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  • 王思璐,刘江勤,黄丽萍,乔晓红,谢晓恬.脐动脉血促红细胞生成素水平与早产儿围产期因素的相关性及临床意义[J].第二军医大学学报,2019,40(12):1344-1349    [点击复制]
  • WANG Si-lu,LIU Jiang-qin,HUANG Li-ping,QIAO Xiao-hong,XIE Xiao-tian.Correlation between umbilical artery erythropoietin level and perinatal factors in premature infants and its clinical significance[J].Acad J Sec Mil Med Univ,2019,40(12):1344-1349   [点击复制]
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脐动脉血促红细胞生成素水平与早产儿围产期因素的相关性及临床意义
王思璐1,刘江勤2,黄丽萍2,乔晓红1,谢晓恬1*
0
(1. 同济大学附属同济医院儿科, 上海 200065;
2. 同济大学附属第一妇婴保健院新生儿科, 上海 201204
*通信作者)
摘要:
目的 探讨脐动脉血促红细胞生成素(EPO)水平与早产儿围产期因素的相关性及其临床意义。方法 收集2019年1月至2019年6月在同济大学附属第一妇婴保健院东院出生的107名新生早产儿脐动脉血,用酶联免疫吸附试验(ELISA)和化学发光分析法分别检测脐动脉血EPO和铁蛋白水平。依据脐动脉血EPO水平四分位数将早产儿分为3组:低位组、中位组、高位组。分析脐动脉血EPO水平与早产儿围产期因素(出生胎龄、出生体质量等)、常见并发症[早产儿贫血(AOP)、坏死性小肠结肠炎(NEC)、动脉导管未闭(PDA)和房间隔缺损(ASD)等]、孕母条件等临床特征的关系。结果 107名新生早产儿脐动脉血EPO水平为5.94~137.18 mU/mL,中位数为23.51(14.60,51.28)mU/mL,低位(脐动脉血EPO水平 < 14.60 mU/mL)组26例、中位(14.60~51.27 mU/mL)组54例、高位(≥ 51.28 mU/mL)组27例。单因素分析显示,低位组的早产儿出生胎龄低于中位组和高位组,孕母年龄高于中位组和高位组,自然受孕率低于高位组,早产儿出生后持续气道正压通气(CPAP)使用率高于中位组(P均<0.05);中位组早产儿脐动脉血铁蛋白水平高于高位组(P<0.05);高位组早产儿AOP的发生率高于中位组(P<0.05)。多重线性回归分析显示,脐动脉血EPO水平与新生早产儿出生胎龄及孕母自然受孕率均呈正相关(P均<0.01)。Logistic回归多因素分析显示,自然受孕率越高早产儿脐动脉血EPO水平越高,自然分娩率越高脐动脉血EPO水平越低(P均<0.05);脐动脉血EPO水平越高,PDA、NEC发生风险越低,ASD发生风险越高(P均<0.05)。结论 受孕方式与分娩方式是脐动脉血EPO水平的影响因素,监测脐动脉血EPO水平有助于判断早产儿AOP、PDA、ASD、NEC等常见并发症的发生情况。
关键词:  脐动脉血  促红细胞生成素  早产儿  围产期学  并发症
DOI:10.16781/j.0258-879x.2019.12.1344
投稿时间:2019-09-11修订日期:2019-10-30
基金项目:上海市先进适宜技术推广项目(2013SY073).
Correlation between umbilical artery erythropoietin level and perinatal factors in premature infants and its clinical significance
WANG Si-lu1,LIU Jiang-qin2,HUANG Li-ping2,QIAO Xiao-hong1,XIE Xiao-tian1*
(1. Department of Pediatrics, Tongji Hospital, Tongji University, Shanghai 200065, China;
2. Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai 201204, China
*Corresponding author)
Abstract:
Objective To explore the correlation between umbilical artery blood erythropoietin (EPO) level and perinatal factors in premature infants and its clinical significance. Methods Umbilical artery blood samples from 107 premature infants born in the Eastern Branch of Shanghai First Maternity and Infant Hospital of Tongji University between Jan. 2019 and Jun. 2019 were collected. The levels of EPO and ferritin were measured by ELISA and chemiluminescence assay, respectively. The 107 infants were divided into three groups according to the quartile EPO level:low level group, medium level group and high level group. The relationship between umbilical artery blood EPO level and gestational age, birth body mass and other perinatal factors, the incidence of anemia of prematurity (AOP), necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA) and atrial septal defect (ASD) in premature infants, and the clinical characteristics of pregnant mothers was analyzed. Results The EPO level of umbilical artery blood in 107 newborn premature infants was 5.94-137.18 mU/mL, and the median level was 23.51 (14.60, 51.28) mU/mL. There were 26 cases in the low level group (the EPO level < 14.60 mU/mL), 54 in the medium level group (14.60-51.27 mU/mL), and 27 cases in the high level group (≥ 51.28 mU/mL). Univariate analysis showed that the gestational age of the infants in the low level group was significantly lower than those in the medium level group and the high level group (both P<0.05), the age of the pregnant mothers was significantly higher than those in the medium level group and the high level group (both P<0.05), the natural pregnancy rate was significantly lower than that in the high level group (P<0.05), and the continuous positive airway pressure (CPAP) usage rate of the infants was significantly higher than that in the medium level group (P<0.05). The ferritin level of umbilical artery blood was significantly higher in the midium level group than that in the high level group (P<0.05). The incidence of AOP in the high level group was significantly higher than that in the midium level group (P<0.05). Multiple linear regression analysis showed that the EPO level of umbilical artery blood was positively correlated with the gestational age of newborn premature infants and the natural pregnancy rate of pregnant mothers (both P<0.01). Multivariate logistic regression analysis showed that the higher the natural pregnancy rate, the higher the level of EPO in umbilical artery blood, and the higher the natural delivery rate, the lower the level of EPO in umbilical artery blood. The risks of PDA and NEC decreased and the risk of ASD increased with the increase of EPO level in umbilical artery blood (all P<0.05). Conclusion Conception method and delivery mode are the influencing factors of EPO level in umbilical artery blood. Monitoring the EPO level of umbilical artery blood is helpful to diagnose the common complications such as AOP, PDA, ASD and NEC in premature infants.
Key words:  umbilical artery blood  erythropoietin  premature infants  perinatology  complications