36周前分娩的宫内生长受限孕妇羊水促红细胞生成素与新生儿不良结局的关系  

Relationship between amniotic fluid erythropoietin and neonatal adverse outcome in fetal growth restriction pregnancy labored before 36 gestational week

作　　者：袁晓兰[1] 刘国成[1] 张丽[1] 齐一鸣[1] 侯亚萍[1] 段红丽[1] YUAN Xiaolan;LIU Guocheng;ZHANG Li;QI Yimin;HOU Yaping;DUAN Hongli.(GuangDong Women and Children＇s Hospital, Guangzhou 511400, China)

机构地区：[1]广东省妇幼保健院,广州511400

出　　处：《实用医学杂志》2018年第6期982-986,共5页The Journal of Practical Medicine

基　　金：广东省医学科学项目(编号:B2017057)

摘　　要：目的评估孕周在28~36周之间,提前分娩的宫内生长受限(FGR)孕妇羊水中促红细胞生成素(EPO)浓度与新生儿不良结局的关系,探讨其在分娩时机选择上的潜在临床意义。方法对我院产科2011年-2016年期间,因合并宫内生长受限而于28~36周期间分娩的单胎妊娠孕妇87例进行回顾性分析。所有研究对象均于剖宫产时或剖宫产前一周内采集羊水,测定EPO浓度,按经典划分方法以<27IU/L为正常组,≥27 IU/L为增高组。观察羊水EPO浓度与胎儿生物物理评分,脐动脉多普勒波形异常,血气参数及新生儿不良妊娠结局的关系。结果对于28~36周分娩的FGR妊娠孕妇而言,羊水EPO浓度增高组的新生儿复合不良结局发生率显著高于正常浓度组,差异有统计学意义(χ~2=9.49,P=0.002)。相关性分析发现,羊水EPO浓度与脐动脉血PH值(P<0.001,r=-0.908)和碱剩余(P<0.001,r=-0.624)呈负相关关系,与PCO_2呈正相关关系(P<0.001,r=0.631),与PO_2则无明显相关性(P=0.068,r=-0.197)。另外,羊水EPO浓度增高与胎儿生物物理活动评分及脐动脉多普勒波形异常亦无明显的关系。结论对于孕36周前的FGR妊娠孕妇,羊水EPO浓度的异常增高与新生儿不良结局有密切关系。羊水EPO浓度的监测有望成为明确其胎儿缺氧的一个额外指标,可帮助决定分娩的时间。Objectives To assess the relationship between amniotic fluid erythropoietin（EPO）and neona-tal adverse outcome in fetal growth restriction（FGR）pregnancy labored during 28-36 gestational weeks. To explorethe clinical application in timing of delivery. Methods The retrospective research had recruited 87 patients withsingle pregnancy complicated FGR,of which the gestational weeks range from 28 weeks to 36 weeks. All subjectswere collected from amniotic fluid at cesarean section or within a week of cesarean section. Amniotic fluid EPOwere detected according to the classical definition. We categorized EPO〈 27 IU/L as an normal state,whereas E-PO ≥ 27 IU/L as an abnormal state. The relationship between amniotic fluid EPO with biophysical profile,the flowvelocity waveform/blood gas parameters of the umbilical artery,and the neonatal adverse outcome were observed.Results For FGR pregnant women who chose 28-36 weeks for delivery,the incidence of neonatal adverse out-comes was significantly higher in the amniotic fluid EPO increased group than that in normal concentration group（χ^2= 9.49,P = 0.002）. Pearson analysis showed that amniotic fluid EPO concentration was negatively correlatedwith umbilical artery p H（P〈0.001,r =-0.908）and base excess（P〈0.001,r =-0.624）. However,it was pos-itively correlated with PCO2（P〈0.001,r = 0.631）,whereas there was no significant correlation between amnioticfluid EPO concentration and PO2（P = 0.068,r =-0.197）. In addition,neither biophysical profile nor flow velocitywaveform has difference in amniotic fluid EPO concentration. Conclusions The abnormal increased amniotic fluidEPO in FGR pregnant women who delivered before 36 gestational weeks were closely related to the adverse out-come of the newborn. The amniotic fluid EPO is expected to be an additional indicator of fetal hypoxia,which canhelp determine the time of birth.

关 键 词：宫内生长受限 促红细胞生成素 羊水 新生儿不良结局 

分 类 号：R714.5[医药卫生—妇产科学]