Jiang Lijun, Yu Qian, Li Hui, Wang Fudong, Liu Feng, Xu Zhenxing
Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province, China.
Department of Interventional Medicine, Yangzhou Hongquan Hospital, Yangzhou, Jiangsu Province, China.
PLoS One. 2025 Jul 24;20(7):e0328904. doi: 10.1371/journal.pone.0328904. eCollection 2025.
To determine the association between blood pressure variability (BPV), coagulation indexes, and germinal matrix-intraventricular hemorrhage (GMH-IVH) in preterm infants with gestational age ≤ 32 weeks. In addition, we aimed to determine whether the combination can predict the occurrence and outcome of GMH-IVH.
This retrospective study included 106 preterm infants. According to the presence of GMH-IVH, the preterm infants were divided into GMH-IVH (51 patients) and no GMH-IVH (55 patients) groups. Furthermore, according to the short-term prognoses, the GMH-IVH group was subdivided into good outcome (30 patients) and poor outcome (21 patients) groups. Coagulation function and BPV indexes were collected at admission. Univariate analysis, logistic regression model, and receiver operating characteristic curve were used to analyze the relationship between indexes and the occurrence and outcome of GMH-IVH in preterm infants.
Univariate analysis showed that the difference between maximum and minimum (Max-Min); standard deviation (SD); coefficient of variation (CV) of BPV, prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), and proportion of premature rupture of membranes (PROM) were higher in the GMH-IVH group than the no GMH-IVH group (P < 0.05). Logistic regression analysis showed that INR and DBP SD were directly correlated with GMH-IVH, and the joint curve had the largest area under the curve (AUC) (82.4% sensitivity and 79.7% specificity). BPV SD, BPV CV, APTT, and INR were higher in the poor outcome group than in the good outcome group (P < 0.05). Logistic regression analysis showed that INR and DBP SD were directly correlated with poor outcomes in preterm infants with GMH-IVH. The joint curve had the largest AUC (sensitivity 76.2% and specificity 90.0%).
Increased INR and DBP SD are directly associated factors for the developement and poor short-term outcome of GMH-IVH, and combined monitoring of INR and DBP SD has certain reference value for the early identification and prognosis evaluation of GMH-IVH in preterm infants with gestational age ≤ 32 weeks.
确定胎龄≤32周的早产儿血压变异性（BPV）、凝血指标与生发基质-脑室内出血（GMH-IVH）之间的关联。此外，我们旨在确定这些指标的组合是否能够预测GMH-IVH的发生及预后。
这项回顾性研究纳入了106例早产儿。根据是否发生GMH-IVH，将早产儿分为GMH-IVH组（51例）和非GMH-IVH组（55例）。此外，根据短期预后，将GMH-IVH组再细分为预后良好组（30例）和预后不良组（21例）。收集入院时的凝血功能和BPV指标。采用单因素分析、逻辑回归模型和受试者工作特征曲线分析各指标与早产儿GMH-IVH发生及预后的关系。
单因素分析显示，GMH-IVH组的血压变异性的最大值与最小值之差（Max-Min）、标准差（SD）、变异系数（CV）、凝血酶原时间（PT）、国际标准化比值（INR）、活化部分凝血活酶时间（APTT）以及胎膜早破比例（PROM）均高于非GMH-IVH组（P<0.05）。逻辑回归分析显示，INR和舒张压SD与GMH-IVH直接相关，联合曲线的曲线下面积（AUC）最大（敏感性82.4%，特异性79.7%）。预后不良组的BPV SD、BPV CV、APTT和INR高于预后良好组（P<0.05）。逻辑回归分析显示，INR和舒张压SD与GMH-IVH早产儿的不良预后直接相关。联合曲线的AUC最大（敏感性76.2%，特异性90.0%）。
INR升高和舒张压SD升高是GMH-IVH发生及短期不良预后的直接相关因素，联合监测INR和舒张压SD对胎龄≤32周的早产儿GMH-IVH的早期识别和预后评估具有一定的参考价值。
