不同胎龄早产儿凝血功能及出血性疾病的临床研究

Coagulation function and hemorrhagic diseases in preterm infants with different gestational ages

摘要:

目的 分析早产儿凝血功能与胎龄间的相关性，并探讨凝血功能检测对出血性疾病的可能预测价值。方法 收集2016年9月至2017年8月住院的早产儿的相关临床资料以及生后2 h内凝血功能检测结果。依据胎龄分为晚期早产儿组（n=322）、早期早产儿组（n=241）和超/极早产儿组（n=128），比较不同胎龄各组早产儿的凝血功能；并比较生后3 d内有无并发出血性疾病早产儿的凝血功能检测指标。结果 不同胎龄的3组间凝血酶时间（TT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原降解产物（FDP）、D-二聚体（DD）的比较差异有统计学意义（P < 0.05），其中APTT、PT、FDP、DD与胎龄呈负相关，而TT与胎龄呈正相关（P < 0.05）。与未患出血性疾病的早产儿相比，罹患出血性疾病早产儿的APTT延长（P < 0.05），DD值升高（P < 0.05）。结论 早产儿随着胎龄的增长，生后凝血功能逐渐成熟。APTT及DD检测结果异常，预示早产儿可能会具有更高的风险罹患出血性疾病。

Abstract:

Objective To study the correlation between coagulation function and gestational age in preterm infants and the possible value of coagulation function measurement in predicting hemorrhagic diseases. Methods The clinical data of preterm infants who were hospitalized between September 2016 and August 2017 were collected. The coagulation indicators were measured within 2 hours after birth. According to the gestational age, the preterm infants were divided into late preterm infant group (n=322), early preterm infant group (n=241) and extremely/very early preterm infant group (n=128). Coagulation function was compared among the three groups, as well as between the preterm infants with and without hemorrhagic diseases within 3 days after birth. Results There were significant differences in thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen degradation product (FDP) and D-dimer (DD) among the three groups (P < 0.05). APTT, PT, FDP and DD were negatively correlated with gestational age, while TT was positively correlated with gestational age (P < 0.05). The preterm infants with hemorrhagic diseases had a longer APTT and a higher level of DD (P < 0.05). Conclusions Coagulation function gradually becomes mature in preterm infants with the increase in gestational age. Abnormal APTT and DD indicate that preterm infants may have a higher risk of hemorrhagic diseases.