妊娠晚期羊水粪染与胎儿促红细胞生成素的关系

Relationship between Meconium-stained Amniotic Fluid and the Level of Fetal Erythropoietin in Third Trimester Pregnancy

目的 研究羊水粪染的脐带动脉血的促红细胞生成素 (EPO)是否发生改变 ,以及这种变化是否受血气分析指标和孕周等因素影响。方法 妊娠晚期孕妇 82例 ,于胎儿娩出检测胎儿脐带动脉血的 pH、pCO2 、pO2 、sO2 、HCO-3 、TCO2 、ABE和EPO。EPO采用ELISA方法。分娩后记录孕妇年龄、分娩孕周、新生儿出生体重、Ap gar评分、羊水粪染。根据是否羊水粪染分成两组 ,比较两组之间的差别。采用应用Logistic逐步回归 (Backward和Forward模式 )分析各因素独立对羊水粪染的影响。羊水粪染为因变量 ,孕周、孕妇年龄、新生儿出生体重、EPO、pH、pCO2 、pO2 、HCO-3 、TCO2 、ABE、sO2 为自变量。结果 羊水粪染组 2 4例 ,无羊水粪染组 5 8例。羊水粪染组的EPO浓度是无羊水粪染对照组的 2倍 [(5 2 .84± 10 .4 0 )mIU/ml,n =2 4 ;(2 5 .0 4± 4 .0 4 )mIU/ml,n =5 8;P<0 .0 5 ]。两组之间的HCO3 -、TCO2 、ABE存在统计学差别 (P <0 .0 5 ) ,但 pH、pCO2 、pO2 等其他指标无明显差别。Logistic逐步回归分析结果显示EPO、HCO3 -、TCO2 为与羊水粪染有关的自变量。结论 EPO浓度的升高是导致羊水粪染的危险因素 ,羊水粪染是胎儿长期、慢性缺氧的结果。EPO浓度的升高对预测围生儿远期预后有一定的临床意义。

Purpose: To determine whether the umbilical cord plasma erythropoietin levels are elevated in deliveries with meconium-stained amniotic fluid, and whether this is influenced by gestational age and cord blood gases. Methods: Erythropoietin concentrations were measured in 82 fetal umbilical cord blood samples from third trimester pregnancies, and among these 24 had meconium-stained amniotic fluid. An enzyme-link immunoabsorption assay kit was used to measure erythropoietin. Maternal age, gestational age at delivery, birth weight, and birth outcomes including Apgar score, cord blood pH, p CO2, pO2, HCO3-, TCO2, ABE were obtained. Logistic regression (backward and forward stepwise) was used to analyze the relationship of neconium-stained amniotic fluid and high risk factors. Results: Cord plasma erythropoietin levels were twice higher [(52.84 ± 10.40) mIU/ml, n = 24 versus (25.04 ± 4.04) mIU/ml, n = 58; P 3-, T CO2, ABE were significantly lower (PCO2, p O2, maternal age, gestational age, or Apgar score at 1 and 5 minutes. Backward Logistic regression analysis with maternal age, gestational age, erythropoietin, and cord blood gases as independent variables showed that EPO, HCO3-, and TCO2 were independently associated with meconium stained-amniotic fluid (P < 0.05). Conclusions: Meconium-stained amniotic fluid can be associated with chronic fetal hypoxia as demonstrated by increased fetal erythropoietin levels, independent of gestational age and cord blood gases.