NICU新生儿血浆FDP及D-二聚体水平的影响因素研究  

Study on influencing factors of plasma FDP and D-dimer levels of newborns in NICU

作　　者：赵瑶 王琳[1] Zhao Yao;Wang Lin(Department of Pediatrics,the Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院儿科,武汉430022

出　　处：《国际儿科学杂志》2022年第7期493-497,共5页International Journal of Pediatrics

摘　　要：目的探讨NICU新生儿出生时的生理和病理状况以及孕母妊娠期情况对血浆纤维蛋白或纤维蛋白原降解产物(fibrin/fibrinogen degradation product,FDP)及D-二聚体水平的影响因素。方法2018年5月1日至2018年10月31日,入住华中科技大学同济医学院附属协和医院NICU的新生儿共222例纳入本研究。新生儿生后2 h内送入NICU并立即采集静脉血。采用免疫比浊法检测FDP及D-二聚体的水平。根据不同性别、胎龄、出生体重、胎龄儿、分娩方式、出生时有无窒息、酸中毒、孕母产前有无使用激素、有无使用抗凝药物、有无围生期危险因素(妊娠期高血压疾病、胎膜早破、胎盘异常、妊娠期糖尿病)等分组;比较各组间血浆FDP及D-二聚体水平。采用Mann-Whitney U检验、Kruskal-Wallis H检验、Spearman秩相关、广义线性模型进行统计学分析。结果222例NICU新生儿出生时血浆FDP和D-二聚体值均为偏态分布,中位数分别为6.00 mg/L和1.74 mg/L,四分位数间距分别为10.40 mg/L和2.55 mg/L。顺产和剖宫产出生的新生儿FDP中位数浓度分别为11.70 mg/L和5.30 mg/L,D-二聚体浓度分别为2.92 mg/L和1.52 mg/L,顺产者的FDP和D-二聚体水平显著升高(Z值分别为-4.006、-4.198,P<0.05)。分别比较不同胎龄、不同出生体重和不同血pH值的新生儿FDP和D-二聚体水平,差异均有统计学意义(χ^(2)值分别为15.322、18.394、9.677、11.492、7.023和8.345,P均<0.05),进一步两两比较,胎龄<34周组较胎龄~<37周组和≥37周组均升高(P<0.05),出生体重<1500 g组较~<2500 g组和≥2500 g组均升高(P<0.05),pH<7.20组较≥7.35组均升高(P<0.05)。广义线性模型结果表明,NICU新生儿出生时血浆FDP和D-二聚体的浓度与胎龄、出生体重和动脉血pH值有关。结论NICU新生儿出生时血浆FDP及D-二聚体的水平受到胎龄、出生体重、酸碱平衡等因素影响。Objective To investigate the influencing factors of physiological and pathological conditions at birth of newborn and gestational conditions of pregnant mothers on plasma fibrin/fibrinogen degradation products(FDP)and D-dimer levels.Methods From May 1,2018 to October 31,2018,222 newborns admitted to NICU of the Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were enrolled in this study.Newborns were sent to NICU within 2 hours after birth and venous blood was collected immediately.The levels of FDP and D-dimer were detected by immunoturbidimetry.Groups were divided according to different gender,gestational age,birth weight,relationship between gestational age and birth weight,mode of delivery,asphyxia at birth,acidosis,antenatal hormone use,anticoagulant drugs,and perinatal risk factors(gestational hypertension,premature rupture of membranes,abnormal placenta,gestational diabetes).The levels of plasma FDP and D-dimer were compared among the groups.Mann Whitney U test,Kruskal Wallis H test,Spearman rank correlation and generalized linear model were used for statistical analysis.Results The plasma FDP and D-dimer values of 222 NICU neonates were skewed at birth,with median values of 6.00 mg/L and 1.74 mg/L,and quartile distances of 10.40 mg/L and 2.55 mg/L,respectively.The concentrations of FDP in neonates born to natural labour and cesarean section were 11.70 mg/L and 5.30 mg/L,respectively,and D-dimer concentrations were 2.92 mg/L and 1.52 mg/L,respectively.The FDP and D-dimer levels were significantly higher in the former(Z values were-4.006 and-4.198,respectively,P<0.05).The levels of FDP and D-dimer in newborns with different gestational age,different birth weight and different blood pH values were compared respectively,and the differences were statistically significant(χ^(2) values were 15.322,18.394,9.677,11.492,7.023 and 8.345,respectively,P<0.05).Further analysis showed that the levels of FDP and D-dimer in neonates with gestational age<34 weeks were si

关 键 词：新生儿 血浆纤维蛋白 纤维蛋白原降解产物 D-二聚体 纤溶活性 

分 类 号：R722.1[医药卫生—儿科]