头孢菌素治疗对细菌性感染婴幼儿出血风险的影响

邸晓华 柴鸣荣 严广荣 陈雪筠

[摘要]目的 探讨头孢菌素治疗婴幼儿细菌性感染对维生素K水平的影响。方法 选取2017年7月～2018年12月我院收治的150例使用头孢菌素治疗的细菌性感染婴幼儿外周血，采用高效液相色谱仪（HPLC）检测维生素K浓度;酶联免疫吸附试验（ELISA）检测凝血酶原前体蛋白（PIVKA-Ⅱ）;血凝仪测凝血酶原时间（PT）、部分活化凝血活酶時间（APTT）及纤维蛋白原（FIB）值，比较用药前后上述参数的变化。结果 头孢菌素使用5～7 d未导致患儿出现明显出血倾向，主要表现为用药后患儿与用药前比较，外周血PT、APTT、FIB、维生素K值差异无统计学意义（P>0.05）;用药后PT、APTT、FIB、维生素K异常率与用药前比较差异无统计学意义（P>0.05）。但药物使用后使患儿潜在出血风险升高：用药后PIVKA-Ⅱ浓度低于用药前，差异有统计学意义（P<0.05）;用药后PIVKA-Ⅱ异常率高于用药前，差异有统计学意义（P<0.05）。结论 短期内使用头孢菌素并没有证据表明可导致婴幼儿出现明显出血倾向。但药物使PIVKA-Ⅱ水平下降表明患儿潜在出血风险升高。

[关键词]头孢菌素;婴幼儿;凝血功能;凝血酶原前体蛋白;维生素K

[中图分类号] R723          [文献标识码] A          [文章编号] 1674-4721（2019）8（a）-0110-03

[Abstract] Objective To investigate the effect of Cephalosporin on vitamin K level in infants with bacterial infections. Methods The peripheral blood of 150 infants and young children infected with Cephalosporin treated with cephalosporin was selected from July 2017 to December 2018. The concentration of vitamin K was detected by HPLC; Enzyme linked immunosorbent assay （ELISA）was used to detect prothrombin precursor protein （PIVKA-Ⅱ）. The values of prothrombin time （PT）， partial activated thrombin time （APTT）， and fibrinogen （FIB） were measured with the coagulometer， and the changes of the above parameters before and after treatment were compared. Results The use of cephalosporin for 5-7 days did not lead to obvious bleeding tendency. The main manifestations were：Comparison between children before and after medication： there were no statistically significant differences in PT， APTT， FIB and vitamin K values in peripheral blood （P>0.05）. The abnormal rates of PT， APTT， FIB and vitamin K were not statistically significant between children before and after medication （P>0.05）. However， the concentration of PIVKA-Ⅱ after dministration was lower than that before administration， and the difference was statistically significant （P<0.05）. The abnormal rate of PIVKA-Ⅱ after treatment was higher than that before treatment， and the difference was statistically significant （P<0.05）. Conclusion The use of Cephalosporins in the short term has no evidence that it can lead to significant bleeding tendency in infants and young children. However， a decrease in the level of PIVKA-Ⅱ indicates an increased risk of potential bleeding in the child.

[Key words] Cephalosporin; Infants and young children; Coagulation function; PIVKA-Ⅱ; Vitamin K

头孢菌素因其药物安全性高，成为治疗儿童细菌性感染疾病的临床常用药物。近些年有报道某些头孢菌素可引起维生素K缺乏及维生素K依赖性凝血因子缺乏，使得患者出血风险增高[1-3]，因婴幼儿这一特殊人群的生理结构特点，可能对其危害尤其大，可导致诸如颅内出血等重要脏器的出血。若能在早期预测维生素K缺乏，可能为早期干预治疗提供宝贵时机。近些年国内外学者比较热衷亚临床维生素K缺乏的研究，亚临床维生素K缺乏是指机体缺乏维生素K的早期，尚未引起明显凝血功能障碍及出血风险，若能在这一阶段及时做出判断并给予干预，可避免出血风险。本研究选取婴幼儿这一特殊人群，选用几种儿童常用头孢菌素，研究药物治疗后对婴幼儿凝血功能及维生素K水平的影响，以期为药物风险评估及临

综上所述，平时体质正常的婴幼儿短期使用头孢菌素（1周内）虽然未发现明显出血风险，但患者出现亚临床维生素K缺乏风险增高。提醒临床医师必要时可行药物维生素K补充早期预防出血发生。

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（收稿日期：2019-05-06  本文編辑：崔建中）