2周内PT-INR、APTT-ratio、TT逐渐下降,而FIB水平逐渐上升,大约在1周左右PT-INR、APTT-ratio、TT、FIB均达到一个较为稳定的水平。B组PT、APTT较A组延长,APTT-ratio低于A组,差异均有统计学意义(P<0.05)。早产儿(孕周<37周)、母亲患有子痫前期/HELLP综合征及低体质量儿(<2500 g)为新生儿出血性疾病的危险因素[OR=3.35(95%CI:1.62~5.79)、1.56(95%CI:1.14~3.23)、1.89(95%CI:1.28~6.33),P<0.05]。结论认识到新生儿凝血系统的发展特征及新生儿出血性疾病的危险因素(早产、母亲患有子痫前期/HELLP综合征、低体质量儿)有助于对新生儿出血性疾病进行迅速诊断和适当处理。

Objective To study the development of neonatal blood coagulation system and investigate possible risk factors for neonatal hemorrhagic diseases.Methods From January 2019 to June 2020 in the hospital,the basic clinical data of newborns delivered and the test results of blood coagulation function indexes[prothrombin time(PT),prothrombin time-international normalized ratio(PT-INR),activated partial thromboplastin time(APTT),APTT measured value ratio(APTT-ratio),thrombin time(TT),fibrinogen(FIB)]at 2 h and 1,2,3,4,5,7,and 14 days of birth were collected.The newborns who met the research conditions were divided into 611 healthy newborns(group A)and 124 newborns with hemorrhagic disease(group B).The differences in blood coagulation function indexes of the two groups were compared,and the risk factors of neonatal hemorrhagic disease were analyzed.Results In group A,PT-INR,APTT-ratio,and TT gradually decreased within 2 weeks after birth,while FIB level gradually increased.PT-INR,APTT-ratio,TT and FIB all reached a relatively stable level about 1 week after birth.The PT and APTT of group B were longer than those of group A,and the APTT-ratio was lower than that of group A,the differences were statistically significant(P<0.05).Premature infants(<37 weeks of gestation),mothers with preeclampsia/HELLP syndrome and low body mass infants(<2500 g)were risk factors for neonatal hemorrhagic diseases[OR=3.35(95%CI:1.62-5.79),1.56(95%CI:1.14-3.23),1.89(95%CI:1.28-6.33),P<0.05].Conclusion Recognizing the development characteristics of the neonatal coagulation system and the risk factors of neonatal hemorrhagic diseases(premature birth,mothers with preeclampsia/HELLP syndrome,low body mass infants)are helpful for rapid diagnosis and appropriate stratagems of neonatal hemorrhagic diseases.