促红细胞生成素、外周血有核红细胞与胎儿宫内生长发育受限及预后关系的研究

Relationship between fetal plasma erythropoietin concentration and intrauterine fetal growth retardation

目的：测定小于胎龄儿（SGA）和适于胎龄儿（AGA）血中的EPO、有核红细胞、血气分析的变化，找出胎儿宫内发育迟缓与EPO、有核红细胞、血气分析之间的关系，以期待为临床找到一种反映SGA慢性缺氧的理想指标。方法：采用ELISA法对24例SGA和28例AGA血中EPO浓度进行定量检测，末梢血涂片经瑞氏染色计数100个白细胞中含有的有核红细胞数（NRBC／100WBC），并根据血常规中的白细胞数计算出有核红细胞的绝对计数（NRBC）。同时检测动脉血pH、BE和HCO^3-等指标。生后3—5天进行头部CT检查，以确定神经系统病变情况。结果：①SGA组和AGA组的体重分别是（1463．83±273．73）g和（1925．8±309．91）g；EPO值分别是（109．4±51．36）mIU／ml和（13．99±6．54）mIU／ml。NRBC／100WBC数分别是（56．67±24．75）个和（8．57±4．28）个；NRBC数分别是（5．627±3．14）×10^9／L和（0．98±0．506）×10^9／L；RBC数分别是（4．486±0．446）×10^12／L和（4．61±0．333）×10^12/L；pH值分别是（7．297±0．1163）和（7．36±0．0525）；BE值分别是（-4．616±5．048）mmol/L和（-1.82±2．047）mmol／L；HCO3^-值分别是（22.81±5．246）mmol／L和（24．725±2．38）mmol/L。其中体重、EPO、NRBC／100WBC、NRBC、pH、BE两组比较有显著性差异（P〈0．05）。两组的RBC、HCO3^-比较无显著性差异（P〉0．05）。②经过相关性分析，SGA组的体重与EPO呈显著负相关，r值为-0．470（P〈0．05）；AGA组的体重与EPO无相关性，r值为0．128（P〉0．05）。③EPO分别和NRBC／100WBC、NRBC呈正相关，r值分别是0．642（P〈0．05）和0．595（P〈0．05）；EPO分别和BE、HCO3呈负相关，r值分别是-0．434（P〈0．05）和-0．487（P〈0．05）。④SGA组根据预后两组颅内出血7名，包括死亡2名，缺氧缺血性脑病3名。头部CT正常的为对照组。两组进行率的比较，P〈0．05，差异显著，说明EPO、有核红细胞的绝对计数显著升高的SGA预后较差。结论：①血中的EPO、NRBC／100WBC、NRBC、BE、pH在SGA组均明显高于AGA组，而RBC数在两组间无显著性差异。②SGA组的体重与EPO呈显著负相关。③血中EPO分别与NRBC／100WBC，NRBC呈显著正相关，与BE、HCO3^-呈负相关。④EPO、NRBC是反映小于胎龄儿慢性缺氧的理想指标，与预后密切相关。

Objective： To deterhline the relationship between fetal plasma erythropoietin （EPO） concentration and intrauterine fetal growth retardation, whether this response stimulates fetal erythroblast and EPO can be used as an indicator of chronic fetal hypoxia in intrauterine fetal growth retardation. . Methods： According to body weight and gestational age, 52 infants were classified into two groups： small for gestational age （SGA） group （24 cases） and approphate for gestational age （AGA） group （28cases） . Serum erythropoietin, blood gas analysis and blood routine were measured in SGA and AGA. Peripheral blood smears of them were stained by wright＇s method and examined by light microscopy fo rnucleated red blood cell count. The absolute nucleated red blood cell count was calculated from the white blood cell count actordlng to the following fornlula： absolute nucleated red blood cell count = （ Nucleated red blood cells/100 white blood cell × adiusted white blood cell count） /100. An enzyme -link immunoabsorption assay kit was used to measure erythropoietin. The results were compared with that obtained from specimens of blood of SGA and AGA. Results： The serum levels of EPO （ 109. 4 ±51.36） mlU/ml in SGA were significantly higher than those （ 13.99 ± 6. 54） mIU/ml in AGA （P 〈 0. 001 ） . The number of NRBC/100WBC （56. 67 ± 24. 75） and NRBC （5. 627 ±3. 14） × 10^9/L in SGA were signifantly higher than those （8. 57 ±4. 28） and （0. 98±0. 506） × 109/L in AGA, respectively （P〈 0.001, P〈 0.001） . The values ofpH （7. 2974±0. 1163） and BE （-4.616±5.048） mmol/L in SGA were significantly lower than those （7.36 ± 0. 052 5） and （ -1.82 ± 2. 047 ） mmol/L in AGA, respectively （ P 〈 0. 05, P 〈 0. 05 ） . The levels of EPO in SGA were correlated with body weight negatively and significantly （ r = - 0. 470, P 〈 0. 05 ）, the levels of EPO in AGA were not correlated with body weight （r = 0. 128, P 〉0. 05） . And the levels of EPO were correlated with NRBC/100WBC and NRBC positively and significantly （ r = 0. 642, P 〈 0. 05 ; r = 0. 595, P 〈 0. 05 ）. EPO was correlated with BE and HCO3^ - negatively and significantly （r = - 0.434, P 〈 0.05; r = - 0.487, P 〈 0.05） .The high levels of EPO and NRBC in SGA had worse perinatal outcomes. Conclusion： ①The results indicate that serum EPO, NRBC/100WBC, NRBC, BE, pH in SGA are significantly higher than those in AGA. ②The levels of EPO in SGA are correlated with body weight negatively and significantly, the levels of EPO in AGA are not correlated with body weight.③The levels of EPO are significantly and positively correlated with nucleated red blood cells. ④EPO, NRBC can be used as an early indicator of chronic fetal hypoxia in small for gestational age.