Cohen H, Scott S D, Mackie I J, Shearer M, Bax R, Karran S J, Machin S J
Department of Haematology, Middlesex Hospital, London.
Br J Haematol. 1988 Jan;68(1):63-6. doi: 10.1111/j.1365-2141.1988.tb04180.x.
A group of nine well-nourished patients, with normal serum vitamin K1 levels (mean 546, range 310-1350 pg/ml), maintained normal prothrombin times (PTs) and factor VII clotting activities throughout a 7 d course of i.v. cefotetan disodium, an N-methyl-thiotetrazole (NMTT) containing cephalosporin antibiotic. However, 11 of 20 patients, with acute intra-abdominal sepsis and initially normal PTs who underwent emergency surgery, developed prolonged PTs (INR 1.4-3.1) associated with reduction in factor VII activities (0.74-0.38 u/ml) after 3-7 d of antibiotic therapy. Nine of these 11 patients had clinical evidence of malnutrition and nine had subnormal serum vitamin K1 levels (mean 119, range 43-354 pg/ml) on admission. Seven received cefotetan but four were treated with a non-NMTT-containing cephalosporin or antibiotics belonging to other groups. The nine patients who maintained normal PTs all had normal nutritional status and normal serum vitamin K1 levels (mean 279, range 103-915 pg/ml) at presentation. The PT is a relatively insensitive indicator of vitamin K stores, and malnourished patients with low serum vitamin K1 levels are at risk of developing hypoprothrombinaemia following intravenous antibiotic therapy.
一组9名营养状况良好的患者，血清维生素K1水平正常（平均546，范围310 - 1350 pg/ml），在静脉输注头孢替坦二钠（一种含N - 甲基 - 硫代四唑（NMTT）的头孢菌素抗生素）的7天疗程中，凝血酶原时间（PT）和因子VII凝血活性维持正常。然而，20例患有急性腹腔内感染且最初PT正常并接受急诊手术的患者中，有11例在抗生素治疗3 - 7天后出现PT延长（国际标准化比值（INR）为1.4 - 3.1），同时伴有因子VII活性降低（0.74 - 0.38 u/ml）。这11例患者中有9例有营养不良的临床证据，9例入院时血清维生素K1水平低于正常（平均119，范围43 - 354 pg/ml）。7例接受了头孢替坦治疗，但4例接受的是不含NMTT的头孢菌素或其他组别的抗生素治疗。9例PT维持正常的患者在就诊时营养状况均正常，血清维生素K1水平也正常（平均279，范围103 - 915 pg/ml）。PT是维生素K储备相对不敏感的指标，血清维生素K1水平低的营养不良患者在静脉使用抗生素治疗后有发生低凝血酶原血症的风险。
