Nako Y, Ohki Y, Harigaya A, Tomomasa T, Morikawa A
Department of Pediatrics, Gunma University School of Medicine, Maebashi, Japan.
Acta Paediatr. 1997 Oct;86(10):1105-9. doi: 10.1111/j.1651-2227.1997.tb14817.x.
Plasma soluble thrombomodulin level reflects endothelial damage. The plasma thrombomodulin level at birth is increased in asphyxiated full-term infants. There is no report of plasma thrombomodulin level in premature infants. To determine the thrombomodulin level in premature infants and whether it might reflect endothelial damage, we examined the plasma thrombomodulin level in very low birthweight (VLBW) infants at birth.
Forty-five VLBW infants, of whom 14 had perinatal asphyxia complications, were recruited. As a control, 50 full-term infants without complications were also studied. Plasma thrombomodulin concentration, pH, base deficit, serum creatinine and D-dimer concentration, platelet count and fibrinogen concentration were measured within 1 hour after birth.
There were significant differences in plasma pH, creatinine concentration, platelet count, antithrombin III activity and D-dimer concentration between VLBW infants and full-term infants. Plasma thrombomodulin concentration (39.0 (16.6-93.7) vs 27.0 (16.6-39.1) microg/L, p < 0.0001) and plasma thrombomodulin-to-serum creatinine ratio (0.82 (0.19-2.65) vs 0.47 (0.24-0.70) microg/micromol, p < 0.0001) were significantly higher in VLBW infants than those in full-term infants. By univariate analyses for all neonates, there were significant relations between plasma thrombomodulin concentration and gestational age, birthweight, plasma pH, creatinine concentration, platelet count and antithrombin III activity. A stepwise multiple linear regression model using the above variables as dependent factors showed only birthweight contributed significantly to plasma thrombomodulin concentration (plasma thrombomodulin concentration (microg/l) = 45.677-0.006 (birthweight; g), r2 = 0.323, p < 0.0001, n = 94). Plasma thrombomodulin concentration and plasma thrombomodulin-to -serum creatinine ratio in VLBW infants with asphyxia were higher than in those without asphyxia, but not significantly different (43.2 +/- 17.7 vs 38.3 +/- 8.5 microg/l and 0.92 +/- 0.60 vs 0.83 +/- 0.37 microg/micromol).
Plasma thrombomodulin level in VLBW infants shows a high value at birth, and we consider the main factor responsible for this elevation may be endothelial damage or low clearance rate of thrombomodulin, which may be related to early gestational age.
血浆可溶性血栓调节蛋白水平反映内皮损伤。足月窒息婴儿出生时血浆血栓调节蛋白水平升高。尚无关于早产儿血浆血栓调节蛋白水平的报道。为了确定早产儿的血栓调节蛋白水平及其是否可能反映内皮损伤，我们检测了极低出生体重（VLBW）婴儿出生时的血浆血栓调节蛋白水平。
招募了45例VLBW婴儿，其中14例有围产期窒息并发症。作为对照，还研究了50例无并发症的足月儿。在出生后1小时内测量血浆血栓调节蛋白浓度、pH值、碱缺失、血清肌酐和D - 二聚体浓度、血小板计数和纤维蛋白原浓度。
VLBW婴儿与足月儿在血浆pH值、肌酐浓度、血小板计数、抗凝血酶III活性和D - 二聚体浓度方面存在显著差异。VLBW婴儿的血浆血栓调节蛋白浓度（39.0（16.6 - 93.7）对27.0（16.6 - 39.1）μg/L，p < 0.0001）和血浆血栓调节蛋白与血清肌酐比值（0.82（0.19 - 2.65）对0.47（0.24 - 0.70）μg/μmol，p < 0.0001）显著高于足月儿。对所有新生儿进行单因素分析，血浆血栓调节蛋白浓度与胎龄、出生体重、血浆pH值、肌酐浓度、血小板计数和抗凝血酶III活性之间存在显著关系。以上述变量为因变量的逐步多元线性回归模型显示，仅出生体重对血浆血栓调节蛋白浓度有显著贡献（血浆血栓调节蛋白浓度（μg/l）= 45.677 - 0.006（出生体重；g），r2 = 0.323，p < 0.0001，n = 94）。窒息的VLBW婴儿的血浆血栓调节蛋白浓度和血浆血栓调节蛋白与血清肌酐比值高于无窒息的婴儿，但差异无统计学意义（43.2±17.7对38.3±8.5μg/l和0.92±0.60对0.83±0.37μg/μmol）。
VLBW婴儿出生时血浆血栓调节蛋白水平较高，我们认为导致这种升高的主要因素可能是内皮损伤或血栓调节蛋白清除率低，这可能与孕早期有关。
