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目的研究血小板减少症与新生儿脑室内出血(IVH)发生的相互关系。方法回顾性分析2009年1月至2011年12月在川北医学院附属医院新生儿重症监护室(NICU)中住院的血小板减少症新生儿625例,根据血小板计数以及血小板质量降低的严重程度分别分为4个亚组:轻度[(100~<150)×109/L;800~1289fL/nL]、中度[(50~<100)×109/L;400~799fL/nL]、重度[(30~<50)×109/L;240~399fL/nL]、极重度(<30×109/L;<240fL/nL)。纳入2级以上的IVH病例。卡方检验和Fisher’s准确检验用于分析每个单因素。亚组分析采用单因素方差分析、Logistic回归分析以及多元线性回归。结果血小板减少症的发生率为21.2%。IVH≥2级的发生率在血小板减少症新生儿中为13.7%,在非血小板减少症的新生儿中为6.4%(P<0.01)。多元线性回归分析发现IVH严重程度与血小板计数减少程度无关(P=0.3),而与血小板质量降低程度有关(P<0.01)。结论血小板减少症是引发IVH的危险因素,而且血小板质量的变化与IVH发生的严重程度密切相关。提示动态监测血小板质量的变化,可能有利于临床上对于IVH的预测和防治。
Objective To study the relationship between thrombocytopenia and neonatal intraventricular hemorrhage (IVH). Methods A retrospective analysis of 625 neonates with thrombocytopenia hospitalized in Neonatal Intensive Care Unit (NICU) from January 2009 to December 2011 in North Sichuan Medical College Hospital was conducted. According to the platelet count and the severity of platelet mass loss (100 ~ <150) × 109 / L; 800 ~ 1289fL / nL], moderate [(50 ~ <100) × 109 / L, 400 ~ 799fL / nL] (30 ~ <50) × 109 / L; 240 ~ 399fL / nL], very severe (<30 × 109 / L; <240fL / nL). Inclusion of grade 2 or higher IVH cases. Chi-square test and Fisher’s exact test were used to analyze each single factor. Subgroup analysis using one-way ANOVA, Logistic regression analysis and multiple linear regression. Results The incidence of thrombocytopenia was 21.2%. The incidence of IVH≥2 was 13.7% in neonates with thrombocytopenia and 6.4% in neonates with non-thrombocytopenia (P <0.01). Multivariate linear regression analysis showed that the severity of IVH was not related to the reduction of platelet count (P = 0.3), but was related to the decrease of platelet mass (P <0.01). Conclusions Thrombocytopenia is a risk factor for IVH, and the change of platelet quality is closely related to the severity of IVH. Prompt dynamic monitoring of platelet quality changes may be conducive to the clinical prediction and prevention of IVH.