Clinical application values of pulmonary artery blood flow indexes and pulmonary surfactant protein level for perinatal lung maturity when pregnant women complicated with severe preeclampsia and gestational diabetes mellitus

doi:10.3877/cma.j.issn.1673-5250.2021.06.011

Objective

To investigate clinical values of pulsatility indexes (PI) and resistance indexes (RI) of fetal pulmonary artery, and pulmonary surfactant protein (SP)-A, SP-B levels in neonatal umbilical cord blood to evaluate perineonate lung maturity when pregnant women complicated with severe preeclampsia (sPE) and gestational diabetes mellitus (GDM).

Methods

A total of 60 perineonates of pregnant women complicated with sPE and GDM delivered in the Second Hospital of Jilin University from January 2018 to October 2019 were selected as research objects. According to gestational age at birth of neonates, they were divided into group A (n=22, gestational age at birth≥37 weeks), group B (n=20, 35 weeks≤ gestational age at birth<37 weeks) and group C (n=18, gestational age at birth<35 weeks). Levels of PI and RI of fetal pulmonary artery, SP-A and SP-B in neonatal umbilical cord blood, and 1 min Apgar scores and neonatal birth weight of three groups were overall compared by Kruskal Wallis H rank sum test, and further compared by Mann-Whitney U test. Chi-square test was used for overall and further comparison of incidences of neonatal respiratory distress syndrome (NRDS) among three groups. The correlation between PI, RI, SP-A, SP-B, Apgar score at 1 min after birth, neonatal birth weight and gestational age at birth in three groups were analyzed by Spearman rank correlation analysis. The procedures in this study were approved by Ethics Committee of the Second Hospital of Jilin University [Approval No. 2019 Yan Shen No. (111)]. All guardians of subjects signed clinical research informed consents.

Results

① There were significant differences in levels of PI and RI of fetal pulmonary artery, and SP-A and SP-B in neonatal umbilical cord blood among three groups, also between any two groups (P<0.05), and levels of PI and RI gradually decreased and SP-A and SP-B gradually increased with the increase of gestational age. ② Apgar score at 1 min after birth and neonatal birth weight in group A and group B were 9 scores (9-9 scores) and 3 010 g (2 777-3 802 g), 9 scores (8-9 scores) and 2 680 g (2 000-3 427 g), respectively, which were significantly higher than those of 8 scores (8-8 scores) and 1 660 g(1 500-2 005 g) in group C; while the incidences of NRDS in group A and group B (4.5% and 20.0%) were significantly lower than that in group C (66.7%), respectively, and all the differences were statistically significant (group A vs group C: Z=28.242, Z=30.202, χ²=17.415; group B vs group C: Z=19.433, Z=21.111, χ²=8.464; all P<0.001). There were no significant differences between group A and group B in these three indexes. ③ The PI and RI of fetal pulmonary artery were negatively correlated with gestational age (r_s=-0.780, r_s=-0.856, all P<0.001). Pulmonary SP-A and SP-B levels in neonatal umbilical cord blood, Apgar score at 1 min after birth and neonatal birth weight were positively correlated with gestational age (r_s=0.842, r_s=0.872, r_s=0.689, r_s=0.820, all P<0.001).

Conclusions

PI and RI of fetal pulmonary artery, and pulmonary SP-A and SP-B levels in neonatal umbilical cord blood, could be used as indexes to evaluate perineonate lung maturity when pregnant women complicated with sPE and GDM.

Key words: Pre-eclampsia, Diabetes, gestational, Pulmonary artery, Pulsatility index, Resistance index, Pulmonary surfactant protein, Fetal lung maturity, Pregnant women, Fetus

表1 3组受试儿肺动脉PI及RI、脐血中肺SP水平总体及两两比较[M(P₂₅~P₇₅)]

组别		例数	肺动脉PI	肺动脉RI	脐血中肺SP-A(ng/L)	脐血中肺SP-B(ng/L)
A组		22	1.9(1.8~2.0)	0.8(0.8~0.9)	522.5(371.0~648.7)	402.6(390.9~434.0)
B组		20	2.0(1.9~2.0)	1.0(0.9~1.0)	261.9(232.5~331.2)	208.9(196.8~250.0)
C组		18	2.3(2.2~2.8)	1.1(1.0~1.2)	141.4(111.4~143.3)	144.8(119.0~161.3)
总体比较(Z值/P值)			42.669/<0.001	47.271/<0.001	51.626/<0.001	51.033/<0.001
两两比较(Z值/P值)
	A组vs B组		13.182/0.043	21.114/<0.001	20.427/<0.001	20.045/0.001
	A组vs C组		35.960/<0.001	37.753/<0.001	39.727/<0.001	39.545/<0.001
	B组vs C组		22.778/<0.001	16.639/0.010	19.300/0.002	19.500/0.002

表1 3组受试儿肺动脉PI及RI、脐血中肺SP水平总体及两两比较[M(P₂₅~P₇₅)]

组别		例数	肺动脉PI	肺动脉RI	脐血中肺SP-A(ng/L)	脐血中肺SP-B(ng/L)
A组		22	1.9(1.8~2.0)	0.8(0.8~0.9)	522.5(371.0~648.7)	402.6(390.9~434.0)
B组		20	2.0(1.9~2.0)	1.0(0.9~1.0)	261.9(232.5~331.2)	208.9(196.8~250.0)
C组		18	2.3(2.2~2.8)	1.1(1.0~1.2)	141.4(111.4~143.3)	144.8(119.0~161.3)
总体比较(Z值/P值)			42.669/<0.001	47.271/<0.001	51.626/<0.001	51.033/<0.001
两两比较(Z值/P值)
	A组vs B组		13.182/0.043	21.114/<0.001	20.427/<0.001	20.045/0.001
	A组vs C组		35.960/<0.001	37.753/<0.001	39.727/<0.001	39.545/<0.001
	B组vs C组		22.778/<0.001	16.639/0.010	19.300/0.002	19.500/0.002

表2 3组新生儿FLM参考指标总体及两两比较

组别		例数	生后1 min Apgar评分[分，M(P₂₅~P₇₅)]	出生体重[g，M(P₂₅~P₇₅)]	NRDS[例数(%)]
A组		22	9(9~9)	3 010(2 777~3 802)	1(4.5)
B组		20	9(8~9)	2 680(2 000~3 427)	4(20.0)
C组		18	8(8~8)	1 660(1 500~2 005)	12(66.7)
总体比较(检验值/P值)			Z＝34.219/<0.001	Z＝30.626/<0.001	χ²＝19.841/<0.001
两两比较(检验值/P值)
	A组vs B组		Z＝8.809/0.192	Z＝9.091/0.274	—^a/0.174
	A组vs C组		Z＝28.242/<0.001	Z＝30.202/<0.001	χ²＝17.415/<0.001
	B组vs C组		Z＝19.433/<0.001	Z＝21.111/0.001	χ²＝8.464/<0.001

表2 3组新生儿FLM参考指标总体及两两比较

组别		例数	生后1 min Apgar评分[分，M(P₂₅~P₇₅)]	出生体重[g，M(P₂₅~P₇₅)]	NRDS[例数(%)]
A组		22	9(9~9)	3 010(2 777~3 802)	1(4.5)
B组		20	9(8~9)	2 680(2 000~3 427)	4(20.0)
C组		18	8(8~8)	1 660(1 500~2 005)	12(66.7)
总体比较(检验值/P值)			Z＝34.219/<0.001	Z＝30.626/<0.001	χ²＝19.841/<0.001
两两比较(检验值/P值)
	A组vs B组		Z＝8.809/0.192	Z＝9.091/0.274	—^a/0.174
	A组vs C组		Z＝28.242/<0.001	Z＝30.202/<0.001	χ²＝17.415/<0.001
	B组vs C组		Z＝19.433/<0.001	Z＝21.111/0.001	χ²＝8.464/<0.001

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