Dept. of Obstet. and Gynecol., Poznan University of Medical Sciences, Poland.
Early Hum Dev. 2012 Jul;88(7):461-5. doi: 10.1016/j.earlhumdev.2011.11.001. Epub 2011 Dec 2.
The accepted standard for assessing the wellbeing of the newborn is the Apgar score and blood gas analysis. However, the prediction of neonatal morbidity or mortality is limited. In small-for-gestation (SGA) fetuses at 18-38 weeks of gestation, pO(2) is <5th centile both in the umbilical artery and vein in 30%. In a previous study in singleton term neonates cardiac specific enzymes (B-type natriuretic peptide, BNP and cardiac troponin T, cTnT) are increased in growth-restricted fetuses compared with normals.
To test the hypothesis, that fetuses with intra uterine growth restriction (IUGR) have elevated AST (GOT) and ALT (GPT) aminotransferases as a result of hypoxic liver cell injury, and to establish references ranges.
Prospective cohort study, serum of umbilical artery (n=156) and vein (n=180), 599 normal singletons at 37(+0)-42(+0)weeks, neonates with IUGR (n=41), analysis for pH, birthweight and maternal weight, spontaneous vs cesarean section, vein vs artery and for the sex.
Aspartate aminotransferase (AST, GOT) and Alanine aminotransferase (ALT, GPT) were measured in normals and IUGR neonates.
Neonates with IUGR (n=41) had AST values that were not different from the reference group, but had significantly lower ALT (-1.49, 95% CI -1.98 to -1.00 vs 0.14, 95% CI -0.42-0.13), (p<0.001), (Fig. 3).
In neonates with IUGR, hypoxic hepatic injury markers in cord blood were not elevated. Rather, a substantially reduced ALT suggests a down-regulated hepatic activity.
评估新生儿健康状况的公认标准是阿普加评分和血气分析。然而，对新生儿发病率或死亡率的预测是有限的。在 18-38 周妊娠的小胎龄（SGA）胎儿中，脐带动脉和静脉的 pO(2)在 30%的情况下均低于第 5 百分位。在之前一项对足月单胎新生儿的研究中，与正常胎儿相比，生长受限胎儿的心脏特异性酶（B 型利钠肽，BNP 和心肌肌钙蛋白 T，cTnT）增加。
检验假设，即宫内生长受限（IUGR）胎儿由于缺氧肝细胞损伤而导致天冬氨酸氨基转移酶（GOT）和丙氨酸氨基转移酶（GPT）升高，并建立参考范围。
前瞻性队列研究，脐带动脉（n=156）和静脉（n=180）血清，599 例 37（+0）-42（+0）周正常单胎，IUGR 新生儿（n=41），分析 pH 值、出生体重和母亲体重、自然分娩与剖宫产、静脉与动脉以及性别。
IUGR 新生儿（n=41）的 AST 值与参考组无差异，但 ALT 显著降低（-1.49，95%CI-1.98 至-1.00 与 0.14，95%CI-0.42-0.13）（p<0.001）（图 3）。
在 IUGR 新生儿中，脐带血中缺氧性肝损伤标志物未升高。相反，ALT 显著降低提示肝脏活性下调。
