Abstract: Objectives To investigate the level of vitamin K₁ (VK₁)and protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ) in neonatal umbilical cord blood of different gestational age,and to discuss the influencing factors,so as to provide the basis for prevention and treatment of vitamin K deficiency hemorrhage and the application of vitamin K in clinical practice. Methods Neonates who did not have prophylactic use of vitamin K₁ born in the First Affiliated Hospital of Xi′an Jiaotong University and Shaanxi People′s Hospital from December 2016 to March 2017 were enrolled in this study,and the umbilical cord blood of 100 neonates were collected by random number method.The level of VK₁ was tested by high performance liquid chromatography-mass spectrometry,and the level of PIVKA-Ⅱ was tested by ELISA.Maternal history and related abnormal factors were investigated and recorded. Results The levels of VK₁ and PIVKA-Ⅱin 100 neonates were (0.293±0.135) ng/ml and (22.479 ± 13.151) AU/ml.The level of VK₁ was negatively related to that of PIVKA-Ⅱ(r=-0.362,P<0.001).The levels of VK₁ and PIVKA-Ⅱin neonatal umbilical cord blood were significantly different on the maternal education level,residence place and the intake of green vegetables during pregnancy (P＜0.05).Moreover,the amount of green vegetables intake was independently influencing factors for the levels of VK₁ and PIVKA-Ⅱ (P<0.05). Conclusions Neonates have high level of VK₁ and low level of PIVKA-Ⅱ in umbilical cord blood.The rate of subclinical and clinical vitamin K deficiency is higher,so it is crucial to monitor the levels of PIVKA-Ⅱand vitamin K for pregnant women and newborn infants.Increasing green vegetable intake during pregnancy and timely monitoring the levels of PIVKA-Ⅱand vitamin K for pregnant women and newborn infants,will help to prevent and find the subclinical and clinical vitamin K deficiency early.

Key words: vitamin K₁, PIVKA-Ⅱ, vitamin K deficiency bleeding, influencing factors

摘要： 目的 了解不同胎龄新生儿脐血维生素K₁及维生素K缺乏诱导蛋白(PIVKA-Ⅱ)水平,探讨其影响因素,为防治维生素K缺乏性出血及维生素K在临床的合理应用提供依据。方法 选择2016年12月-2017年3月在西安交通大学第一附属医院及陕西省人民医院出生,且尚未预防性注射维生素K₁的新生儿,按随机数字法采集100例新生儿脐血,用高效液相质谱法检测VK₁水平,用ELISA法检测PIVKA-Ⅱ水平,并记录产妇病史及相关异常因素。结果 100例新生儿脐血VK₁水平为(0.293±0.135) ng/ml, PIVKA-Ⅱ水平为(22.479±13.151)AU/ml,脐血VK₁水平与PIVKA-Ⅱ水平呈负相关(r=-0.362,P＜0.001)。孕母不同文化程度、不同居住地以及孕期食用绿色蔬菜的多少不同,其新生儿脐血VK₁水平、PIVKA-Ⅱ水平的差异有统计学意义(P＜0.05),其中孕期食用绿色蔬菜的多少是新生儿脐血VK₁,PIVKA-Ⅱ水平的独立影响因素(P＜0.05)。结论 新生儿的脐血VK₁含量较低,PIVKA-Ⅱ水平高。亚临床及临床VK缺乏率较高,围生期母儿PIVKA-Ⅱ、VK监测很有必要。提高孕母孕期绿色蔬菜摄入和孕母孕期、新生儿期PIVKA-Ⅱ、VK₁的监测,有助于预防和及早发现亚临床及临床VK缺乏。

关键词: 维生素K₁, PIVKA-Ⅱ, 维生素K缺乏性出血, 影响因素