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

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