頭孢菌素治療對細菌性感染嬰幼兒出血風險的影響

邸曉華 柴鳴榮 嚴廣榮 陳雪筠

[摘要]目的 探討頭孢菌素治療嬰幼兒細菌性感染對維生素K水平的影響。方法 選取2017年7月～2018年12月我院收治的150例使用頭孢菌素治療的細菌性感染嬰幼兒外周血，采用高效液相色譜儀（HPLC）檢測維生素K濃度;酶聯(lián)免疫吸附試驗（ELISA）檢測凝血酶原前體蛋白（PIVKA-Ⅱ）;血凝儀測凝血酶原時間（PT）、部分活化凝血活酶時間（APTT）及纖維蛋白原（FIB）值，比較用藥前后上述參數(shù)的變化。結果 頭孢菌素使用5～7 d未導致患兒出現(xiàn)明顯出血傾向，主要表現(xiàn)為用藥后患兒與用藥前比較，外周血PT、APTT、FIB、維生素K值差異無統(tǒng)計學意義（P>0.05）;用藥后PT、APTT、FIB、維生素K異常率與用藥前比較差異無統(tǒng)計學意義（P>0.05）。但藥物使用后使患兒潛在出血風險升高：用藥后PIVKA-Ⅱ濃度低于用藥前，差異有統(tǒng)計學意義（P<0.05）;用藥后PIVKA-Ⅱ異常率高于用藥前，差異有統(tǒng)計學意義（P<0.05）。結論 短期內使用頭孢菌素并沒有證據(jù)表明可導致嬰幼兒出現(xiàn)明顯出血傾向。但藥物使PIVKA-Ⅱ水平下降表明患兒潛在出血風險升高。

[關鍵詞]頭孢菌素;嬰幼兒;凝血功能;凝血酶原前體蛋白;維生素K

[中圖分類號] R723? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 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

頭孢菌素因其藥物安全性高，成為治療兒童細菌性感染疾病的臨床常用藥物。近些年有報道某些頭孢菌素可引起維生素K缺乏及維生素K依賴性凝血因子缺乏，使得患者出血風險增高[1-3]，因嬰幼兒這一特殊人群的生理結構特點，可能對其危害尤其大，可導致諸如顱內出血等重要臟器的出血。若能在早期預測維生素K缺乏，可能為早期干預治療提供寶貴時機。近些年國內外學者比較熱衷亞臨床維生素K缺乏的研究，亞臨床維生素K缺乏是指機體缺乏維生素K的早期，尚未引起明顯凝血功能障礙及出血風險，若能在這一階段及時做出判斷并給予干預，可避免出血風險。本研究選取嬰幼兒這一特殊人群，選用幾種兒童常用頭孢菌素，研究藥物治療后對嬰幼兒凝血功能及維生素K水平的影響，以期為藥物風險評估及臨

綜上所述，平時體質正常的嬰幼兒短期使用頭孢菌素（1周內）雖然未發(fā)現(xiàn)明顯出血風險，但患者出現(xiàn)亞臨床維生素K缺乏風險增高。提醒臨床醫(yī)師必要時可行藥物維生素K補充早期預防出血發(fā)生。

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（收稿日期：2019-05-06? 本文編輯：崔建中）