The Changes Of Serum Platelet-activating Factor, Thrombomodulin And The Function Of Blood Coagulation And Fibrinolysis Of The Neonate With Meconium Aspiration Syndrome

Objective:Meconium Aspiration Syndrome (MAS) is acritical disease in neonatal period.Its incidence rate and casefatality rate in live births is very high and meconium aspirationsyndrome coincidences frequent hemorrhoid,persistentpulmonary hypertension of the newborn (PPHN),acuterespiratory distress syndrome(ARDS), chronic lungdisease(CLD),pulmonary hemorrhage and so on. Meconiumaspiration syndrome not only has a high case fatality rate,difficult clinical therapy and very long course of the disease ,butalso impact the life quality of the child.But the pathogenesis ofmeconium aspiration syndrome is not very clear up tonow.Inflammation and endothelial cell injury are critical in thepathogenesis of meconium aspiration syndrome.In clinicalwork,we find the neonate with meconium aspiration syndromealways coincidences skin petech,ecchymosis,coagulatingimmediately in drawing vein blood or the puncture spotcapillary hemorrhage.This phenomenon hint the change ofcoagulation in meconium aspiration syndrome,especially in thesevere case.This change is possible relevant with PPHN andARDS.Through the investigation of serum platelet-activatingfactor(PAF), thrombomodulin(TM) and plasma plasminogenactivator(tPA),plasminogen activator inhibitor-1 (PAI-1),D-Dimer levels and white blood cell count (WBC),plateletcount(PLT) in meconium aspiration syndrome.We hypothesis itcan give some numerrical data for investigate the pathogenesisof MAS and give some scientific evaluation for clinical to treatneonate with MAS.Methods: All the cases were diagnosed in Hebei Province Children Hospital and treated from 2003.11.1 to2004.11.1, less than 24hour,weight2500g-4000g,gestation age37-42week. Group(A) have 30 health full-term newborns. Group(B) includes 30 samples who were diagnosed to be massive aminotic fluid aspiration. Experimental groups(group C and D )consist of 60 newborns who were diagnosed to be with MAS,except congenital bronchi-pumonary dysplasia, congenital diaphragmatic,congenital heart disease and congenital coagulation disorders.According to their symptom,they are divided to two groups.In group C(no symptom case or popular case),there are 30 patients, who have accelerated breathing,cyanochroia or light symptom and revert eupnea in one or two weeks .In group D( the severe case), there are 30 patients. In this group MAS patients with type â…¡ acute respiratory distress(arterial blood analysis: PH<7.2, PaO2<6.65Kpa , PaCO₂>9.33 Kpa) required mechanical ventilation.All of them were intubated and mechanicallyventilated with IPPV+PEEP mode of neonatal VIP bird ventilators.In 24 hour ,72-96hour after birth, 3ml vein blood was taken from each newborn with empty stomach quickly,then 1ml was dropped to one empty tube,2ml was dropped to another tube mixed evenly with 0.9% natrium citricum 0.2ml, and treated with centrifugation at 4℃,3000rpm 10 minutes .Serum and plasma were obtained and put in refrigerator at -40℃, blood white cell count,platelet count and arterial blood analysis were done at the same time .The samples were again mixed evenly at room temperature before test,and again treated with at 4℃,3000rpm for 10 minutes .PAF TM t-PA PAI-1 D-Dimer were analyses by EILSA technique.During implementing the test ,we strictly adhered to the operation precedure showed in the instruction manuals.SPSS11.5 were used to deal with the data.P values<0.05 were considered to indicate statistical significance.Results:1 Within 24hour after birth, the concentration of PAF tPAof massive aminotic fluid aspiration group(B) were significantincreased and D-Dimer decreased obviously than healthfull-term newborn group(A),(P<0.01),but the concentration ofTM PAI-1 PAI-1/tPA PLT WBC had no differencesbetween these two groups. All of the index of the popular caseof MAS(C) were significant different with health full-termnewborn group(A)(P<0.01).The concentration of D-Dimer ofthe popular case of MAS(C) was not significant different withhealth full-term newborn group(A)(P>0.05),but the other indexwere significant different(P<0.01). the severe case of MAS(D)had the higher concentration of PAF TM tPA PAI-1 PAI-1/tPA WBC and lower concentration of D-Dimer PLT than healthfull-term newborn group(A), but had the higher concentration ofPAF TM tPA PAI-1 PAI-1/ tPA D-Dimer WBC and lowerconcentration of PLT than massive aminotic fluid aspirationgroup(B) ( P<0.01 ) .Among MAS groups(C D), Theconcentration of PAF tPA D-Dimer WBC in the severecase of MAS (D)were significant increased than the popularcase of MAS (P<0.05),but The concentration of TMPAI-1 PAI-1/ tPA PLT had no differences between them(P>0.05). 2 In 72-96hours after birth, the concentration of PAF ofmassive aminotic fluid aspiration group(B) were significantincreased and D-Dimer decreased obviously than healthfull-term newborn group(A)(P<0.01), the concentration of TMTPA PAI-1 PLT WBC had no differences in these two groups(P>0.05).The concentration of PAF TM TPA WBC PLT ofMAS patients(C ,D) were significant increased and D-Dimerdecreased obviously than health full-term newborn group(A)(P<0.01),but the concentration of PAI-1/ tPA had nodifferences between them. MAS patients have the higherconcentration of PAF TM TPA PAI-1 PAI-1/ tPA PLT WBC thanmassive aminotic fluid aspiration patients (P<0.05),theconcentration of PAI-1/ tPA D-Dimer had no differences inthese two groups . Among MAS groups(C ,D), Theconcentration of PAF TM in the severe case of MAS weresignificant increased than the popular case of MAS(P<0.05),but The concentration of tPA PAI -1 PAI-1/ tPAD-Dimer WBC PLT have no differences(P>0.05).3 the concentration of PAF TM tPA PAI-1 PAI-1/ tPAD-Dimer WBC PLT in different group are different within24hour comparing to in 72-96hour. Within 24hour after birth thehealth full-term newborns have the higher concentration of TMtPA PAI-1 WBC (P<0.05),but the concentration of D-Dimerchange oppositely ( P<0.01 ) than in 72-96hour,but theconcentration of PAF PLT have no difference in different time(P>0.05).The concentration of each detected index in massiveaminotic fluid aspiration group(B) had the same changetendency with the health full-term newborns group(A) .Theconcentration of PAF TM tPA PAI-1 D-Dimer WBC decreasedobviously and PAI-1/ tPA increased gradually(P<0.01), but theconcentration of PLT have no difference in different time(P>0.05). The concentration of PAF TM tPA PAI-1 D-DimerWBC of the popular case of MAS(C) decreased gradually andthe concentration of PAI-1/ tPA PLT increased with the timedevelopment(P<0.01).The concentration of TM PAI-1/ tPA PLTof the severe case of MAS(D) increased significantly and theconcentration of PAF tPA PAI-1 D-Dimer WBC decreasedgradually with the pathogenetic condition aggravation(P<0.01).4 Associativity analysis show PAF had obvious correlationwith TM PAI-1/tPA tPA D-Dimer WBC PLT.Further partialcorrelation analysis show TM had obvious correlation withWBC PLT , correlation coefficient were r=0.3422 andr=-0.2758.tPA had obvious correlation with WBC correlationcoefficient was r= 0.2644.PAI-1/tPA had obvious correlationwith D-Dimer,correlation coefficient was r=0.2464.Conclusion:1 White blood cell count of the health full-term newborns in 24hour after birth is higher than in 72-96hour after birth.The function of blood coagulation and fibrinolysis is at dynamic balanced state of high level.2 Massive aminotic fluid aspiration may lead to inflammatory reaction and the decreased function of fibrinolysis.3 The pathogenesis of meconium aspiration syndrome is other than Massive aminotic fluid aspiration. Meconium is critical in the pathogenesis of meconium aspiration syndrome.4 The concentration of PAF,WBC of MAS patients increased significantly in 24hour,but PLT count change oppositely.Inflammatory reaction is the critical pathological change in MAS.5 Vascular endothelial cell injured is an other critical pathological change in MAS.The concentration of TM of MAS patients increased significantly with patients condition aggravation. The concentration of TM is an signal of organ...