摘要
目的探讨早产儿颅内出血(ICH)与外周血血小板参数变化的关系,分析血小板膜糖蛋白GPIbαHPA-2基因多态性与ICH的相关性。方法选择2005年5月至2007年5月在温州医学院附属育英儿童医院新生儿科住院的胎龄<34周、出生体重<1500g的早产儿为研究对象。按生后2周内头颅B超检查结果,分为ICH组和无ICH组。ICH组根据ICH分度结果分为轻度(Ⅰ和Ⅱ度)和重度ICH(Ⅲ和Ⅳ度)亚组。入选患儿在入院第2天检测血小板各项参数,采用PCR及限制性内切酶分析法检测血小板膜糖蛋白GPIbαHPA-2基因多态性。各组等位基因比例采用Hardy-Weinberg平衡检验。结果ICH组纳入68例,其中轻度ICH亚组53例,重度ICH亚组15例;无ICH组纳入75例。ICH组PLT和平均血小板体积(PCT)显著低于无ICH组,P<0.05;重度ICH亚组较轻度ICH亚组上述指标下降更显著,P<0.05。ICH组58/68例、无ICH组65/75例成功进行了血小板膜糖蛋白GPIbαHPA-2基因多态性检测。ICH组血小板膜糖蛋白GPIbαHPA-2的各基因型比例为:TT77.6%(45/58例),TM17.2%(10/58例),MM5.2%(3/58例);M基因频率为13.8%(16/116频次);无ICH组为TT89.2%(58/65例),TM10.8%(7/65例),MM0;M基因频率为5.4%(7/130频次)。两组M基因频率差异有统计学意义。轻度ICH亚组与重度ICH亚组M基因频率差异无统计学意义(12.5%vs20.0%)。ICH组和无ICH组各基因型比例符合Hardy-Weinberg遗传平衡。含有M等位基因患儿PLT和PCT显著低于无M等位基因患儿。结论①ICH早产儿存在血小板参数异常现象;②血小板膜糖蛋白GPIbαHPA-2基因多态性与早产儿ICH发生的关联性值得更细化的研究;③血小板膜糖蛋白GPIbαHPA-2M等位基因可能与早产儿ICH的严重程度无关。
Objective To study the relationship between peripheral blood platelet parameters and intracranial hemorrhage （ICH） in prematures and analyze the platelet＇s genetic polymorphism. To explain the changes of parameters with genetic knowledge. Methods Preterm infants （ 〈 34 weeks） and extremely low birth weight infants （ 〈 1 500 g） who were hospitalized within 24 hours after birth in the NICU of the Yuying Children＇s Hospital of Wenzhou Medical College from May 2005 to May 2007 were enrolled in the study, and those infants were excluded who were diagnosed as congenital malformation, congenital metabolism disorder and severe coagulation disturbance. They were divided into ICH and non-ICH groups according to the result of ultrasonic examination assessed by radiologists independently. The polymorphism of the platelet glycoprotein GPIbαHPA-2 alleles was determined in 58 preterm infants with ICH and 65 control infants without ICH. Results （1）Compared with the non-ICH group, preterm infants with ICH had a significantly lower platelet count [ （172.20 ± 75.81 ） ×10^9 · L^- 1 vs （230. 92 ± 86. 50） × 10^9 · L-1 ], higher mean platelet volume [ （ 8.39 ± 1.23 ） fl vs （ 8.07 -± 1.46 ） fl ], lower volume ration [ （ 0. 135 ± 0. 08 ） % vs （0. 188 ± 0.06） % ], and higher platelet distribution width [ （ 17.6 ± 1.04） % vs （ 17.3 ± 1.08 ） % ]. （2）The prevalence rates of the platelet glycoprotein GPIbαHPA-2 were 77.6% of TF,17.2% of TM, and 5.2% of MM in ICH group;and those were 89.2% of TT, 10.8% of TM, 0 of MM in non-ICH group. Frequency of M was 13.8% in ICH group versus 5.4% in non-ICH group. There were significant differences in frequency of TM, MM and M between these two groups. Conclusions （1）In preterm infants ,the platelet indexes were abnormal. （2）The relationship between the polymorphism of the alleles of the platelet glycoprotein GPIbαHPA-2 and ICH needs more studies. （3）The polymorphism of the platelet glycoprotein GPlbαHPA-2 alleles may be not related to the severity of ICH
出处
《中国循证儿科杂志》
CSCD
2009年第5期448-452,共5页
Chinese Journal of Evidence Based Pediatrics
基金
温州市科技局基金项目:Y2005-A014
