不同胎龄早产儿凝血功能与颅内出血发生风险的关系

Correlation between coagulation function of preterm infants in different gestational ages and the risk of intracranial hemorrhage

目的分析不同胎龄早产儿出生24小时内凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(DD)水平与颅内出血发生风险的相关性。方法选取2018年1月至2023年1月保定市第二中心医院收治的早产儿132例。根据出生时胎龄分为早期组、晚期组,根据早产儿是否出现颅内出血分为出血组和未出血组。收集早产儿一般资料及24小时内PT、APTT、DD、FIB水平,比较不同胎龄、有/无颅内出血早产儿24小时内PT、APTT、DD、FIB水平,分析影响颅内出血发生危险因素以及PT、APTT、DD、FIB与胎龄的相关性。采用受试者工作特征曲线(ROC)分析各指标预测颅内出血的价值,计算曲线下面积(AUC)。结果早期组早产儿出生体重小于晚期组(t=5.254,P<0.05)。Pearson相关性分析显示,PT、APTT、DD与胎龄为负相关,FIB与胎龄为正相关(r=-0.674、-0.588、-0.509、0.634,P<0.001)。出血组的胎龄、出生体重、FIB低于非出血组,PT、APTT、DD水平均高于非出血组(t=145.99、6.970、2.738、6.003、5.418、13.186,P<0.05)。Logistic回归分析结果显示,胎龄(OR=1.406,95%CI:1.135~1.741)、出生体重(OR=1.436,95%CI:1.051~1.961)、FIB(OR=1.593,95%CI:1.220~2.080)、PT(OR=1.430,95%CI:1.115~1.834)、APTT(OR=1.319,95%CI:1.071~1.623)、DD(OR=1.658,95%CI:1.075~2.557)为影响早产儿发生颅内出血的危险因素(P<0.05)。PT、APTT、DD、FIB预测早产儿颅内出血的AUC分别为0.750、0.774、0.798、0.884。结论不同胎龄早产儿生后24小时内PT、APTT、DD、FIB水平不同,胎龄、出生体重、PT、APTT、DD及FIB可为临床评估早产儿颅内出血的发生风险提供参考。

Objective To analyze the correlation between prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-Dimer(DD)levels and the risk of intracranial hemorrhage of preterm infants in different gestational ages within 24 hours.Methods A total of 132 premature infants admitted to Baoding Second Central Hospital from January 2018 to January 2023 were selected.They were divided into early preterm and late preterm groups based on gestational age at birth,and into hemorrhage and non-hemorrhage groups based on whether they experienced intracranial hemorrhage.General information and PT,APTT,DD,and FIB levels within 24 hours of birth were collected.The levels of PT,APTT,DD,and FIB within 24 hours were compared between preterm infants of different gestational ages and between those with and without intracranial hemorrhage.The risk factors for intracranial hemorrhage and the correlation between PT,APTT,DD,and FIB and gestational age were analyzed.The receiver operating characteristic(ROC)curve was used to assess the predictive value of each indicator for intracranial hemorrhage,and the area under the curve(AUC)was calculated.Results The birth weight of preterm infants in the early preterm group was lower than that in the late preterm group(t=5.254,P<0.05).Pearson correlation analysis showed that PT,APTT,and DD were negatively correlated with gestational age,while FIB was positively correlated(r=-0.674,-0.588,-0.509 and 0.634,respectively,P<0.001).The gestational age,birth weight,and FIB in the hemorrhage group were lower than those in the non-hemorrhage group,while the levels of PT,APTT,and DD were higher than those in the non-hemorrhage group(t=145.99,6.970,2.738,6.003,5.418 and 13.186,respectively,P<0.05).Logistic regression analysis showed that gestational age(OR=1.406,95%CI:1.135-1.741),birth weight(OR=1.436,95%CI:1.051-1.961),FIB(OR=1.593,95%CI:1.220-2.080),PT(OR=1.430,95%CI:1.115-1.834),APTT(OR=1.319,95%CI:1.071-1.623),DD(OR=1.658,95%CI:1.075-2.557)were risk factors for intracranial hemorrhage in preterm infants(P<0.05).The AUCs of PT,APTT,DD,and FIB for predicting intracranial hemorrhage in preterm infants were 0.750,0.774,0.798,and 0.884,respectively.Conclusion PT,APTT,DD,and FIB levels within 24 hours of birth differ among preterm infants of different gestational ages.Gestational age,birth weight,PT,APTT,DD,and FIB can serve as clinical indicators for assessing the risk of ICH in preterm infants.