新生儿止血系统与新生儿血栓形成风险。

The Hemostatic System in Newborns and the Risk of Neonatal Thrombosis.

机构信息

Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children's Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia.

Hematology and Thrombosis Center, Tenon Hospital, Sorbonne University, 4 Rue de la Chine, 75020 Paris, France.

出版信息

Int J Mol Sci. 2023 Sep 8;24(18):13864. doi: 10.3390/ijms241813864.

Abstract

Newborns are the most vulnerable patients for thrombosis development among all children, with critically ill and premature infants being in the highest risk group. The upward trend in the rate of neonatal thrombosis could be attributed to progress in the treatment of severe neonatal conditions and the increased survival in premature babies. There are physiological differences in the hemostatic system between neonates and adults. Neonates differ in concentrations and rate of synthesis of most coagulation factors, turnover rates, the ability to regulate thrombin and plasmin, and in greater variability compared to adults. Natural inhibitors of coagulation (protein C, protein S, antithrombin, heparin cofactor II) and vitamin K-dependent coagulation factors (factors II, VII, IX, X) are low, but factor VIII and von Willebrand factor are elevated. Newborns have decreased fibrinolytic activity. In the healthy neonate, the balance is maintained but appears more easily converted into thrombosis. Neonatal hemostasis has less buffer capacity, and almost 95% of thrombosis is provoked. Different triggering risk factors are responsible for thrombosis in neonates, but the most important risk factors for thrombosis are central catheters, fluid fluctuations, liver dysfunction, and septic and inflammatory conditions. Low-molecular-weight heparins are the agents of choice for anticoagulation.

摘要

新生儿是所有儿童中最容易发生血栓形成的脆弱患者,危重症和早产儿处于最高风险群体。新生儿血栓形成率呈上升趋势,这可能归因于严重新生儿疾病治疗的进步和早产儿存活率的提高。新生儿的止血系统与成人存在生理差异。新生儿的大多数凝血因子的浓度和合成速度、周转率、调节凝血酶和纤溶酶的能力以及与成人相比的更大变异性都有所不同。天然抗凝剂(蛋白 C、蛋白 S、抗凝血酶、肝素辅因子 II)和维生素 K 依赖性凝血因子(因子 II、VII、IX、X)水平较低,但因子 VIII 和血管性血友病因子升高。新生儿的纤维蛋白溶解活性降低。在健康的新生儿中,这种平衡得以维持,但似乎更容易转化为血栓形成。新生儿止血的缓冲能力较低,几乎 95%的血栓形成是由触发因素引起的。不同的触发风险因素导致新生儿发生血栓形成,但血栓形成的最重要危险因素是中心导管、液体波动、肝功能障碍以及感染和炎症状态。低分子量肝素是抗凝治疗的首选药物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e9d1/10530883/f3f1c33f2425/ijms-24-13864-g001.jpg

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