趋化因子12对足月妊娠急性胎儿窘迫的预测价值

The Predictive Value of CXCL12 for Acute Fetal Distress in Term Pregnancy

目的探讨足月妊娠母血、脐血趋化因子12(chemokine 12,CXCL12)水平对急性胎儿窘迫(fetal distress,FD)预测的临床价值。方法选取2017年5月至2019年5月在青海红十字医院待产的148例孕妇,遵循急性FD诊断标准将新生儿分为正常对照组和FD组。胎儿娩出后获取脐动脉血做血气分析。使用ELISA法测定母血、脐血中CXCL12的表达水平;免疫组化染色法分析胎盘组织中CXCL12的表达水平,探究CXCL12的表达与急性FD之间的关系。结果FD组与对照组新生儿的分娩方式差异有统计学意义(P<0.05)。FD组胎盘组织中CXCL12的表达量高于对照组;FD组母血、脐血CXCL12表达水平均高于对照组(P均<0.05)。两组新生儿pH值、血氧分压、碱剩余及血二氧化碳分压、Apgar评分差异均有统计学意义(P均<0.05);母血中CXCL12的表达与pH值、碱剩余均呈负相关(P均<0.05),与PaCO2呈正相关(P<0.05);脐血中CXCL12表达水平与pH值、PaO2、碱剩余均呈负相关(P均<0.05),与PaCO2呈正相关(P<0.05)。结论CXCL12与FD的发生密切相关,FD时发生胎盘组织、母血、脐血中CXCL12水平均升高,提示母血中CXCL12水平在产前急性FD的监测中具有重要的临床意义和价值。

Objective The purpose of this study was to investigate the value of chemokine 12(CXCL12)in maternal and umbilical cord blood in predicting fetal distress.Methods From May 2017 to May 2019,totally 148 cases in our hospital were included in this study,and were divided into the fetal distress group(FD group)and control group according to the diagnostic criteria of acute fetal distress.The umbilical artery blood was collected by aseptic arterial puncture after fetal disengagement for arterial blood gas detection.Enzyme-linked immunosorbent assay was used to determine the expression of CXCL12 in maternal and cord blood serum.Immunohistochemistry and immunofluorescence staining techniques were conducted to analyze the expression level of CXCL12 in placental tissue.Results The clinical data indicated that there was significant different in delivery mode between FD group and control group(P<0.05).Immunohistochemistry and immunofluorescence staining showed that CXCL12 expression was significantly increased in the placental tissue of the FD group.Enzyme-linked immunosorbent analysis showed that the expression of CXCL12 in maternal and umbilical cord blood in the FD group was higher than that in the control group(P all<0.05).Compared with the control group,there were significant differences in pH value,PaO2,negative alkali residual value and PaCO2(P all<0.05).The level of CXCL12 in maternal blood was negatively correlated with pH value and alkali residue(P all<0.05),and positively correlated with PaCO2(P all<0.05).The level of CXCL12 in cord blood was negatively correlated with pH,PaO2 and alkali residue(P all<0.05),and positively correlated with PaCO2(P<0.05).Conclusion The level of CXCL12 in placental tissue,peripheral blood and umbilical cord blood of patients with fetal distress was significantly increased,which suggested that the expression of CXCL12 in in maternal peripheral blood has potential value in predicting acute fetal distribution.