脐动脉血缺血修饰白蛋白联合血气分析对新生儿轻度窒息后心脏损害的预测价值  

Predictive value of umbilical arterial blood gas analysis combined with ischemia-modified albumin levels in umbilical artery blood on cardiac damage after mild asphyxia in neonates

作　　者：谷奇 周文娣 蔡中华 王立生 许长礼 GU Qi;ZHOU Wendi;CAI Zhonghua(Department of Pediatrics,Huai’an Clinical College,Xuzhou Medical University,Jiangsu,Huai’an 223300,China;不详)

机构地区：[1]徐州医科大学淮安临床学院,江苏省淮安市223300 [2]江苏省阜宁县人民医院儿科

出　　处：《河北医药》2024年第15期2276-2281,共6页Hebei Medical Journal

基　　金：盐城市卫健委医学科研立项项目(编号:YK2023113)。

摘　　要：目的 探讨脐动脉血气分析联合脐动脉血缺血修饰白蛋白(ischemia-modified albumin,IMA)水平检测对新生儿轻度窒息后心脏损害的预测价值。方法 以2022年1月至2023年3月于江苏省阜宁县人民医院分娩的68例轻度窒息新生儿为研究对象,符合方案者65例,根据是否发生心脏损害,分为非心脏损害组(39例)及心脏损害组(26例)。全部研究对象均在分娩现场进行脐动脉血气分析,同时留取脐动脉血,测定IMA、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)及高敏肌钙蛋白I(high-sensitivity troponin I,hsTnI)水平。应用SPSS 25.0软件对数据进行统计分析,并绘制受试者操作特征(receiver operating characteristic,ROC)曲线。结果 心脏损害组脐动脉血气分析指标[酸碱度(pondus hydrogenii,pH)、氧分压(partial pressure of oxygen,PO_(2))、二氧化碳分压(partial pressure of carbon dioxide,PCO_(2))、剩余碱(base excess,BE)、乳酸]及生物标记物(IMA、CK-MB、hsTnI)均显著高于非心脏损害组(P<0.05)。以心脏损害(否=0,是=1)为因变量,上述指标等为协变量,进行多因素Logistic回归分析。结果显示,pH值、PO_(2)及IMA差异有统计学意义(P<0.05)。IMA与pH值呈中度负相关,与PO_(2)呈弱负相关。用于预测新生儿轻度窒息后心脏损害的脐动脉血气pH值、脐动脉血IMA的ROC曲线下面积(area under curve,AUC)、cut-off值、灵敏度、特异度分别为0.840、7.14、96.20%、64.10%,0.893、79.65、73.10%、89.70%。脐动脉血气pH值及脐动脉血IMA二者联合预测新生儿轻度窒息后心脏损害时,AUC、灵敏度和特异度分别为0.927、76.90%、92.30%,优于单一指标。结论 脐动脉血气pH值联合脐动脉血IMA对新生儿轻度窒息后的心脏损害具有良好的预测价值,且方便、快捷,可考虑作为新生儿轻度窒息后心脏损害的临床早期诊断依据,具有潜在的临床应用价值。Objective To explore the predictive value of umbilical artery blood gas analysis combined with ischemia-modified albumin(IMA) levels in umbilical artery blood on cardiac damage after mild asphyxia in neonates.Methods Sixty-eight neonates with mild asphyxia delivered in Funing People's Hospital from January 2022 to March 2023 were studied.A total of 65 cases were eligible.According to the occurrence of cardiac damage,they were assigned into non-cardiac damage group(n=39) and cardiac damage group(n=26).All cases underwent umbilical artery blood gas analysis at the delivery site.Umbilical artery blood samples were taken to determine the levels of IMA,creatine kinase isoenzyme(CK-MB) and high sensitivity troponin I(hsTnI).Data processing was performed by SPSS 25.0 software,and the receiver operating characteristic(ROC) curve was drawn.Results The Umbilical artery blood gas analysis indicators,including the pH value,partial pressure of oxygen(PO_(2)),partial pressure of carbon dioxide(PCO_(2)),and residual base(BE),as well as lactic acid and biomarkers,including IMA,CK-MB,and hsTnI were significantly higher in the cardiac damage group than those of the non-cardiac damage group(P<0.05).Multivariate Logistic regression analysis was carried out with cardiac damage(not applicable=0,applicable=1) as the dependent variable and the above indexes as covariables.The results showed that there were significant differences in pH,PO_(2) and IMA between groups(P<0.05).IMA was moderately negatively correlated with pH and weakly negatively correlated with PO_(2).The area under ROC curve(AUC),cut-off value,sensitivity and specificity of pH value of umbilical artery blood gas to predict cardiac damage after mild asphyxia were 0.840,7.14,96.20%,and 64.10%,respectively.Those of IMA in umbilical artery blood were 0.893,79.65,73.10% and 89.70%,respectively.AUC,sensitivity and specificity of pH value of umbilical artery blood gas combined with IMA in umbilical artery blood to predict cardiac damage after mild asphyxia in neonates were 0.927

关 键 词：脐动脉血气分析 缺血修饰白蛋白 轻度窒息 心脏损害 新生儿 预测 

分 类 号：R722.12[医药卫生—儿科]