Vitamin K Deficiency Chinese Infants

中國嬰兒維他命K缺乏症

林明燦(Ming-Tsan Lin) ； 沈銘鏡(Ming-Ching Shen) ； 曾龍彥(Lon-Yeh Tsao)

《Acta Paediatrica Sinica》 28卷6期 (1987/12) Pp. 401-411

摘要

彰化基督教醫院自1976年6月至1987年2月共經歷了89個嬰兒維他命K缺乏症的病例，本文就其病史，臨床症狀及凝血檢驗結果做一回顧性分析。病人年齡分佈自12天到4個月大，而以2週到2個月為最多，男女比例約為1.8:1，病例多數發生於秋冬兩季，所有病人都是足月兒，無週產期併發症，出生時只有1例曾注射維他命K，絕大多數純以母乳餵食(89.9%)，發病前都健康良好無外傷，但32%病人曾有輕微的前驅症狀，少數病人(17.9%)有肝腫大現象，發病症狀主要是不明原因的蒼白，燥動，拒食，前囪門隆起，抽筋，血便，肚臍或注射針孔溶血不止，顱內出血比例高達75.4%，而以蜘蛛膜下腔出血佔最多。
所有病人的PT及PTT都顯著延長而血小板都正常，十例做過詳細的凝血因子檢驗，結果顯示和維他命K有關的Ⅱ、Ⅶ、Ⅸ、Ⅹ凝血因子都極度缺乏，但fibrinogen和factorⅡ antigen卻正常，在給予維他命K 1-2mg治療後，所有病人的出血症狀都迅速停止，且在10至24小時內PT，APTT及缺乏的Ⅱ、Ⅷ、Ⅸ、Ⅹ凝血因子都已恢復正常。17例中有4例肝臟轉氨酶有輕度增加，15例中有13例血清膽紅素增高，有顱內出血者死亡率為26.5%，全部病例的死亡率為20%。本文並就嬰兒凝血因子的生理起伏變化、母親授乳期的飲食俗信、母乳、腸道感染及肝機能異常等因素與維他命K缺乏之關係加以探討，並特別強調出生時注射維他命K的重要性。

並列摘要

Eighty-nine Chinese infants were diagnosed as vitamin K deficiency in Changhua Christian Hospital during the period from June 1976 to February 1987. Their ages ranged from 12 days to 4 months; most were between 2 weeks and 2 months old. The male to female ratio was 1.8 to 1. All patients were full-term infants, and 89.9% of them were exclusively breast fed. Only one out of 89 cases had vitamin K injection at birth. All were apparently healthy until bleeding occurred spontaneously, and only 32 per cent had mild preceding symptoms. Mild hepatomegaly was noted in 17.9% of patients. Bleeding and pallor were the most noticeable features. The incidence of intracranial hemorrhage (ICE) was strikingly high (75.4%), particularly with subarachnoid hemorrhage.
Marked prolongation of prothrombin time and partial thromboplastin time with normal platelet levels were noted in all patients. A severe deficiency of vitamin K-dependent factors (II, VII, IX, and X) was found in all 10 patients studied. Normal coagulant activities were rapidly restored after administration of vitamine K. Liver chemistry showed mildly elevated serum transaminase in 4 of 17 cases, and abnormal bilirubin levels were noted in 13 out of 15 cases. Mortality of patients with ICH was 26.5%, and overall mortality rate of vitamin K deficiency patients was 20%. Possible causes of vitamin K deficiency are discussed, but no definite conclusions can be drawn. Further investigation of the pathogenesis of vitamin K deficiency is needed.

並列關鍵字

vitamin K deficiency ； breast feeding ； intracranial hemorrhage ； hepatic dysfunction