窒息新生儿血清促生长激素释放多肽与超敏C反应蛋白水平动态变化及临床意义

A dynamic prospective study of Ghrelin and hs-CRP levels in neonates with asphyxia

目的探讨窒息新生儿血清促生长激素释放多肽(Ghrelin)及超敏C反应蛋白(hs-CRP)水平的动态变化。方法选择我院产科2010年4月至2011年6月分娩的轻度、重度窒息新生儿各40例为观察组,检测脐血、急性期(1～3天)及恢复期(7～10天)血清Ghrelin和hs-CRP水平;选择同期住院无窒息史的健康新生儿40例为对照组,检测脐血Ghrelin和hs-CRP水平。结果窒息组Ghrelin水平随病程变化先降后升,急性期[(22.1±8.8)ng/ml]与恢复期[(33.2±12.2)ng/ml]均低于脐血[(38.0±13.2)ng/ml],恢复期高于急性期,差异有统计学意义(P<0.05)。对照组脐血Ghrelin水平[(72.3±15.6)mg/ml]明显高于窒息组,轻度窒息组脐血、急性期、恢复期Ghrelin水平高于重度窒息组。窒息组hs-CRP水平随病程变化先升后降,急性期[(0.48±0.22)mg/L]高于脐血[(0.14±0.11)mg/L],恢复期[(0.12±0.09)mg/L]低于急性期,差异有统计学意义(P<0.05)。对照组脐血hs-CRP水平[(0.02±0.00)mg/L]低于窒息组;轻度窒息组急性期低于重度窒息组,脐血和恢复期与重度窒息组比较差异无统计学意义。结论 Ghrelin、hs-CRP水平与窒息的发生、发展有关,窒息新生儿脐血、恢复期血清中Ghrelin变化比Hs-CRP更能反应窒息严重程度。

Objective To explore the dynamic relationships between serum Ghrelin and hs-CRP levels in neonates with asphyxia.Methods A total of 80 neonates in equal groups of 40 patients based the severity（mild vs.severe）of asphyxia during labor were recruited in the current prospective study;40 healthy neonates born at the same period of time without asphyxia were recruited as controls.While in the observation groups,umbilical blood and serum Ghrelin as well as hs-CRP levels were measured during the acute（1-3 days）and the recovery（7-10 days）phases,only the cord blood Ghrelin and hs-CRP levels were tested in the control group.Results（1）The average serum Ghrelin level in the mild and severe asphyxia combined group changes according to the course of the disease.The level initially decreased in the acute phase[（22.1±8.8）ng/dl],then improved during the recovery phase[（33.2 ±12.2）ng/ml].In both phases of the illness,patients’serum Ghrelin levels were lower than the umbilical cord blood levels[（38.0±13.2）ng/ml]（P〈0.05）;and much lower than the levels in patients of the control group[（72.3±15.6）ng/ml].（2）In the mild asphyxia group,Ghrelin levelswas higher in both of the acute and the recovery phases[acute：（25.1±8.6）ng/ml,vs.recovery： （35.7±13.1）ng/ml]when compare to Ghrelin levels in the severe asphyxia group[acute：（19.1± 7.8）ng/ml vs.recovery：（30.0±10.7）ng/ml,P〈0.05].（3）The average serum hs-CRP level in the asphyxia combined group was first increased during the acute phase[（0.48±0.22）mg/L],then decreased[（0.12±0.09）mg/L]during the recovery phase.Serum hs-CRP level in the acute phase [（0.48±0.22）mg/L]was higher than the level in the umbilical cord blood[（0.14±0.11）mg/L] （P〈0.05）.Although the umbilical cord hs-CRP level in the control group was higher than the level in the asphyxia combined group,its level in the mild asphyxia group is lower than the level in the severe asphyxia group.Conclusions Ghrelin and hs-CRP levels correlate to the occurrence and the clinical stages of asphyxia.In asphyxia newborns,the change of Ghrelin level in the umbilical cord blood,and in the serum during recovery phase is a better clinical indicator than hs-CRP level in reflecting the severity of asphyxia.