探讨低剂量维生素K对病理性黄疸早产儿(PJPI)血清胆红素水平及血液学指标的影响。

选择2019年5月至2020年5月，于惠州市第二妇幼保健院就诊的68例PJPI为研究对象。采用随机数字表法，将其随机分为研究组(n＝34，采取肌内注射低剂量维生素K 1 mg/次×1次/d×7 d+蓝光照射治疗7 d)和对照组(n＝34，仅采取蓝光照射治疗7 d)。对2组PJPI均于治疗第7天或出院前24 h内，进行血清总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、血小板计数、白细胞计数、红细胞计数、血清红蛋白浓度(Hb)，活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)及凝血酶时间(TT)检测。2组PJPI上述指标比较，采用成组t检验或Mann-Whitney U检验。本研究遵循的程序符合病例收集医院医学伦理委员会要求，经过其伦理委员会批准[审批文号：深妇幼伦审(2019)128号]，并与所有受试儿监护人签署临床研究知情同意书。2组PJPI性别构成比及入院时体重、身长等一般临床资料比较，差异均无统计学意义(P>0.05)。

治疗后，2组PJPI血清胆红素水平及血液学指标比较结果如下。①研究组PJPI血清TBIL、DBIL、IBIL浓度分别为(130.0±35.6)、(18.6±4.7)、(111.3±37.4) μmol/L，均显著低于对照组的(152.0±14.7)、(21.6±4.8)、(130.4±13.7) μmol/L，并且差异均有统计学意义(t＝2.864、2.668、2.282，P＝0.004、0.008、0.023)。②研究组PJPI白细胞计数为(8.6±3.5)×10⁹/L，显著低于对照组的(10.8±2.9)×10⁹/L，并且差异有统计学意义(t＝2.811，P＝0.005)。2组PJPI血小板计数、红细胞计数与Hb水平分别比较，差异均无统计学意义(P>0.05)。③2组PJPI的APTT、PT、Fib水平、TT分别比较，差异均无统计学意义(P>0.05)。

肌内注射低剂量维生素K联合蓝光照射治疗，可有效降低PJPI血清胆红素水平与白细胞计数，控制病情进展，可能是临床治疗PJPI的潜在有效方案。

To explore effects of low-dose vitamin K on serum bilirubin level and hematological indexes of pathological jaundice of premature infants (PJPI).

A total of 68 cases of PJPI in Huizhou No.2 Women′s and Children′s Healthcare Hospital from May 2019 to May 2020 were selected as research subjects, and they were randomly sorted into study group (n=34, received intramuscular injection of low-dose vitamin K 1 mg once-daily for 7 days + blue light therapy for 7 days) and control group (n=34, only received blue light therapy for 7 days) by random digits table method. Serum levels of total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), platelet count, white blood cell count, red blood cell count, hemoglobin (Hb), activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (Fib) and thrombin time (TT) of PJPI in two groups were detected on day 7 of vitamin K treatment or within 24 h before discharge. The above indexes of PJPI in two groups were compared by independent-samples t test or Mann-Whitney U test. This study met requirements of the Ethics Committee of cases collected hospital, and was approved by this committee [approval No. SFYLS(2019)128], and guardians of all premature infants signed clinical research informed consent forms. There were no statistically significant differences in general clinical data of premature infants between two groups, such as gender, body weight and length at admission (P>0.05).

After treatment, comparison results of serum bilirubin levels and hematological indexes of PJPI in two groups were as follows. ①Serum TBIL, DBIL and IBIL concentrations in study group were (130.0±35.6), (18.6±4.7), (111.3±37.4) μmol/L respectively, which were significantly higher than those in control group (152.0±14.7), (21.6±4.8), (130.4±13.7) μmol/L, and all differences were statistically different (t=2.864, 2.668, 2.282; P=0.004, 0.008, 0.023). ②White blood cell count in study group was (8.6±3.5)×10⁹/L, which was significantly lower than that in control group (10.8±2.9)×10⁹/L, and the difference was statistically significant (t=2.811, P=0.005). However, platelet count, red blood cell count and serum Hb level showed no statistically differences between two groups (P>0.05). ③There were no statistically significant differences in APTT, PT, Fib and TT between two groups after treatment (P>0.05).

Intramuscular injection of low-dose vitamin K combined with blue light therapy can effectively reduce serum level of bilirubin and white blood cell count of PJPI, and control the progress of pathological jaundice. Vitamin K may be a potential clinical strategy for treatment of PJPI.