新生儿血17-羟孕酮的正常水平及其影响因素

Peripheral blood level of 17-hydroxyprogesterone in neonates and influencing factors

目的探讨新生儿末梢血17羟孕酮的水平及影响因素。方法2012年11月1日至2014年1月31日，在福建省妇幼保健院分娩的新生儿中，排除先天性肾上腺皮质增生症患儿，共18461例纳入本研究。新生儿出生后72h后采集末梢血，采用时间分辨荧光免疫分析法检测17-羟孕酮水平。根据不同性别、分娩方式、胎龄、出生体重、胎数、采血时日龄、是否住院治疗分组；18461例中，2997例因各种原因住院治疗，根据其全血血糖水平、酸碱平衡状况以及是否电解质紊乱分组；比较各组间17-羟孕酮水平。17-羟孕酮水平采用几何均数（95％CI）表示，采用Mann—Whitney U检验、Kruskal—Wallis H检验、多元线性回归进行统计学分析。结果18461例新生儿的17-羟孕酮水平为0．0～196．0nmol／L，几何均数为5．7（5．6～5．8）nmol／L；男性（n=10026）与女性（n=8435）分别为6．1（6．0～6．2）与5．4（5．2-5．5）nmol／L；剖宫产（n=7014）与阴道分娩者（n=11447）分别为6．2（6．0～6．3）与5．5（5．4～5．6）nmol／L；多胎妊娠（n=656）与单胎妊娠者（n=17805）分别为8．7（8．2-9．3）与5．6（5．6～5．7）nmol／L；住院治疗（n=2997）与未住院治疗者（n=15464）分别为8．0（7．7～8．4）与5．4（5．3～5．5）nmol／L。男性、剖宫产、多胎及住院治疗者的血17-羟孕酮水平较高（Z值分别为-10．65、-10．88、-14．2l和-27．63，P值均〈0．05）。分别比较8组不同胎龄、7组不同出生体重和5组不同采血时日龄的新生儿17-羟孕酮水平，差异均有统计学意义（χ^2值分别为2409．25、l510．30与636．60，P值均〈0．05）。进一步两两比较，胎龄≥29周新生儿的17-羟孕酮水平随胎龄增加呈下降趋势；出生体重〈4000g新生儿的17-羟孕酮水平随出生体重增加呈下降趋势；采血时日龄3、4和5d组的17-羟孕酮水平呈下降趋势。2997例住院新生儿中，酸碱失衡组与平衡组的17-羟孕酮水平的几何均数分别为9．7（8．6～10．8）与7．0（6．3～7．7）nmol／L，电解质紊乱组和电解质正常组分别为9．4（8．5～10．3）与7．9（7．5～8．3）nmol／L．酸碱失衡组和电解质紊乱组均较高（Z值分别为-6．21和-4．49，P值均〈0．05）。低血糖、正常血糖、高血糖水平的3组新生儿17-羟孕酮水平分别为9．7（9．1～10．4）、8．1（7．6～8．6）与8．6（6．7～11．1）nmol／L，低血糖组和高血糖组均高于正常血糖组（z值分别为-4．18和-2．11，P值均〈O．05）。根据R^2值，前3位影响因素依次为胎龄、出生体重和血糖（R^2值分别为0．200、0．115和0．080）。多元线性回归分析显示，9个影响因素均进入回归方程，按作用从大到小依次为胎龄、出生体重、血糖、酸碱平衡、胎数、血电解质、分娩方式、性别和采血时日龄。结论新生儿末梢血17-羟孕酮水平受到胎龄、出生体重、血糖、酸碱平衡等多种因素影响。

Objective To determine the peripheral blood level of 17-hydroxyprogesterone （17-OHP） in neonates and to analyze its influencing factors. Methods All newborns （n=18 461） born in Fujian Maternity and Child Health Care Hospital from November 1, 2012 to January 31, 2014 were included in this study, except for those with congenital adrenal hyperplasia. Heel prick blood samples were collected after 72 h after birth for determination of 17-OHP by time resolved fluorescence immunoassay. All subjects were grouped according to different factors such as gender, mode of delivery, gestational age, birth weight, number of pregnancies, time of blood sampling and whether to be hospitalized. While 2 997 inpatients among them were grouped according to blood glucose level, acid-base equilibrium, and levels of electrolytes, respectively. The level of 17-OHP was analyzed with Mann-Whitney U test, Kruskal-Wallis H test and multiple linear regression. Results The level of 17-OHP in these newborns ranged from 0.0 to 196.0 nmol/L with a geometric mean （GM） of 5.7 （5.6-5.8） nmol/L. The GM level was higher in male group （n=10 026 ） than in female group （n=8 435） [6.1 （6.0-6.2） vs 5.4 （5.2-5.5） nmol/L, Z= -10.65, P 〈 0.05]; higher in cesarean delivery group （n=7 014） than in vaginal delivery group （n=11 447 ） [6.2 （6.0-6.3） vs 5.5 （5.4-5.6） nmol/L, Z= - 10.88, P 〈 0.05]; higher in multiply pregnancy group （n=656） than in singleton pregnancy group （n=17 805） [8.7 （8.2-9.3） vs 5.6 （5.6- 5.7） nmol/L, Z= - 14.21, P 〈 0.05]; higher in inpatient treatment group （n=2 997 ） than in outpatient treatment group （n=15 464） [8.0 （7.7-8.4） vs 5.4 （5.3-5.5） nmol/L, Z= - 27.63, P 〈 0.05]. Significant difference was found in 17-OHP level among the eight groups with different gestational age, seven groups with different birth weight and five groups with different age at sampling （χ^2=2 409.25, 1 510.30 and 636.60, all P 〈 0.05）. Further analysis showed that the 17-OHP level deceased with the increasing birth weight （if less than 4 000 g）, with the increase of gestational age （if≥ 29 weeks）, and with the growth of the babies （from day 3 after birth to day 5）. Among the 2 997 inpatients, higher 17-OHP level was found in the acid-base imbalance group than in the acid-base equilibrium group [9.7 （8.6-10.8） vs 7.0 （6.3 7.7） nmol/L, Z= - 6.21, P 〈 0.05], and higher in the electrolyte disturbance group than in the electrolyte balanced group [9.4 （8.5-10.3） vs 7.9 （7.5- 8.3） nmol/L, Z= - 4.49, P 〈 0.05]. The 17-OHP level in the hypoglycemia and hyperglycaemia group than in the euglycemia group respectively [9.7 （9.1-10.4） and 8.1 （7.6-8.6） vs 8.6 （6.7-11.1） nmol/L, Z= - 4.18 and - 2.11, both P 〈 0.05]. The R^2 value of gestational age, birth weight and glucose were 0.200, 0.115 and 0.080 respectively. Multivariate linear regression analysis showed that 17-OHP was influenced the most by gestational age, followed by birth weight, blood glucose, acid-base balance status, number of pregnancies, electrolytes, mode of delivery, gender and days on blood sampling. Conclusion The peripheral blood level of 17-OHP in neonates is affected by many factors, such as gestational age, birth weight, blood glucose and acid- base equilibrium.