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目的分析维生素K1治疗新生儿出血症(HDN)前后凝血指标的变化,探讨反映机体维生素K营养状况的敏感指标。方法选取我科2011年住院的HDN患儿30例,确诊时采静脉血,应用酶联免疫分析法检测凝血酶原前体蛋白(PIVKA-Ⅱ),sysmexCA-1500血凝仪测凝血酶原时间(PT)、部分活化凝血活酶时间(APTT)、凝血酶原活动度、凝血酶时间(TT)及纤维蛋白原(FIB);静脉滴注维生素K1每天3mg,3天后复查以上指标并比较治疗前后变化。结果患儿临床表现为皮肤瘀斑20例(66.6%)、颅内出血9例(30.0%)、穿刺部位出血不止7例(23.3%)、脐端渗血6例(20.0%)、消化道出血且合并贫血1例(3.3%)。本组HDN患儿治疗前后PIVKA-Ⅱ、PT、APTT、凝血酶原活动度异常率(%)比较分别为(93.3比10.0)、(73.3比13.3)、(70.0比33.3)、(83.3比13.3),差异均有统计学意义(P<0.05);TT及FIB治疗前后异常率比较差异无统计学意义(P>0.05)。治疗后PIVKA-Ⅱ(ng/ml)、PT(s)、APTT(s)及凝血酶原活动度(%)较治疗前均明显改善,分别为(9.8±2.9)比(45.6±25.0)、(15.2±1.9)比(21.6±4.4)、(46.9±12.5)比(61.3±12.9)、(91.8±14.6)比(52.2±2.6),差异均有统计学意义(P<0.05);TT和FIB数值治疗前后比较差异无统计学意义(P>0.05)。结论 HDN患儿补充维生素K1后,PIVKA-Ⅱ、PT、APTT及凝血酶原活动度异常率及数值均有明显改善,是HDN诊断及疗效监测的敏感指标,而TT和FIB对HDN的诊断和治疗无指导意义。
Objective To analyze the changes of coagulation index before and after vitamin K1 treatment of neonatal hemorrhagic disease (HDN), and to explore the sensitive indexes reflecting the nutritional status of vitamin K in the body. Methods Thirty patients with HDN admitted to our hospital in 2011 were enrolled in this study. Venous blood was collected during the diagnosis. Prothrombin precursor protein (PIVKA-Ⅱ) was detected by enzyme-linked immunosorbent assay. Prothrombin time was measured by sysmexCA-1500 coagulation analyzer. (PT), partial activated thromboplastin time (APTT), prothrombin activity, thrombin time (TT) and fibrinogen (FIB); intravenous vitamin K1 3mg daily, after 3 days to review the above indicators and compare the treatment Before and after the change. Results The clinical manifestations were as follows: 20 cases (66.6%) of ecchymosis, 9 cases (30.0%) of intracranial hemorrhage, more than 7 cases of puncture site bleeding (23.3%), 6 cases of umbilical cord bleeding (20.0% And anemia in 1 case (3.3%). The abnormal rates (%) of PIVKA-Ⅱ, PT, APTT and prothrombin activity in children with HDN before and after treatment were 93.3 to 10.0, 73.3 to 13.3, 70.0 to 33.3, 83.3 to 13.3 ), The differences were statistically significant (P <0.05); TT and FIB treatment before and after the abnormal rate was no significant difference (P> 0.05). The activities (%) of PIVKA-Ⅱ, PT (s), APTT (s) and prothrombin in treatment group were significantly higher than those before treatment (9.8 ± 2.9 vs 45.6 ± 25.0, (15.2 ± 1.9) vs (21.6 ± 4.4), (46.9 ± 12.5) vs (61.3 ± 12.9), (91.8 ± 14.6) vs (52.2 ± 2.6) respectively, with statistical significance (P <0.05) FIB value before and after treatment was no significant difference (P> 0.05). Conclusions The abnormal rate and value of PIVKA-Ⅱ, PT, APTT and prothrombin activity in HDN children after vitamin K1 supplementation were significantly improved, which is a sensitive index for the diagnosis and curative effect monitoring of HDN. Treatment is not instructive.