早产儿延期断脐对EPO、Ghrelin和肠系膜动脉血流的影响

Effects of delayed umbilical cord clamping on serum erythropoietin,ghrelin and mesenteric artery blood flow in premature infants

目的探讨延期断脐对早产儿血清促红细胞生成素(EPO)、胃促生长素(Ghrelin)和肠系膜动脉血流的影响。方法选择2015年1月至2017年12月在上海市长宁区妇幼保健院产科分娩的早产儿110例。根据断脐方法不同将早产儿分为观察组和对照组,每组各55例。对照组予以早断脐,观察组予以延期断脐。观察两组的脐带残端脱落时间、平均红细胞比容(MCV)、血清铁(SI)、铁蛋白(SF)、铁蛋白受体(sTfR)、未饱和铁结合力(UIBC)、最大血流速度(Vmax)、平均速度(Vmean)、最小血流速度(Vmin)、搏动指数(PI)、阻力指数(RI)和每分钟血流量(Q)水平变化,以及两组脐血和出生第3天足跟血血红蛋白(Hb)、血细胞比容(HCT)、EPO、Ghrelin、胰岛素样生长因子-1(IGF-1)和胰岛素敏感指数(ISI)水平的变化。结果观察组的残端脱落时间、MCV和PI水平较对照组明显降低(t值分别为7.105、12.171、2.200,均P<0.05),而SI、SF、sTfR、Vmax、Vmean、Vmin、D和Q水平较对照组明显升高(t值分别为4.096、2.100、4.183、2.731、2.510、3.715、13.991、3.087,均P<0.05),而两组的UIBC和RI水平比较差异均无统计学意义(均P>0.05)。两组脐血的Hb、HCT、EPO、Ghrelin、IGF-1和ISI水平比较差异均无统计学意义(均P>0.05),出生第3天足跟血的Hb、HCT、EPO、IGF-1和ISI水平较脐血(t值分别为2.697、3.079、4.233、5.900、6.590,均P<0.01)及对照组明显升高(t值分别为2.309、3.079、3.765、5.336、5.433,均P<0.05),观察组早产儿出生第3天足跟血的Ghrelin水平较脐血(t=12.673,P<0.01)和对照组(t=13.915,P<0.01)明显降低。结论延期断脐对早产儿能够明显改善铁储存,能够明显改善患者神经内分泌激素水平,可能与改善肠系膜上动脉的血液供应有关。

Objective To explore the effects of delayed umbilical cord clamping on serum erythropoietin(EPO),ghrelin and mesenteric artery blood flow in premature infants.Methods 110 premature infants delivered in department of obstetrics of Maternal and Child Health Care Hospital of Changning District in Shanghai from January 2015 to December 2017 were selected.According to the methods of breaking umbilical cord,the premature infants were divided into observation group and control group,with 55 cases in each group.The control group was performed with early umbilical cord clamping while the observation group was given delayed umbilical cord clamping.Finally,the differences in umbilical cord stump shedding time,mean corpuscular volume(MCV),serum iron(SI),ferritin(SF),serum transferrin receptor(sTfR),unsaturated iron binding force(UIBC),and maximum blood flow velocity(Vmax),mean velocity(Vmean),minimum blood velocity(Vmin),pulsatility index(PI),resistance index(RI) and blood flow per minute(Q) were observed between the two groups,and the levels of hemoglobin(Hb),hematocrit(HCT),EPO,ghrelin,insulin-like growth factor-1(IGF-1) and insulin sensitivity index(ISI) in umbilical cord blood and heel blood on the third day after birth were also observed in the two groups.Results The levels of umbilical cord stump shedding time,MCV and PI in the observation group were significantly lower than those in the control group(t=7.105,12.171 and 2.200,respectively,all P<0.01),while the levels of SI,SF,sTfR,Vmax,Vmean,Vmin,D and Q in the observation group were significantly higher than those in the control group(t=4.096,2.100,4.183,2.731,2.510,3.715,13.991 and 3.087,respectively,all P<0.05).But there was no significant difference in UIBC and RI levels between the two groups(P>0.05).In addition,no significant differences were found in the levels of Hb,HCT,EPO,Ghrelin,IGF-1 and ISI between the two groups(all P>0.05).But the levels of Hb,HCT,EPO,IGF-1 and ISI in heel blood on the third day after birth in the observation group were significantly higher than those in umbilical cord blood(t=2.697,3.079,4.233,5.900 and 6.590,respectively,all P<0.01) and those in control group(t=2.309,3.079,3.765,5.336 and 5.433,respectively,all P<0.05).Moreover,the level of Ghrelin in heel blood was significantly lower than that in umbilical cord blood(t=12.673,P<0.01) and in the control group(t=13.915,P<0.01).Conclusion The delayed umbilical cord clamping can significantly improve iron storage and the levels of neuroendocrine hormone for preterm infants,which might be related to the improvement of blood supply to the superior mesenteric artery.