间断性脐带闭塞对胎羊静脉导管搏动指数、Tei指数、脐血神经元特异性烯醇化酶、S100B蛋白的影响及其相关性分析  

Relationship between ductns venosus pulsatility index, Tei index, the serum levels of neuron specific enolase, S100B and intermittent umbilical cord occlusion of the near-term hircine fetus

作　　者：何韶铮[1] 吕国荣[1] 王振华[1] 李伯义[1] 陈秋月[1] 金鹏[1] 苏瑞娟[1] 

机构地区：[1]福建医科大学附属第二医院超声科,泉州362000

出　　处：《中华围产医学杂志》2007年第5期331-335,I0003,共6页Chinese Journal of Perinatal Medicine

基　　金：福建医科大学科研发展基金项目（FJGXY04023）;福建省科学基金高校专项（CD540002）

摘　　要：目的 探讨胎羊间断性脐带闭塞后静脉导管搏动指数（ductus venosus pulsatility index，DVPI）、Tel指数评估胎儿缺氧缺血性脑损伤的应用价值。方法 7只晚孕山羊作为实验组，于妊娠116～130d对胎羊行宫内外科手术，用套囊充气闭合器完全夹闭脐带，每次夹闭90S，间隔30min，重复5次。于实验前5min、每次夹闭后3min应用彩色多普勒血流显像技术检测DVPI、Tei指数，抽取胎羊脐动脉血做血气分析，应用电化学发光法测定脐血神经元特异性烯醇化酶（neuron specific enolase，NSE）、S100B蛋白含量，同时分析这些指标的相关性。另选5只晚孕山羊作为对照组，只手术不夹闭脐带。结果 实验组胎羊脐动脉血PaO2和pH随夹闭时间下降，PaCO2、DVPI、右心室和左心室Tei指数、脐血NSE和S100B均随夹闭时间而升高（P均〈0．05）。实验组夹闭后PaO2低于对照组，夹闭后36min开始pH值低于对照组，PaCO2高于对照组；从夹闭后36min开始实验组NSE和S100B蛋白较对照组升高（P均〈0．05）。实验组DVPI、右心室Tei指数、左心室Tei指数、脐血NSE、S100B含量与血pH值呈负相关（r分别为-0．358、-0．538，-0．681、-0．388、-0．539，P均〈0．05），与血PaO2呈负相关（r分别为-0．435、-0．684、-0．725、-0．602，-0．447，P均〈0．01），与血PaCO2呈正相关（r分别为0．699、0．682、0．780、0．477、0．527，P均〈0．01）。实验组DVPI、右心室和左心室Tei指数与血清NSE含量呈正相关（r分别为0．394、0．653、0．687，P均〈0．05），与血清S100B含量呈正相关（r分别为0．359、0．606、0．640，P均〈0．05）。结论 Tei指数与血气指标及血清NSE、S100B的相关性较好，可能成为预测胎儿缺氧缺血性脑损伤简便而有效的指标。Objective To explore the value of the ductus venosus pulsatility index （DVPI）and Tei index in evaluating fetal hypoxic-ischemic brain damage of near-term hircine fetus model after intermittent umbilical cord occlusion （UCO）. Methods Seven fetal goats （occlusion group） received intrauterine umbilical cord occlusions （total cord occlusion for 90 seconds every 30 minutes for 5 times） at 116-130 days of gestation, and 5 fetal goats who did not received occlusions as control group. The Fetal arterial blood samples were collected to detect the blood gas and serum S100B, neuron specific enolase （NSE） level. And DVPI value, Tel index of right ventricular （RV） and left ventricular（LV） of the goats were also detected at 5 minutes before the first umbilical cord occlusion and 3 minutes after each occlusion. Results In occlusion group, pH and PaO2 in umbilical arterial decreased with occlusion time, while PaCO2 , DVPI, Tei index, NSE and S100B increased （P〈0. 05, respectively）. After occlusion, PaO2 in occlusion group was lower than control group at every time points （P〈0. 05）. Comparing with control group, from the beganing of 36 min after occlusion, PaCO2 and the levels of NSE and S100B in occlusion group increased, while pH was decreased（P〈 0.05）. The DVPI, RV Tel index, LV Tei index, NSE and S100B had negative correlation with pH and PaO2 （P〈0.01, respectively）, while positive relationship with PaCO2 （P〈0. 01, respectively）. The DVPI, RV Tel index, LV Tei index had positive relationship with the serum levels of NSE （r= 0.394, 0.653, 0.687, P〈0.05, respectively） and S100B （r=0.359, 0.606,0.640, P〈0.05, respectively）. Conclusions There were relations between Tel index and blood gas, serum level of NSE and S100B. And Tei index might be a convenient and useful index for predicting fetal hypoxic-ischemic brain damage.

关 键 词：胎儿缺氧 超声检查 产前 磷酸丙酮酸水合酶 S100蛋白质类 血液动力学现象 血气分析 

分 类 号：R714[医药卫生—妇产科学]