Department of Pediatrics, Centers for Free Radical Biology and Pulmonary Injury Repair Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
PLoS One. 2012;7(9):e45164. doi: 10.1371/journal.pone.0045164. Epub 2012 Sep 12.
Inhaled nitric oxide (iNO) reduces death or need for extracorporeal membrane oxygenation (ECMO) in infants with persistent pulmonary hypertension of the newborn (PPHN). However, the response to iNO is variable and only 50-60% of infants demonstrate a response to iNO. It is not known why only some infants respond to iNO. Adults and children with blood groups B or AB do not respond as well to iNO as those with blood groups O/A.
METHODS/PRINCIPAL FINDINGS: To determine if blood group was associated with iNO response in newborn infants, a retrospective medical record review was done of infants admitted to a regional NICU from 2002-9 with a diagnosis of PPHN. Data were collected during the first twelve hours post-initiation of treatment. Of 86 infants diagnosed with PPHN, 23 infants had blood group A [18 received iNO], 21 had group B [18 with iNO], 40 had group O [36 with iNO], and 2 had group AB [both received iNO]. Change in PaO(2)/FiO(2) was less in infants with blood group A, of whom less than half were responders (ΔPaO(2)/FiO(2)>20%) at 12 h versus 90% of infants with either O or B. Race, sex, birth weight, gestational age, Apgar scores at 1 and 5 minutes, and baseline PaO(2)/FiO(2) were similar among groups. Outcomes including need for ECMO, death, length of ventilatory support, length of iNO use, and hospital stay were statistically not different by blood groups.
CONCLUSIONS/SIGNIFICANCE: Our results indicate that blood group influences iNO response in neonates. We hypothesize that either there is genetic linkage of the ABO gene locus with vasoregulatory genes, or that blood group antigens directly affect vascular reactivity.
吸入一氧化氮（iNO）可降低新生儿持续性肺动脉高压（PPHN）患儿的死亡率或体外膜氧合（ECMO）需求。然而，iNO 的反应是可变的，只有 50-60%的患儿对 iNO 有反应。尚不清楚为什么只有部分患儿对 iNO 有反应。与 O/A 血型的患儿相比，血型为 B 或 AB 的成人和儿童对 iNO 的反应不如 O/A 血型的患儿。
方法/主要发现：为了确定血型是否与新生儿 iNO 反应有关，对 2002-2009 年期间在一家区域性新生儿重症监护病房（NICU）就诊并诊断为 PPHN 的患儿进行了回顾性病历审查。数据在治疗开始后 12 小时内收集。在 86 例被诊断为 PPHN 的患儿中，有 23 例为 A 组[18 例接受 iNO]，21 例为 B 组[18 例接受 iNO]，40 例为 O 组[36 例接受 iNO]，2 例为 AB 组[均接受 iNO]。A 组患儿的 PaO(2)/FiO(2) 变化较小，其中不到一半（ΔPaO(2)/FiO(2)>20%）在 12 小时时为反应者，而 O 组或 B 组患儿的反应率为 90%。各组之间的种族、性别、出生体重、胎龄、1 分钟和 5 分钟时的 Apgar 评分以及基线 PaO(2)/FiO(2) 相似。各组之间的 ECMO 需求、死亡、通气支持时间、iNO 使用时间和住院时间等结局均无统计学差异。
结论/意义：我们的结果表明，血型影响新生儿的 iNO 反应。我们假设 ABO 基因座与血管调节基因之间存在遗传连锁，或者血型抗原直接影响血管反应性。
