影响新生儿氨基酸代谢的多因素分析  

Multivariate analyses of factors that affect neonatal screening amino acids

作　　者：周婧瑶[1] 张钰[1] 胡琦[1] 陈雪莲[1] 杨丽涓 张亚果[1] 苏星月 杨云霞[1] 欧明才[1] Zhou Jingyao;Zhang Yu;Hu Qi;Chen Xuelian;Yang Lijuan;Zhang Yaguo;Su Xingyue;Yang Yunxia;Ou Mingcai(Department of Neonatal Disease Screening,Sichuan Provincial Maternity and Child Health Care Hospital,Chengdu 610045,China)

机构地区：[1]四川省妇幼保健院新生儿疾病筛查科,成都610045

出　　处：《中华实用儿科临床杂志》2020年第23期1773-1776,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家重点研发计划(2017YFC1001703)。

摘　　要：目的探讨新生儿体内氨基酸变化特点,为临床精准判读提供理论依据。方法在2018年1月至12月四川地区采用串联质谱技术进行遗传代谢病(IMD)筛查的32855例新生儿中,纳入经初筛、复查确定为未患IMD的32843例新生儿。根据胎龄(早产儿1363例,足月儿31468例,过期产儿12例)、采血时间(日龄3~7 d采血30958例、8~28 d采血1637例、>28 d采血248例)、出生季节(第1季度出生7737例、第2季度出生11428例、第3季度出生5482例、第4季度出生8196例)进行分组,比较各组新生儿体内氨基酸的水平差异,分析多种影响因素与代谢指标的相关性。结果1.新生儿体内11种氨基酸[丙氨酸(ALA)、精氨酸(ARG)、瓜氨酸(CIT)、甘氨酸(GLY)、亮氨酸+异亮氨酸+羟脯氨酸(LEU+ILE+PRO-OH)、蛋氨酸(MET)、鸟氨酸(ORN)、苯丙氨酸(PHE)、脯氨酸(PRO)、酪氨酸(TYR)、缬氨酸(VAL)]均呈非正态分布。2.按胎龄分组,除PHE(H=0.61,P>0.05)、TYR(H=2.02,P>0.05)差异无统计学意义外,ALA(H=187.11,P<0.05)、ARG(H=23.60,P<0.05)、CIT(H=22.90,P<0.05)、GLY(H=85.18,P<0.05)、LEU(H=56.42,P<0.05)、MET(H=18.74,P<0.05)、ORN(H=129.27,P<0.05)、PRO(H=344.40,P<0.05)、VAL(H=272.92,P<0.05)差异均有统计学意义。3.按采血时间分组,ALA(H=65.19,P<0.05)、ARG(H=404.48,P<0.05)、CIT(H=502.13,P<0.05)、GLY(H=1719.44,P<0.05)、LEU(H=396.41,P<0.05)、MET(H=199.39,P<0.05)、ORN(H=31.26,P<0.05)、PHE(H=325.49,P<0.05)、PRO(H=70.09,P<0.05)、TYR(H=159.29,P<0.05)、VAL(H=102.52,P<0.05)差异均有统计学意义。4.按出生季节分组,ALA(H=401.37,P<0.05)、ARG(H=3229.03,P<0.05)、CIT(H=65.45,P<0.05)、GLY(H=597.82,P<0.05)、LEU(H=1120.42,P<0.05)、MET(H=10515.18,P<0.05)、ORN(H=1275.23,P<0.05)、PHE(H=2260.17,P<0.05)、PRO(H=319.57,P<0.05)、TYR(H=884.37,P<0.05)、VAL(H=1824.49,P<0.05)差异均有统计学意义。结论新生儿体内氨基酸根据不同胎龄、出生季节和采血时间,呈不同的代谢差异,采用串联质谱技术检测时应根据不同条件选择适�Objective To explore the change characteristics of amino acid levels in neonates,so as to provide theoretical basis for accurate clinical interpretation.Methods By preliminary screening and diagnosis from 32855 newborns,32843 samples were collected using tandem mass spectrometry to inherited metabolic disease(IMD)scree-ning in Sichuan Province from January to December 2018.Afterwards,according to gestational age(1363 premature infants,31468 full-term infants and 12 overdue infants),blood collection time(3-7 days old,3095 cases,8-28 days old,1637 cases,and more than 28 days old,248 cases)and season(7737 cases in the first quarter,11428 cases in the second quarter,5482 cases in the third quarter,and 8196 cases in the fourth quarter),neonates were divided into different study groups.The difference of amino acid level in each group was compared,and the correlation between various influencing factors and metabolic index was analyzed.Results(1)The distribution of 11 amino acids[alanine(ALA),arginine(ARG),citrulline(CIT),glycine(GLY),leucine+isoleucine+hydroxyproline(LEU+ILE+PRO-OH),methionine(MET),ornithine(ORN),phenylalanine(PHE),proline(PRO),tyrosine(TYR),and valine(VAL)]in neonates showed non-normally distribution.(2)The distribution of 11 amino acids in different gestational age were tested by nonparametric test,except for PHE(H=0.61,P>0.05)and TYR(H=2.02,P>0.05),and other indicators were significantly different[ALA(H=187.11,P<0.05),ARG(H=23.60,P<0.05),CIT(H=22.90,P<0.05),GLY(H=85.18,P<0.05),LEU(H=56.42,P<0.05),MET(H=18.74,P<0.05),ORN(H=129.27,P<0.05),PRO(H=344.40,P<0.05),and VAL(H=272.92,P<0.05)].(3)The distribution of 11 amino acids in different blood collection time were significantly different[ALA(H=65.19,P<0.05),ARG(H=404.48,P<0.05),CIT(H=502.13,P<0.05),GLY(H=1719.44,P<0.05),LEU(H=396.41,P<0.05),MET(H=199.39,P<0.05),ORN(H=31.26,P<0.05),PHE(H=325.49,P<0.05),PRO(H=70.09,P<0.05),TYR(H=159.29,P<0.05),and VAL(H=102.52,P<0.05)].(4)The distribution of 11 amino acids in different birth seasons were significantly diffe

关 键 词：新生儿疾病筛查 串联质谱 氨基酸 胎龄 采血时间 季节 

分 类 号：R722.1[医药卫生—儿科]