Zanardo Vincenzo, Mari Giancarlo, de Luca Federico, Scambia Giovanni, Guerrini Pietro, Straface Gianluca
Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme, Italy.
Tennessee Institute of Fetomaternal and Infant Health, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA.
Early Hum Dev. 2015 Mar;91(3):165-8. doi: 10.1016/j.earlhumdev.2015.01.003. Epub 2015 Feb 3.
In the human fetus, an increased lactate and glucose level can be anticipated when hypoxia and stress are present and is likely to be a function of both anaerobic metabolism and catecholamine-mediated glycogenolysis/glycolysis.
We assessed if measurement of lactate in cord artery blood after vaginal and cesarean delivery may predict glucose concentration.
Umbilical artery cord blood lactacidemia, acidemia, and glucose concentration was tested by 'mini-lab' Radiometer ABL90 FLEX analyzers (Radiometer®, Copenhagen, Denmark) after vaginal delivery (VD), spontaneous (n=493) and by vacuum extractor (n=41) or by cesarean delivery (CD), elective (n=120) and emergency (n=68) in at term, vigorous neonates delivered from March to December 2012 at the 2nd level maternity ward of Policlinico Abano Terme, Abano Terme (Italy).
Cord blood lactacidemia and glucose levels were significantly higher in VD by vacuum extractor than in all other groups (5.32±1.96mmol/L, p=0.050 and 103.6±30.5mg/dL, p<0.001, respectively) and significantly lower in elective CD group (1.77±0.99mmol/L, p<0.001 and 69.8±13.0mg/dL, p<0.001). The cord blood lactate concentration was significantly and positively correlated with glucose levels (r=0.434, p<0.001), but significantly and negatively correlated with pH (r=-0,662, p<0.001), NaHCO3(-) (r=-0,802, p<0.001), and base excess (BE) (r=-0,698, p<0.001). However, in multivariate linear regression analysis, only BE, PaCO2 and cord blood lactate were significant predictive variables (R(2)=0.410; p<0.001) of glucose levels at birth.
Cord blood artery lactate and glucose concentration are significantly and positively correlated at birth in healthy, at term vaginally and cesarean delivered neonates, but BE is the best indicator of activated fetal gluconeogenesis.
在人类胎儿中，当存在缺氧和应激时，乳酸和葡萄糖水平会升高，这可能是无氧代谢和儿茶酚胺介导的糖原分解/糖酵解共同作用的结果。
我们评估了阴道分娩和剖宫产术后脐动脉血中乳酸的测量是否可以预测葡萄糖浓度。
采用“微型实验室”Radiometer ABL90 FLEX分析仪（Radiometer公司，丹麦哥本哈根）检测2012年3月至12月在意大利阿巴诺泰尔梅市波利克利尼科阿巴诺泰尔梅二级产科病房足月、活力良好的新生儿经阴道分娩（VD），包括自然分娩（n = 493）、真空吸引分娩（n = 41）或剖宫产（CD），包括择期剖宫产（n = 120）和急诊剖宫产（n = 68）后的脐动脉血乳酸血症、酸血症和葡萄糖浓度。
真空吸引阴道分娩组的脐血乳酸血症和葡萄糖水平显著高于所有其他组（分别为5.32±1.96mmol/L，p = 0.050和103.6±30.5mg/dL，p < 0.001），择期剖宫产组则显著较低（1.77±0.99mmol/L，p < 0.001和69.8±13.0mg/dL，p < 0.001）。脐血乳酸浓度与葡萄糖水平显著正相关（r = 0.434，p < 0.001），但与pH显著负相关（r = -0.662，p < 0.001）、NaHCO3(-)（r = -0.802，p < 0.001）和碱剩余（BE）（r = -0.698，p < 0.001）。然而，在多变量线性回归分析中，只有BE、PaCO2和脐血乳酸是出生时葡萄糖水平的显著预测变量（R(2)=0.410；p < 0.001）。
在健康的足月经阴道和剖宫产分娩的新生儿中，出生时脐动脉血乳酸和葡萄糖浓度显著正相关，但BE是胎儿糖异生激活的最佳指标。
