目的 评估孕周在28~36周之间,提前分娩的宫内生长受限(FGR)孕妇羊水中促红细胞生成素(EPO)浓度与新生儿不良结局的关系,探讨其在分娩时机选择上的潜在临床意义.方法 对我院产科2011年-2016年期间,因合并宫内生长受限而于28~36周期间分娩的单胎妊娠孕妇87例进行回顾性分析.所有研究对象均于剖宫产时或剖宫产前一周内采集羊水,测定EPO浓度,按经典划分方法以<27 IU/L为正常组,≥27 IU/L为增高组.观察羊水EPO浓度与胎儿生物物理评分,脐动脉多普勒波形异常,血气参数及新生儿不良妊娠结局的关系.结果 对于28~36周分娩的FGR妊娠孕妇而言,羊水EPO浓度增高组的新生儿复合不良结局发生率显著高于正常浓度组,差异有统计学意义(χ2=9.49,P=0.002).相关性分析发现,羊水EPO浓度与脐动脉血PH值(P<0.001,r=-0.908)和碱剩余(P<0.001,r=-0.624)呈负相关关系,与PCO2呈正相关关系(P < 0.001,r = 0.631),与PO2则无明显相关性(P = 0.068,r =-0.197).另外,羊水EPO浓度增高与胎儿生物物理活动评分及脐动脉多普勒波形异常亦无明显的关系.结论 对于孕36周前的FGR妊娠孕妇,羊水EPO浓度的异常增高与新生儿不良结局有密切关系.羊水EPO浓度的监测有望成为明确其胎儿缺氧的一个额外指标,可帮助决定分娩的时间.
Objectives To assess the relationship between amniotic fluid erythropoietin(EPO)and neona-tal adverse outcome in fetal growth restriction(FGR)pregnancy labored during 28-36 gestational weeks.To explore the clinical application in timing of delivery. Methods The retrospective research had recruited 87 patients with single pregnancy complicated FGR,of which the gestational weeks range from 28 weeks to 36 weeks. All subjects were collected from amniotic fluid at cesarean section or within a week of cesarean section. Amniotic fluid EPO were detected according to the classical definition. We categorized EPO < 27 IU/L as an normal state,whereasE-PO≥27 IU/L as an abnormal state.The relationship between amniotic fluid EPO with biophysical profile,the flow velocity waveform/blood gas parameters of the umbilical artery,and the neonatal adverse outcome were observed. Results For FGR pregnant women who chose 28-36 weeks for delivery,the incidence of neonatal adverse out-comes was significantly higher in the amniotic fluid EPO increased group than that in normal concentration group (χ2= 9.49,P = 0.002). Pearson analysis showed that amniotic fluid EPO concentration was negatively correlated with umbilical artery pH(P<0.001,r=-0.908)and base excess(P<0.001,r=-0.624).However,it was pos-itively correlated with PCO2(P<0.001,r=0.631),whereas there was no significant correlation between amniotic fluid EPO concentration and PO2(P=0.068,r=-0.197).In addition,neither biophysical profile nor flow velocity waveform has difference in amniotic fluid EPO concentration. Conclusions The abnormal increased amniotic fluid EPO in FGR pregnant women who delivered before 36 gestational weeks were closely related to the adverse out-come of the newborn.The amniotic fluid EPO is expected to be an additional indicator of fetal hypoxia,which can help determine the time of birth.