摘要
目的探讨有核红细胞(NRBC)计数与围生期窒息新生儿早期脑损伤的关系。方法选择2011年5月1日至2013年10月1日在南华大学附属郴州市第一人民医院产科分娩的足月新生儿共计140例为研究对象,根据有无围生期窒息将其分为围生期窒息组(n=55)及正常组(n=85)。根据新生儿缺氧缺血性脑病(HIE)诊断标准,将围生期窒息组进一步分为4个亚组:重度脑病亚组(n=6)、中度脑病亚组(n=7)、轻度脑病亚组(n=12)及无脑病亚组(n=30)。采集新生儿脐动脉血及生后1~4d足跟末梢血,测定NRBC计数,并于随访至出生3个月时测定Gesell发育商。采用统计学方法比较各组及各亚组NRBC计数差异,并分析脐动脉血NRBC计数与Gesell发育商的相关性。围生期窒息组与正常组新生儿性别构成比、分娩方式构成比、出生体质量、胎龄及母亲年龄比较,差异均无统计学意义(P>0.05)。本研究遵循的程序符合南华大学附属郴州市第一人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人知情同意,并与监护人签署临床研究知情同意书。结果 1围生期窒息组患儿脐动脉血NRBC计数较正常组显著升高,而血气分析pH值则较正常组显著降低,且差异均有统计学意义(t=5.52,7.18;P<0.001)。2围生期窒息各亚组(无脑病亚组及轻、中、重度脑病亚组)脐动脉血NRBC计数除轻度脑病亚组与中度脑病亚组间比较,差异无统计学意义(t=1.44,P=0.172)外,其余亚组间两两比较,均为脑病程度重亚组较程度轻亚组显著升高,且差异有统计学意义(P<0.05)。3生后1~4d足跟末梢血的NRBC计数平均值,除轻度脑病亚组与中度脑病亚组比较,差异无统计学意义(t=0.36,P=0.985)外,其余组间(包括围生期窒息各亚组与正常组)两两比较,均为脑病程度重亚组较程度轻亚组显著升高,且差异有统计学意义(P<0.05);围生期窒息各亚组与正常组同组患儿生后不同时间足跟末梢血NRBC计数比较,则均为后1d日龄较前1d日龄显著下降,且差异亦有统计学意义(P<0.05),即NRBC计数随生后日龄增加呈下降趋势。4随访至生后3个月时,围生期窒息组Gesell发育商显著低于正常组,且差异有统计学意义(t=4.52,P<0.001),发育商与脐动脉血NRBC计数存在负相关关系(r=-0.85,P<0.05)。结论 NRBC计数与围生期窒息新生儿早期脑损伤程度存在相关性,对评估新生儿脑损伤预后有一定价值。
Objective To explore the correlation between nucleated red blood celI（NRBC） count and early brain injury in perinatal asphyxia newborns. Methods A total of 140 full-term newborns who were born in Department of Obstetrical, First People＇s Hospital of Chenzhou, South China University, from May 1,2011 to October 1, 2013 were chosen as study subjects. They were divided into perinatal asphyxia group （n=55） and normal group（n=85）in accordance with whether had perinatal asphyxia. And also according to neonatal hypoxic ischemic encephalopathy（HIE） diagnostic criteria for judging whether had encephalopathy, perinatal asphyxia group was further divided into four subgroups： severe encephalopathy subgroup（n = 6）, moderate encephalopathy subgroup （ n=7）, mild encephalopathy subgroup （n = 12 ） and no encephalopathy subgroup （n=30）. The umbilical arterial blood and heel peripheral blood within 1 4 d after birth ofnewborns were collected, and NRt^C numbers were eounted. And the Gessell development quotient was determined after 3 months＇ follow-up. The different levels of NRBC count were compared among different groups and subgroups with statistical method, and the correlation between umbilical arterial blood NRBC count and Gesell developmental quotient was analyzed. There were no statistically significant differences between perinatal asphyxia group and normal group in constituent ratio of gender and delivery mode, body weight at birth,gestational age and mother＇s age of newborns（P〉0.05）. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of First People＇s Hospital of Chenzhou, South China University. Informed consent was obtained from the parents of each participant. Results ① The NRBC count of umbilical arterial blood in perinatal asphyxia group was significantly higher than that in normal group,while pH value of blood gas analysis was significantly lower than that in normal group, and the differences were statistieally significant（t=5.52,7.18;P〈0. 001）. ②Compared umbilical arterial blood NRBC count in each subgroup of perinatal asphyxia group （no encephalopathy and mild, moderate, severe encephalopathy subgroup）, there was no significant difference between mild and moderate encephalopathy subgroups （t=1.44, P= 0. 172）; and compared the rest subgroups each other, NRBC count of severer degree subgroup was significantly higher than that in lighter degree subgroup, and the differences were statistically significant （P〈0.05）. ③Compared mean NRBC count within four days after birth from heel peripheral blood, there was no statistically significant difference between mild and moderate eneephalopathy subgroups （t=0.36, P=0. 985）, and compared the rest groups （including perinatal asphyxia subgroups and normal group） each other, NRBC count of severer degree subgroup was significantly higher than that in lighter degree subgroup, and the differences were statistieally significant （P〈0. 05）. Compared heel peripheral blood NRBC count in the same group, each subgroup of perinatal asphyxia and normal group all showed signifieantly lower than the age of earlier one day, and the differences were statistically significant （P〈0. 05）. NRBC counts had downward trend with the increase of postnatal day age. ④On all newborns followed up 3 months,Gesell developmental quotient of perinatal asphyxia group was significantly lower than that of normal group,and the difference was statistically significant（t=4.52 ,P〈0. 001）. There was negative correlation between developmental quotient and umbilical arterial blood NRBC counts （ r=-0. 85, P〈0.05）. Conclusions NRBC counts are associated with the degree of early brain injury of perinatal asphyxia newborns,and have certain value in evaluating the prognosis of neonatal brain injury.
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2015年第1期50-54,共5页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
南华大学附属郴州市第一人民医院资助项目(N2011-031)~~
关键词
窒息
幼红细胞
缺氧缺血
脑
婴儿
新生
Asphyxia
Erythroblasts
Hypoxia-ischemia, brain
Infant, newborn
