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中华妇幼临床医学杂志(电子版) ›› 2015, Vol. 11 ›› Issue (01) : 52 -57. doi: 10.3877/cma.j.issn.1673-5250.2015.01.012

所属专题： 文献；

论著

围生期窒息新生儿有核红细胞计数与早期脑损伤的关系
谭宁1, 彭华保1,*,*(), 费淑兰1, 王永红1, 史文元1, 陈磊1   
  1. 1. 423000　南华大学附属郴州市第一人民医院新生儿科
  • 收稿日期:2014-06-09 修回日期:2015-01-13 出版日期:2015-02-01
  • 通信作者: 彭华保

Correlation between nucleated red blood cell count and early brain injury in perinatal asphyxia newborns

Ning Tan1, Huabao Peng1(), Shulan Fei1, Yonhong Wang1, Wenyuan Shi1, Lei Chen1   

  1. 1. Department of Neonatology, First People's Hospital of Chenzhou, South China University, Chenzhou 423000, Hunan Province, China
  • Received:2014-06-09 Revised:2015-01-13 Published:2015-02-01
  • Corresponding author: Huabao Peng
  • About author:
    Corresponding author: Peng Huabao, Email:
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谭宁, 彭华保, 费淑兰, 王永红, 史文元, 陈磊. 围生期窒息新生儿有核红细胞计数与早期脑损伤的关系[J]. 中华妇幼临床医学杂志(电子版), 2015, 11(01): 52-57.

Ning Tan, Huabao Peng, Shulan Fei, Yonhong Wang, Wenyuan Shi, Lei Chen. Correlation between nucleated red blood cell count and early brain injury in perinatal asphyxia newborns[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2015, 11(01): 52-57.

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1～4 d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1～4 d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1 d日龄较前1 d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。

关键词: 窒息, 幼红细胞, 缺氧缺血，脑, 婴儿，新生
Objective

To explore the correlation between nucleated red blood cell(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 of newborns were collected, and NRBC numbers were counted.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

①The 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 statistically 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 encephalopathy 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 statistically significant(P<0.05). Compared heel peripheral blood NRBC count in the same group, each subgroup of perinatal asphyxia and normal group all showed significantly 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.

Key words: Asphyxia, Erythroblasts, Hypoxia-ischemia, brain, Infant, newborn
表1 围生期窒息组与正常组患儿一般临床资料比较(±s)
Table 1 Comparison of general clinical characteristics between perinatal asphyxia group and normal group(±s)
组别 例数 性别构成比[例数(%)] 分娩方式构成比[例数(%)] 出生体质量(g) 胎龄(周) 母亲年龄(岁)
男 女 剖宫产 顺产
围生期窒息组 55 29(52.7) 26(47.3) 28(50.9) 27(49.1) 3 144±295 39.5±2.3 27.2±3.4
正常组 85 44(51.8) 41(48.2) 43(50.1) 42(49.9) 3 265±336 39.3±1.9 25.3±2.8
χ2值/t值 ? 0.012 0.011 1.890 1.630 1.510
P值 ? 0.93 0.96 0.08 0.12 0.14
表2 围生期窒息组与正常组患儿脐动脉血NRBC计数及血气分析pH值比较(±s)
Table 2 Comparison of NRBC counts and pH value of umbilical arterial blood between perinatal asphyxia group and normal group(±s)
组别 NRBC计数(/100 WBC) 血气分析pH值
围生期窒息组 11.30±1.32 7.13±0.11
正常组 3.54±0.45 7.32±0.05
t值 5.52 7.18
P值 <0.001 <0.001
表3 围生期窒息各亚组脐动脉血NRBC计数比较(/100 WBC, ±s)
Table 3 Comparison of NRBC counts of umbilical arterial blood among subgroups of perinatal asphyxia(/100WBC，±s)
组别 例数 NRBC计数
无脑病亚组 30 6.3±3.4
轻度脑病亚组 12 10.5±6.3
中度脑病亚组 7 11.0±4.9
重度脑病亚组 6 20.8±8.6
F值 ? 15.58
P值 ? <0.05
图1 围生期窒息各亚组及正常组足跟末梢血NRBC计数动态变化
Figure 1 Dynamic changes of NRBC counts in heel peripheral blood among subgroups of perinatal asphyxia and normal group
表4 围生期窒息各亚组与正常组足跟末梢血NRBC计数平均值及同组患儿生后不同时间NRBC计数比较(/100 WBC，±s)
Table 4 Comparison of mean NRBC counts of heel peripheral blood among subgroups of perinatal asphyxia and normal group and NRBC counts at different time in same group(/100WBC，±s)
组别 例数 NRBC计数 F值 P值
生后第1天 生后第2天 生后第3天 生后第4天 1～4 d平均值
无脑病亚组 30 8.31±5.44 3.20±1.71 1.10±0.66 0.20±0.13 2.85±1.72a 11.53 <0.001
轻度脑病亚组 12 10.50±6.31 5.79±3.09 2.86±1.44 1.00±0.11 5.04±2.07b 11.72 <0.001
中度脑病亚组 7 11.00±4.94 5.60±3.81 2.60±1.06 0.80±0.22 5.10±2.60c 17.82 <0.001
重度脑病亚组 6 15.83±8.64 9.67±7.00 5.00±3.52 2.83±1.63 10.08±3.32d 6.22 　0.004
正常组 85 2.43±1.06 0.73±0.23 0.27±0.14 0.00±0.00 0.85±0.15e 17.87 <0.001
F值 16.62 15.66 15.12 7.89 12.53 － －
P值 ? <0.001 <0.001 <0.001 <0.001 <0.001 － －
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