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目的 研究新生儿缺氧缺血性脑病 (HIE)时血浆颗粒膜蛋白 - 140 (GMP- 140 )、D二聚体的变化 ,并探讨其临床意义。 方法 43例 HIE患儿按病情轻重分为轻、中、重三组。采用 EL ISA双抗体夹心法测定其血浆 GMP- 140、D二聚体的含量 ,并以 19例正常新生儿作为对照。 结果 三组HIE患儿 GMP- 140值分别为 (2 9.0 3± 9.48)、(37.39± 12 .94)、(6 2 .11± 15 .0 3) μg/ L,较对照组的(14.73± 6 .5 8)μg/ L显著升高 (P<0 .0 1)。血浆 D二聚体水平分别为 (2 .0 3± 0 .81)、(4.6 3± 1.48)、(8.16± 4.0 2 ) m g/ L ,较对照组的 (0 .6 5± 0 .31) mg/ L显著升高 (P<0 .0 1)。血浆 GMP- 140、D二聚体水平随着病情的加重而升高。血浆 GMP- 140水平与血小板数量呈负相关 (n=43,r=- 0 .44 ,P<0 .0 5 )。结果还表明轻度 HIE患儿血小板数量尚未明显下降时 GMP- 140、D二聚体就已较对照组升高(P<0 .0 5 ) ,危重儿在恢复期虽然血小板数量明显上升 ,但 GMP- 140、D二聚体水平仍高于对照组 (P<0 .0 5 )。 结论 HIE患儿体内存在血小板活化、高凝状态及纤溶的改变 ,表明患儿处于血栓前状态。监测血浆 GMP- 140、D二聚体的变化 ,有助于血栓前状态的早期诊断、指导治疗及判断预后。
Objective To study the changes of plasma granular membrane protein 140 (GMP-140) and D-dimer in neonates with hypoxic-ischemic encephalopathy (HIE) and to explore its clinical significance. Methods Forty-three HIE infants were divided into mild, moderate and severe groups according to their severity. The content of plasma GMP-140, D dimer was measured by EL ISA double antibody sandwich method, and 19 normal newborns were used as control. Results The GMP-140 values in three groups of HIE children were (2 9.0 3 ± 9.48), (37.39 ± 12.94) and (62.11 ± 15.0 3) μg / L respectively, which were significantly higher than those in the control group (14.73 ± 6 .5 8) μg / L was significantly higher (P <0.01). Plasma D dimer levels were (2.03 ± 0.81), (4.6 ± 1.48) and (8.16 ± 4.02) mg / L, respectively, which were significantly higher than those in the control group (± 0.55 ± 0.31) mg / L was significantly higher (P <0.01). Plasma GMP-140, D dimer levels increased with the severity of the disease. There was a negative correlation between plasma GMP-140 level and platelet count (n = 43, r = - 0.44, P <0.05). The results also showed that mild platelet count in children with HIE has not significantly decreased GMP-140, D dimer than the control group increased (P <0. 05), critically ill children in the recovery period although the number of platelets increased significantly, GMP-140, D dimer level is still higher than the control group (P <0. 05). Conclusion There is platelet activation, hypercoagulability and fibrinolysis in children with HIE, indicating that the children are in a prethrombotic state. Monitoring plasma GMP-140, D dimer changes, contribute to the early diagnosis of prethrombotic state, guide the treatment and prognosis.