新生儿感染性黄疸血浆组织因子和组织因子途径抑制物含量的变化

目的　探讨新生儿感染性黄疸患儿血浆组织因子 (TF)和组织因子途径抑制物 (TFPI)含量的变化及其意义。方法　运用酶联免疫吸附法 (ELISA)测定 8例非感染性高胆红素血症新生儿 (对照组 )及 2 1例感染性黄疸新生儿 (感染组 )血浆TF和TFPI水平。结果　感染组的血浆TFPI含量和TF含量显著高于对照组 [TFPI( 2 1 0± 4 3 )、( 16 2± 1 9) μg/L ,P <0 0 1;TF ( 177± 79)、( 5 1± 2 4)ng/L ,P <0 0 1];TFPI/TF比值显著低于对照组 ( 13 7± 61、3 19± 67,P <0 0 1)。根据患儿血清胆红素 (SB)浓度 ,将 2 1例感染性黄疸新生儿分为胆红素重度增高感染组 (SB≥ 2 0 5 2 μmol/L ,n =10 )和胆红素轻度增高感染组 (SB <2 0 5 2 μmol/L ,n =11) ,两组间TFPI水平差异无显著性 (P >0 0 5 )。胆红素重度增高感染组TF水平高于胆红素轻度增高感染组 [( 2 16± 79)、( 141± 63 )ng/L ,P <0 0 1],而TFPI/TF低于胆红素轻度增高感染组 ( 10 0± 3 0、171± 74,P <0 0 1)。结论　感染可引起新生儿体内抗凝与促凝作用的平衡失调。黄疸可提高血浆TF水平 ,加重感染新生儿体内抗凝与促凝作用的失衡

Changes of tissue factor and tissue factor pathway inhibitor in neonatal jaundice due to infection

OBJECTIVE: Tissue factor (TF) is an important factor in extrinsic coagulation. Tissue factor pathway inhibitor (TFPI) is a negative regulator of coagulation mediated by TF. Studies on TF and TFPI focus mainly on adult objects, seldom have been done on newborns, especially on sick newborns. The aim of this study was to observe the changes of TF and TFPI in plasma of newborns with infection jaundice and to research the effect of jaundice and infection on the balance of TF and TFPI in newborns. METHODS: The content of TF and TFPI in plasma of 21 jaundiced newborns with infection and 8 jaundiced newborns without infection as control was determined quantitatively with the enzyme-linked immunosorbent assay (ELISA). RESULTS: The content of TFPI and TF in plasma of jaundiced newborn with infection was significantly higher than that of controls [TFPI (21.0 +/- 4.3) vs. (16.2 +/- 1.9) microg/L, P < 0.01; TF (177 +/- 79) vs. (51 +/- 24) ng/L, P < 0.01]. The ratio of TFPI/TF was significantly lower in newborn with infection jaundice than the controls (137 +/- 61 vs. 319 +/- 67, P < 0.01). The 21 jaundiced newborns with infection were divided into the severe hyperbilirubinemia group (serum bilirubin > or = 205.2 micromol/L, n = 10) and the mild hyperbilirubinemia group (serum bilirubin < 205.2 micromol/L, n = 11). There was no significant difference of TFPI level between the severe hyperbilirubinemia group and mild hyperbilirubinemia group (P > 0.05). The TF content in the severe hyperbilirubinemia group was higher than that in the mild hyperbilirubinemia group (216 +/- 79 vs.141 +/- 63, P < 0.01), while the ration of TFPI/TF was lower in the severe hyperbilirubinemia group than in the mild hyperbilirubinemia group (100 +/- 30 vs. 171 +/- 74, P < 0.01). CONCLUSION: Infection might induce imbalance between the coagulation inhibition and activation in newborns. Hyperbilirubinemia can aggravate the imbalance induced by the infection through increasing plasma TF level.