不同胎龄新生儿凝血功能及血小板计数的临床分析

贾文婷; 汪灵芝; 刘敏敏; 张阵

doi:10.16766/j.cnki.issn.1674-4152.002725

不同胎龄新生儿凝血功能及血小板计数的临床分析

doi: 10.16766/j.cnki.issn.1674-4152.002725

1.
蚌埠医学院第二附属医院儿科，安徽蚌埠 233040
2.
蚌埠医学院第一附属医院儿科，安徽蚌埠 233004

基金项目:

安徽高校自然科学研究重点项目 KJ2021A0800

蚌埠医学院自然科学重点项目 BYKY2019155ZD

详细信息

通讯作者:
张阵, E-mail: 22568714@qq.com

中图分类号: R722 R554.8
计量
- 文章访问数: 313
- HTML全文浏览量: 72
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2022-06-18
- 网络出版日期: 2022-12-30

Clinical analysis of coagulation function and platelet count in neonates of different gestational ages

1.
Department of Pediatrics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233040, China

摘要

摘要: 目的分析不同胎龄新生儿出生后凝血功能及血小板，为新生儿诊治及出血倾向评估提供依据。方法选取蚌埠医学院第二附属医院儿科2019年10月—2022年4月收治的新生儿89例，依据胎龄分组，早期早产儿(胎龄28~31⁺⁶周)11例，中期早产儿(胎龄32~33⁺⁶周)17例，晚期早产儿(胎龄34~36⁺⁶周)26例，足月儿(胎龄37~41⁺⁶周)35例。所有患儿入院6 h内检测血小板(PLT)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)及国际标准化比值(INR)；比较4组患儿临床资料、检测指标、凝血功能异常发生率及出血发生率；比较早产儿及足月儿新生儿弥散性血管内凝血(DIC)发生率。结果早期及中期早产儿血清PT、APTT、TT、D-D和INR均高于晚期早产儿及足月儿；血清FIB低于晚期早产儿及足月儿；早期早产儿PLT低于其他三组(均P＜0.05)；早期、中期、晚期早产儿及足月儿出血发生率分别为72.73%(8/11)、52.94%(9/17)、30.77%(8/26)、25.71%(9/35)，凝血功能异常发生率分别为81.82%(9/11)、70.59%(12/17)、53.85%(14/26)、37.14%(13/35)，早期及中期早产儿出血发生率和凝血功能异常发生率均高于晚期早产儿及足月儿；早产儿DIC发生率为22.22%(12/54)，高于足月儿的2.86%(1/35)。结论胎龄越小，新生儿凝血功能越差，出血发生率、凝血功能异常发生率及DIC发生率越高。
- 早期早产儿 /
- 中期早产儿 /
- 晚期早产儿 /
- 足月儿 /
- 凝血功能 /
- 血小板 /
- 弥散性血管内凝血
Abstract: Objective To explore the coagulation function and platelets of neonates of different gestational ages after birth, and to provide a basis for the diagnosis and treatment of neonates and the evaluation of bleeding tendency. Methods A total of 89 neonates admitted to the Department of Pediatrics of the Second Affiliated Hospital of Bengbu Medical College from October 2019 to April 2022 were selected. Based on the gestational age, there were 11 cases of early preterm infants (28-31⁺⁶ weeks), 17 cases of moderately preterm infants (32-33⁺⁶ weeks) and 26 cases of late preterm infants (34-36⁺⁶ weeks). Meanwhile, there were a total of 35 full-term infants (gestational age 37-41⁺⁶ weeks). The platelet (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer (D-D) and international normalized ratio (INR) were measured within 6 hours after admission. In addition, the clinical data, detection indicators, incidence of abnormal coagulation function and incidence of bleeding were compared among the four groups to compare the incidence of disseminated intravascular coagulation (DIC) in preterm infants and full-term infants. Results Serum PT, APTT, TT, D-D and INR of early and moderately preterm infants were higher than those of late preterm infants and full-term infants, and the serum FIB was lower than that of late preterm and full-term infants. Meanwhile, PLT in early preterm infants was lower than that in the other three groups (all P < 0.05). The incidence of bleeding in early, middle, late preterm and full-term infants were 72.73% (8/11), 52.94% (9/17), 30.77% (8/26) and 25.71% (9/35), respectively. Moreover, the incidences of abnormal coagulation function were 81.82% (9/11), 70.59% (12/17), 53.85% (14/26) and 37.14% (13/35), respectively. Furthermore, the incidences of bleeding and abnormal coagulation function in early and moderately preterm infants were higher than those in late preterm infants and full-term infants. The incidence of DIC in preterm infants was 22.22% (12/54), which was higher than that in full-term infants at 2.86% (1/35). Conclusion The lower the gestational age, the more imperfect the coagulation function, and the higher the incidence of bleeding, coagulation dysfunction and DIC.
- Early preterm infant /
- Moderate preterm infant /
- Late preterm infant /
- Full-term infant /
- Coagulation function /
- Blood platelet /
- Disseminated intravascular coagulation

HTML全文

表 1 4组新生儿一般资料比较

Table 1. Comparison of general data among the four groups

组别	例数	性别(例)		出生方式(例)		胎龄(x±s，周)	出生体重(x±s, g)
组别	例数	男	女	顺产	剖宫产	胎龄(x±s，周)	出生体重(x±s, g)
早期早产儿组	11	6	5	4	7	30.16±1.80	1 046.57±296.57
中期早产儿组	17	10	7	7	10	32.93±0.89	1 356.35±343.67
晚期早产儿组	26	14	12	17	9	35.22±1.63	2 295.57±281.60
足月新生儿组	35	17	18	20	15	38.67±1.59	3 565.94±375.63
统计量		0.524^a		4.790^a		111.881^b	255.748^b
P值		0.914		0.188		＜0.001	＜0.001
注：^a为χ²值，^b为F值。

下载: 导出CSV

表 2 4组新生儿凝血功能和PLT结果比较(x±s)

Table 2. Comparisom of coagulation function and PLT results among the four groups (x±s)

组别	例数	PT(s)	APTT(s)	TT(s)	FIB(g/L)	D-D(mg/L)	INR	PLT(×10⁹ /L)
早期早产儿	11	16.19±2.76	62.27±6.31	29.13±3.57	0.92±0.26	5.19±1.72	1.67±0.49	142.52±37.61
中期早产儿	17	15.87±1.89	59.36±6.22	27.42±2.76	0.99±0.37	4.93±1.33	1.54±0.47	178.64±25.21^a
晚期早产儿	26	13.65±2.60^ab	52.14±5.25^ab	24.44±2.25^ab	1.93±0.46^ab	3.25±0.87^ab	1.27±0.39^ab	176.31±29.53^a
足月新生儿	35	13.26±2.13^ab	49.52±4.61^ab	23.89±2.36^ab	2.09±0.55^ab	2.13±0.81^ab	1.18±0.19^ab	182.44±24.80^a
F值		8.046	24.541	16.346	33.723	37.733	7.492	5.839
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	0.001
注：与早期早产儿比较，^aP＜0.05；与中期早产儿比较，^bP＜0.05。

下载: 导出CSV

表 3 4组新生儿出血发生率、凝血功能异常发生率比较

Table 3. Comparison of neonatal bleeding rate and abnormal coagulation function rate among the four groups[cases(%)]

组别	例数	皮肤瘀点瘀斑(例)	消化道出血(例)	肺出血(例)	颅内出血(例)	出血发生率(%)	凝血功能异常发生率(%)
早期早产儿	11	3	3	0	2	72.73(8/11)	81.82(9/11)
中期早产儿	17	6	2	0	1	52.94(9/17)	70.59(12/17)
晚期早产儿	26	5	1	1	1	30.77(8/26)	53.85(14/26)
足月新生儿	35	6	2	0	1	25.71(9/35)	37.14(13/35)
χ²值						10.039	9.312
P值						0.018	0.025

下载: 导出CSV

表 4 2组新生儿DIC发生率比较

Table 4. Comparison of neonatal DIC incidence between the two groups

组别	例数	DIC例数	DIC发生率(%)
早产儿	54	12	22.22
足月儿	35	1	2.86
注：2组DIC发生率比较，χ²=6.385，P=0.012。

下载: 导出CSV

参考文献(25)

[1]	罗素云. APTT、PT、FIB与D-D水平在新生儿早期凝血功能障碍中的诊断价值分析[J]. 中国实用医药, 2019, 14(16): 69-70. doi: 10.14163/j.cnki.11-5547/r.2019.16.036 LUO S Y. APTT, PT, FIB and D-D levels in the diagnosis of early coagulopathy in neonates[J]. China Practical Medicine, 2019, 14(16): 69-70. doi: 10.14163/j.cnki.11-5547/r.2019.16.036
[2]	PADUNGMANEESUB W, REUNGRONGRAT S, MANOWONG S, et al. Biomarkers of disseminated intravascular coagulation in pediatric intensive care unit in Thailand[J]. Int J Lab Hematol, 2019, 41(1): 32-38. doi: 10.1111/ijlh.12917
[3]	HVAS A M, FAVALORO E J. Platelet function testing in pediatric patients[J]. Expert Rev Hematol, 2017, 10(4): 281-288. doi: 10.1080/17474086.2017.1293518
[4]	FAVALORO E J, LIPPI G. Translational aspects of developmental hemostasis: Infants and children are not minature adults and even adults may be different[J]. Ann Transl Med, 2017, 5(10): 212. doi: 10.21037/atm.2017.04.18
[5]	王道霞, 薛炜. 凝血检验危急值在重症新生儿病房中的应用价值[J]. 中国妇幼保健, 2016, 31(15): 3063-3065. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201615029.htm WANG D X, XUE W. Application value of blood coagulation test critical value in intensive neonatal unit[J]. Maternal and Child Health Care of China, 2016, 31(15): 3063-3065. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201615029.htm
[6]	王卫平, 孙锟, 常立文. 儿科学[M]. 9版. 北京: 人民卫生出版社, 2018: 86. WANG W P, SUN K, CHANG L W. Pediatrics[M]. 9 Ed. Beijing: People's Medical Publishing House, 2018: 86.
[7]	SCHOLL J E, YANOWITZ T D. Pulmonary hemorrhage in very low birth weight infants: A case-control analysis[J]. J Pediatr, 2015, 166(4): 1083-1084. doi: 10.1016/j.jpeds.2014.12.032
[8]	DONG L Q, WANG X Q, GUO Y N, et al. HS N-sulfation and iduronic acids play an important tole in the infection of respiratory syncytial virus in virto[J]. Eur Rev Med Pharmacol Sci, 2013, 17(14): 1864-1868.
[9]	VANVOOREN D M, BRADSHAW W T, BLAKE S M. Disseminated intravascular coagulation in the neonate[J]. Neonatal Netw, 2018, 37(4): 205-211. doi: 10.1891/0730-0832.37.4.205
[10]	林柏杏, 冯炳棋, 陈慧. 高胆红素血症新生儿胆红素的变化与凝血功能及继发性血小板增多症的临床研究[J]. 检验医学与临床, 2019, 16(14): 2072-2075. doi: 10.3969/j.issn.1672-9455.2019.14.036 LIN B X, FENG B Q, CHEN H. Study on the changes of bilirubin and coagulation function in neonates with hyperbilirubin and secondary thrombocythemia[J]. Laboratory Medicine and Clinic, 2019, 16(14): 2072-2075. doi: 10.3969/j.issn.1672-9455.2019.14.036
[11]	李康裕, 史惠, 陈日玲. 早产儿凝血功能异常的危险因素分析及其与新生儿危重病例评分的相关性[J]. 中华实用诊断与治疗杂志, 2021, 35(8): 834-837. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD202108022.htm LI K Y, SHI H, CHEN R L. Risk factors of coagulation disorders in premature infants and its correlation with neonatal critical illness scores[J]. Journal of Chinese Practical Diagnosis and Therapy, 2021, 35(8): 834-837. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD202108022.htm
[12]	牟凤萍, 冯丽娟. 不同胎龄早产儿早期凝血功能的变化及临床意义[J]. 中国妇幼保健, 2017, 32(16): 3803-3805. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201716039.htm MU F P, FENG L J. Changes and clinical significance of early coagulation function in preterm infants at different gestational ages[J]. Maternal and Child Health Care of China, 2017, 32(16): 3803-3805. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201716039.htm
[13]	靳蓓蓓. 凝血检验危急值在重症新生儿病房中的应用价值研究[J]. 医药论坛杂志, 2019, 40(1): 161-164. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYX201901065.htm JIN B B. Application of critical value of coagulation test in intensive neonatal unit[J]. Journal of Medical Forum, 2019, 40(1): 161-164. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYX201901065.htm
[14]	吴燕琴. 凝血检验临界值用于重症新生儿病情预测的价值[J]. 血栓与止血学, 2019, 25(4): 653-654, 656. https://www.cnki.com.cn/Article/CJFDTOTAL-XSZX201904043.htm WU Y Q. The value of critical value of coagulation test in predicting severe neonatal disease[J]. Chinese Journal of Thrombosis and Hemostasis, 2019, 25(4): 653-656. https://www.cnki.com.cn/Article/CJFDTOTAL-XSZX201904043.htm
[15]	邹婷婷, 杜敏, 徐颖. 胃肠外科新生儿围手术期凝血功能异常的影响因素分析[J]. 临床麻醉学杂志, 2017, 33(8): 760-764. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ201708011.htm ZOU T T, DU M, XU Y. Risk factors of perioperative coagulation dysfunction in neonatal gastrointestinal surgery[J]. Journal of Clinical Anesthesiology, 2017, 33(8): 760-764. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ201708011.htm
[16]	SHAABAN H A, SAFWAT N. Mean platelet volume in preterm: A predictor of early onset neonatal sepsis[J]. J Matern Fetal Neonatal Med, 2020, 33(2): 206-211.
[17]	ILHAN O, BOR M. Platelet mass index and prediction of severity of transient tachypnea of the newborn[J]. Pediatr Int, 2019, 61(7): 697-705.
[18]	陈瑛, 张迪, 王晓颖, 等. 血小板参数与极低出生体重儿严重并发症和住院时长的相关性[J]. 中华临床医师杂志(电子版), 2021, 15(2): 87-94. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYD202102002.htm CHENG Y, ZHANG D, WANG X Y, et al. Platelet parameters are associated with severe complications and length of hospital stay in very low birth weight infants[J]. Chinese Journal of Clinicians (Electronic Edition), 2021, 15(2): 87-94. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYD202102002.htm
[19]	陈智, 李明, 葛中玲. 凝血六项联合检测预测早产儿颅内出血临床价值[J]. 中国临床研究, 2020, 33(8): 1101-1103, 1107. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202008024.htm CHEN Z, LI M, GE Z L. Clinical value of six items of blood coagulation in predicting intracranial hemorrhage in premature infants[J]. Chinese Journal of Clinical Research, 2020, 33(8): 1101-1103, 1107. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202008024.htm
[20]	MACQUEEN B C, CHRISTENSEN R D, WARD D M, et al. The iron status at birth of neonates with risk factors for developing iron deficiency: A pilot study[J]. J Perinatol, 2017, 37(4): 436-440.
[21]	郝鹏. 解读早产新生儿凝血四项检查的临床价值[J]. 临床医药文献电子杂志, 2019, 6(61): 136. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWX201961120.htm HAO P. To explore the clinical value of four tests of blood coagulation in premature neonates[J]. Journal of Clinical Medical Literature (Electronic Edition), 2019, 6(61): 136. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWX201961120.htm
[22]	罗敏, 宗莹, 吴李萍, 等. TEG指导新生儿凝血功能障碍诊治过程中的临床研究[J]. 国际检验医学杂志, 2020, 41(11): 1362-1365, 1370. https://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ202011020.htm LUO M, ZONG Y, WU L P, et al. Clinical study of thromboelastography in the diagnosis and treatment of neonatal coagulation dysfunction[J]. International Journal of Laboratory Medicine, 2020, 41(11): 1362-1365, 1370. https://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ202011020.htm
[23]	庾小敏. 妊娠期高血压疾病母亲所娩新生儿凝血功能变化及临床意义[J]. 中国医药科学, 2020, 10(4): 105-108. https://www.cnki.com.cn/Article/CJFDTOTAL-GYKX202004033.htm YU X M. Changes of coagulation function and its clinical significance in neonatal delivery by mothers with hypertensive disease during pregnancy[J]. China Medicine And Pharmacy, 2020, 10(4): 105-108. https://www.cnki.com.cn/Article/CJFDTOTAL-GYKX202004033.htm
[24]	李明芳. 早产新生儿APTT、PT、FIB与D-D水平变化及其临床意义[J]. 临床医学, 2022, 42(2): 32-33. https://www.cnki.com.cn/Article/CJFDTOTAL-EBED202202011.htm LI M F. Changes of APTT, PT, FIB and D-D levels in preterm neonates and their clinical significance[J]. Clinical Medicine, 2022, 42(2): 32-33. https://www.cnki.com.cn/Article/CJFDTOTAL-EBED202202011.htm
[25]	陈茹茹, 罗厚江, 杨军, 等. 低分子量肝素联合新鲜冰冻血浆在危重新生儿凝血功能异常中的应用[J]. 中华全科医学, 2021, 19(4): 607-610. doi: 10.16766/j.cnki.issn.1674-4152.001873 CHEN R R, LUO H J, YANG J, et al. Application of low molecular weight heparin combined with fresh frozen plasma in the treatment of coagulation abnormalities in critically ill neonates[J]. Chinese Journal of General Practice, 2021, 19(4): 607-610. doi: 10.16766/j.cnki.issn.1674-4152.001873