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目的探讨窒息新生儿血浆中抗凝血酶Ⅲ(AT-Ⅲ)、血管性假血友病因子(VWF)、D-二聚体(D-D)的变化及其意义。方法深圳市人民医院于2002~2004年,采用酶联荧光分析法和发色底物法分别测定39例不同程度窒息新生儿和16名正常新生儿VWF、D-D的水平及AT-Ⅲ的活性,同时检测血小板计数(BPC)、凝血酶原时间(PT)、纤维蛋白原(Fbg)的变化。结果重度窒息组的AT-Ⅲ明显降低;窒息新生儿血浆的VWF、D-D平均值均有不同程度增高,重度窒息组升高更为显著,与正常对照组比较,其差异具有显著性意义(P<0·05,P<0·01)。窒息后并发器官功能损害新生儿较无并发症组血浆的VWF、D-D均有不同程度的升高,以颅内出血患儿升高最为明显(P<0·05,P<0·01)。结论窒息新生儿表现以高凝状态为主的早期DIC、VWF及D-D的升高与窒息的程度有关,VWF及D-D明显升高者常合并组织器官损害。测定窒息新生儿血浆中AT-Ⅲ、VWF、D-D等指标对窒息后新生儿临床选用抗凝药物治疗及疗效观察、预后判断,均有一定的指导意义。

A study on antithrombin III,VWF and D-dimer in plasma of asphyxial newborns

Objective To observe the changes of antithrombin III,VWF and D-dimer in asphyxial newborns and study their clinical significane.Methods From 2002 to 2004 ELISA was used to detect AT-III,VWF and D-dimer in 39 cases of asphyxic newborns and 16 normal newborns in Shenzhen People's Hospital.Results Anti-thrombin III in the newborns with severe asphyxia decreased significantly.VWF and D-dimer in the asphyxic newborns were higher than those in the normal controls,especially for the severe asphyxia (P<0.05,P<0.01).VWF and D-dimer in the asphyxial newborns complicated with intracranial hemorrhage were higher than those with other complications or without complications(P<0.05;P<0.01).Conclusion Measurement of anti-thrombin III,VWF and D-dimer are useful in evaluating the severity,therapy and prognosis for asphyxic newborns.