Research of Myocardial Injury Markers in Placental Abruption Premature Infant

doi:10.3877/cma.j.issn.1673-5250.2014.04.020

Objective

To explore level changes of myocardial injury markers including myocardial enzymes spectrum (MES) and cardiac troponin (cTn) I in placental abruption (PA) premature infants, and provide scientific evidence for early interventions of myocardial injury on PA.

Methods

From June 2010 to May 2013, a total of 87 placental abruption (PA) premature infants were included in the study as observation group(n = 87). Meanwhile, another 87 premature infants who had healthy mothers were accepted as control group(n = 87). Their heart rate, heartsound, MES, cTn I, electrocardiogram (ECG) and ultrasonic cardiogram(UCG) were determined at the first, third, seventh and fourteenth days after birth. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Suizhou Women and Children's Health Hospital. Informed consent was obtained from each participants's parents. There had no significant differences in gender and age between two groups (P>0.05).

Results

There had significant differences in gestational age, birth weight, total incidence of arrhythmia, dull heart sounds, abnormal ECG and UCG between two groups (P < 0.05). The levels of MES and cTn I in observation group were obviously higher than those of control group at four different observation time points (P<0.01). MES and cTn I levels of both groups peaked at 1-3 days after birth and declined to normal until the fourteenth day except phosphocreatine kinase (CK), creatine kinase isoenzyme (CK-MB) and cTn I of the observation group.

Conclusions

Dynamic monitoring of MES and cTn I in PA is an effective method to detect myocardial injury as early as possible, which can reduce complications.

Key words: Placental abruption, Infant, premature, Biological markers, Myocardium, Troponin I

表1 两组早产儿一般情况比较[n(%)]

Table 1 Comparison of general information between two groups [n(%)]

组别	n	性别		胎龄（±s，孕周）	出生体质量（±s，g）	心肌损伤	心律失常	心音减弱	心电图异常	超声心动图异常
组别	n	男性	女性	胎龄（±s，孕周）	出生体质量（±s，g）	心肌损伤	心律失常	心音减弱	心电图异常	超声心动图异常
观察组	87	47(54.02)	40(45.98)	32.90±2.29	2 093.45±550.14	50(57.47)	29(33.33)	30(34.48)	23(26.44)	22(25.28)
对照组	87	46(52.87)	41( 47.13)	33.73±1.99	2 295.29±636.41	16(18.39)	17(19.54)	13(14.94)	11(12.64)	9(10.34)
χ²/t		0.023		2.260	2.238	28.220	4.255	8.927	5.264	6.633
P		0.879		0.011	0.027	<0.001	0.039	0.003	0.022	0.013

表1 两组早产儿一般情况比较[n(%)]

Table 1 Comparison of general information between two groups [n(%)]

组别	n	性别		胎龄（±s，孕周）	出生体质量（±s，g）	心肌损伤	心律失常	心音减弱	心电图异常	超声心动图异常
组别	n	男性	女性	胎龄（±s，孕周）	出生体质量（±s，g）	心肌损伤	心律失常	心音减弱	心电图异常	超声心动图异常
观察组	87	47(54.02)	40(45.98)	32.90±2.29	2 093.45±550.14	50(57.47)	29(33.33)	30(34.48)	23(26.44)	22(25.28)
对照组	87	46(52.87)	41( 47.13)	33.73±1.99	2 295.29±636.41	16(18.39)	17(19.54)	13(14.94)	11(12.64)	9(10.34)
χ²/t		0.023		2.260	2.238	28.220	4.255	8.927	5.264	6.633
P		0.879		0.011	0.027	<0.001	0.039	0.003	0.022	0.013

表2 两组早产儿不同时间点CK水平比较(U/L，±s)

Table 2 Comparison of CK levels at different observing time points between two groups (U/L,±s)

组别	n	生后第1天	生后第3天	生后第7天	生后第14天	平均值	F	P
观察组	87	358.44±78.96	355.18±78.97	229.94±59.40	132.32±35.62	268.97±114.95	239.37	<0.001
对照组	87	247.22±60.10	234.64±65.20	130.91±42.15	107.52±35.03	180.07±80.60	161.91	<0.001
平均值		302.83±89.47	294.91±94.16	180.43±71.44	119.92±37.35	224.52±108.72	235.19	<0.001
t		10.45	10.98	12.68	4.63	12.14
F		<0.001	<0.001	<0.001	<0.001	<0.001

表2 两组早产儿不同时间点CK水平比较(U/L，±s)

Table 2 Comparison of CK levels at different observing time points between two groups (U/L,±s)

组别	n	生后第1天	生后第3天	生后第7天	生后第14天	平均值	F	P
观察组	87	358.44±78.96	355.18±78.97	229.94±59.40	132.32±35.62	268.97±114.95	239.37	<0.001
对照组	87	247.22±60.10	234.64±65.20	130.91±42.15	107.52±35.03	180.07±80.60	161.91	<0.001
平均值		302.83±89.47	294.91±94.16	180.43±71.44	119.92±37.35	224.52±108.72	235.19	<0.001
t		10.45	10.98	12.68	4.63	12.14
F		<0.001	<0.001	<0.001	<0.001	<0.001

表3 两组早产儿不同时间点CK-MB水平比较(U/L，±sL)

Table 3 Comparison of CK-MB levels at different observing time points between two groups (U/L,±s)

组别	n	生后第1天	生后第3天	生后第7天	生后第14天	平均值	F	P
观察组	87	266.08±34.32	254.38±40.40	176.09±42.63	91.6 4±31.95	197.05±79.46	402.55	<0.001
对照组	87	162.41±35.27	143.59±33.35	97.46±37.84	38.37±16.05	110.46±47.45	262.68	<0.001
平均值		214.25±62.50	198.98±66.71	136.77±56.30	65.01±26.73	153.75±71.72	249.89	<0.001
t		19.65	19.73	12.87	13.90	16.47
P		<0.001	<0.001	<0.001	<0.001	<0.001

表3 两组早产儿不同时间点CK-MB水平比较(U/L，±sL)

Table 3 Comparison of CK-MB levels at different observing time points between two groups (U/L,±s)

组别	n	生后第1天	生后第3天	生后第7天	生后第14天	平均值	F	P
观察组	87	266.08±34.32	254.38±40.40	176.09±42.63	91.6 4±31.95	197.05±79.46	402.55	<0.001
对照组	87	162.41±35.27	143.59±33.35	97.46±37.84	38.37±16.05	110.46±47.45	262.68	<0.001
平均值		214.25±62.50	198.98±66.71	136.77±56.30	65.01±26.73	153.75±71.72	249.89	<0.001
t		19.65	19.73	12.87	13.90	16.47
P		<0.001	<0.001	<0.001	<0.001	<0.001

表4 两组早产儿不同时间点AST水平比较(U/L，±s)

Table 4 Comparison of AST levels at different observing time points between two groups (U/L,±s)

组别	n	生后第1天	生后第3天	生后第7天	生后第14天	平均值	F	P
观察组	87	60.98±16.12	98.31±20.84	86.23±19.94	29.14±10.38	68.66±31.65	271.62	<0.001
对照组	87	48.92±14.96	74.40±19.25	61.41±15.45	27.00±9.55	52.93±23.14	153.28	<0.001
平均值		54.95±16.64	86.36±23.32	73.82±21.71	28.07±10.00	60.80±28.80	321.34	<0.001
t		5.11	7.86	9.18	1.41	7.49
P		<0.001	<0.001	<0.001	<0.001	<0.001

表4 两组早产儿不同时间点AST水平比较(U/L，±s)

Table 4 Comparison of AST levels at different observing time points between two groups (U/L,±s)

组别	n	生后第1天	生后第3天	生后第7天	生后第14天	平均值	F	P
观察组	87	60.98±16.12	98.31±20.84	86.23±19.94	29.14±10.38	68.66±31.65	271.62	<0.001
对照组	87	48.92±14.96	74.40±19.25	61.41±15.45	27.00±9.55	52.93±23.14	153.28	<0.001
平均值		54.95±16.64	86.36±23.32	73.82±21.71	28.07±10.00	60.80±28.80	321.34	<0.001
t		5.11	7.86	9.18	1.41	7.49
P		<0.001	<0.001	<0.001	<0.001	<0.001

表5 两组早产儿不同时间点LDH水平比较(U/L，±s)

Table 5 Comparison of LDH levels at different observing time points between two groups (U/L,±s)

组别	n	生后第1天	生后第3天	生后第7天	生后第14天	平均值	F	P
观察组	87	527.52±133.74	840.49±241.36	397.41±103.99	265.00±94.02	507.61±263.49	220.64	<0.001
对照组	87	356.13±110.58	485.69±121.22	275.33±89.53	160.00±41.10	319.29±152.34	178.47	<0.001
平均值		441.82±149.52	663.09±260.61	336.37±114.49	212.50±89.48	413.45±234.79	227.96	<0.001
t		9.21	12.25	8.30	9.54	11.54
P		<0.001	<0.001	<0.001	<0.001	<0.001

表5 两组早产儿不同时间点LDH水平比较(U/L，±s)

Table 5 Comparison of LDH levels at different observing time points between two groups (U/L,±s)

组别	n	生后第1天	生后第3天	生后第7天	生后第14天	平均值	F	P
观察组	87	527.52±133.74	840.49±241.36	397.41±103.99	265.00±94.02	507.61±263.49	220.64	<0.001
对照组	87	356.13±110.58	485.69±121.22	275.33±89.53	160.00±41.10	319.29±152.34	178.47	<0.001
平均值		441.82±149.52	663.09±260.61	336.37±114.49	212.50±89.48	413.45±234.79	227.96	<0.001
t		9.21	12.25	8.30	9.54	11.54
P		<0.001	<0.001	<0.001	<0.001	<0.001

表6 两组早产儿不同时间点α-HBDH水平比较(U/L，±s)

Table 6 Comparison of α-HBDH levels at different observing time points between two groups (U/L,±s)

组别	n	生后第1天	生后第3天	生后第7天	生后第14天	平均值	F	P
观察组	87	506.47±112.86	777.52±165.02	363.59±84.44	236.05±59.84	470.91±230.57	370.70	<0.001
对照组	87	345.28±77.51	478.02±81.06	271.93±44.74	144.22±23.44	309.86±135.62	447.84	<0.001
平均值		425.87±125.90	627.77±198.38	317.76±81.56	190.13±64.60	390.38±205.48	361.83	<0.001
t		10.98	15.19	8.95	13.33	11.23
P		<0.001	<0.001	<0.001	<0.001	<0.001

表6 两组早产儿不同时间点α-HBDH水平比较(U/L，±s)

Table 6 Comparison of α-HBDH levels at different observing time points between two groups (U/L,±s)

组别	n	生后第1天	生后第3天	生后第7天	生后第14天	平均值	F	P
观察组	87	506.47±112.86	777.52±165.02	363.59±84.44	236.05±59.84	470.91±230.57	370.70	<0.001
对照组	87	345.28±77.51	478.02±81.06	271.93±44.74	144.22±23.44	309.86±135.62	447.84	<0.001
平均值		425.87±125.90	627.77±198.38	317.76±81.56	190.13±64.60	390.38±205.48	361.83	<0.001
t		10.98	15.19	8.95	13.33	11.23
P		<0.001	<0.001	<0.001	<0.001	<0.001

表7 两组早产儿不同时间点cTn I水平比较(ng/L，±s)

Table 7 Comparison of premature cTn I levels at different time points between two groups (ng/L,±s)

组别	n	生后第1天	生后第3天	生后第7天	生后第14天	平均值	F	P
观察组	87	390.25±137.93	464.17±162.28	237.49±79.18	231.99±84.83	330.96±156.71	78.47	<0.001
对照组	87	155.17±42.51	168.29±40.71	121.53±37.87	79.89±33.16	131.22±51.56	90.43	<0.001
平均值		272.71±135.73	316.23±149.55	179.51±84.92	155.94±69.71	231.11±153.55	51.87	<0.001
t		15.19	16.49	12.32	15.58	22.59
P		<0.001	<0.001	<0.001	<0.001	<0.001

表7 两组早产儿不同时间点cTn I水平比较(ng/L，±s)

Table 7 Comparison of premature cTn I levels at different time points between two groups (ng/L,±s)

组别	n	生后第1天	生后第3天	生后第7天	生后第14天	平均值	F	P
观察组	87	390.25±137.93	464.17±162.28	237.49±79.18	231.99±84.83	330.96±156.71	78.47	<0.001
对照组	87	155.17±42.51	168.29±40.71	121.53±37.87	79.89±33.16	131.22±51.56	90.43	<0.001
平均值		272.71±135.73	316.23±149.55	179.51±84.92	155.94±69.71	231.11±153.55	51.87	<0.001
t		15.19	16.49	12.32	15.58	22.59
P		<0.001	<0.001	<0.001	<0.001	<0.001

表8 两组早产儿前10位并发症比较[n(%)]

Table 8 Comparison of top 10 complications of premature infants between two groups [n(%)]

组别	n	高胆红素血症	电解质紊乱	肾功能不全	贫血	休克	DIC	心功能衰竭	感染	NRDS	颅内出血
观察组	87	67(77.0)	65(74.7)	53(60.9)	46(52.9)	35(40.2)	32(36.8)	29(33.3)	27(31.0)	23(26.4)	17(19.5)
对照组	87	61(70.1)	59(67.8)	47(54.0)	16(18.4)	19( 21.8)	14(16.1)	13(14.9)	10(11.5)	11(12.6)	8 (9.2)
χ²		1.064	1.010	0.846	22.552	6.874	9.575	8.035	9.920	5.264	3.784
P		0.302	0.315	0.358	<0.001	0.009	0.002	0.005	0.002	0.022	0.052

表8 两组早产儿前10位并发症比较[n(%)]

Table 8 Comparison of top 10 complications of premature infants between two groups [n(%)]

组别	n	高胆红素血症	电解质紊乱	肾功能不全	贫血	休克	DIC	心功能衰竭	感染	NRDS	颅内出血
观察组	87	67(77.0)	65(74.7)	53(60.9)	46(52.9)	35(40.2)	32(36.8)	29(33.3)	27(31.0)	23(26.4)	17(19.5)
对照组	87	61(70.1)	59(67.8)	47(54.0)	16(18.4)	19( 21.8)	14(16.1)	13(14.9)	10(11.5)	11(12.6)	8 (9.2)
χ²		1.064	1.010	0.846	22.552	6.874	9.575	8.035	9.920	5.264	3.784
P		0.302	0.315	0.358	<0.001	0.009	0.002	0.005	0.002	0.022	0.052

1	陈颖，张建平．胎盘早剥的早期诊断[J]．中国实用妇科与产科杂志，2011，27(6)：420-422.
2	陈叙，王妍平．重型胎盘早剥的诊断和处理[J]．中国实用妇科与产科杂志，2011，27(2)：83-85.
3	马玉燕，陈璐瑛．胎盘早剥合并弥漫性血管内凝血急诊处理[J]．中国实用妇科与产科杂志，2011，27(6)：422-425.
4	张乾忠．小儿心血管疾病实验室检查进展及指标正确解析-心肌损伤生化标志物应用进展及检测结果解析[J]．中国实用儿科杂志，2013，28(7)：481-487.
5	Ananth CV, Demissie K, Hanley ML. Birth weight discordancy and adverse perinatal outcomes among twin gestations in the United States: the effect of placental abruption [J]. Am J Obstet Gynecol, 2003, 188(4):954-960.
6	封志纯，王斌，陶少华，等．胎盘早剥产妇所生新生儿的临床资料回顾分析[J]．中国儿童保健杂志，2000，8(2)：94-96.
7	中华医学会妇产科学分会产科学组．胎盘早剥的临床诊断与处理规范(第1版)[J]．中华妇产科杂志，2012，47(12)：957-958.
8	邵肖梅，叶鸿瑁，丘小汕，主编．实用新生儿学．4版[M]．北京：人民卫生出版社，2011：46-71，237，563.
9	许靖，李秋平，孔祥永，等．胎盘早剥晚期早产儿临床特征及干预分析[J]．中国实用儿科杂志，2012，27(5)：371-374.
10	封志纯，王斌，陶少华，等．不同程度胎盘早剥产妇所生新生儿的临床特征[J]．中华围产医学杂志，2001，4(1)：22-24.
11	封志纯，常平，钟春霞．胎盘早剥新生儿的临床特征和危险性[J]．实用儿科临床杂志，2003，18(6)：415-416.
12	Tikkanen M. Etiology, clinical manifestations, and prediction of placental abruption[J]. Acta Obstet Gynecol Scand, 2010, 89(6):732-740.
13	郑铁生，樊绮诗，姜旭淦．临床生物化学实验诊断与病例解析[M]．北京：中国医药科技出版社，2010：159-165.
14	Al-Blitagi M, Issa M, Hagar HA, et al. Circulating cardiac troponins levels and cardiac dysfunction in children with acute and fulminant viral myocarditis[J]. Acta Paediatr, 2010, 99(10):1510-1511.
15	鲁珊，叶鸿瑁，李国权，等．1~6岁健康儿105名心肌酶谱检测与分析[J]．中国儿童保健杂志，2004，12(6)：532-533.
16	李怀远，蒋黎敏，郑建新，等．肌钙蛋白I和肌酸激酶同工酶儿童参考区间的建立[J]．中华检验医学杂志，2012，35(12)：1142-1145.
17	Apple FS, Collinson PO. IFCC task force on clinical application of cardiac biomarkers. Analytical characteristics of high-sensitivity cardiac troponin assays [J]. Clin Chem, 2012, 58(1):54-61.
18	Morrow DA, Cannon CP, Jesse RL, et al. National academy of clinical biochemistry laboratory medicine practice guidelines: clinical characteristics and utilization of biochemical markers in acute coronary syndromes [J]. Grculation, 2007, 115(13):356-375.
19	池卡，周北燕．胎盘早剥新生儿的临床特征及处理[J]．中国儿童保健杂志，2007，15(4)：434-435.

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