Bahlmann Franz, Al Naimi Ammar, Ossendorf Manfred, Schmidt-Fittschen Monica, Willruth Arne
Department of Obstetrics and Gynecology, Bürgerhospital Frankfurt.
Center of Laboratory Medicine, Klinikum Darmstadt, Darmstadt.
J Perinat Med. 2017 Apr 1;45(3):367-373. doi: 10.1515/jpm-2016-0240.
Erythropoietin seems to play an important role in the regulation of fetal hypoxemia. The present prospective study was designed to determine if changes in erythropoietin levels can be found in fetuses with severe early-onset growth restriction and hemodynamic compromise.
Erythropoietin, hemoglobin, hematocrit, platelet counts, normoblasts, lacate, arterial and venous blood gasses in the umbilical cord were determined in 42 fetuses with fetal growth restriction (IUGR) with absent (zero-flow) and 26 IUGR fetuses with retrograde end-diastolic flow (reverse-flow) in the umbilical artery. Color Doppler measurements were performed on the middle cerebral artery (PI) and ductus venosus [(S-a)/D and (S-a)/Vmean]. Erythropoietin concentrations were significantly lower in the zero-flow group (median: 128.0 mU/mL; range: 60.3-213 mU/mL) compared with the reverse-flow group (median: 202.5 mU/mL; range: 166-1182 mU/mL). Significant differences in median lactate concentrations were observed between the zero-flow group: 3.28 mmol/L (range; 2.3-4.7 mmol/L), and reverse-flow group: 5.6 mmol/L (range: 3.8-7.5 mmol/L). Fetuses with reverse-flow had significantly lower median platelet counts than fetuses with zero-flow (74 vs. 155/μL) and significantly lower normoblast counts (63 vs. 342/100 WBC).
Fetuses with severe IUGR due to chronic placental insufficiency and absent or reversed flow in the umbilical artery show increased erythropoietin levels.
促红细胞生成素似乎在胎儿低氧血症的调节中发挥重要作用。本前瞻性研究旨在确定严重早发性生长受限且伴有血流动力学损害的胎儿促红细胞生成素水平是否会发生变化。
对42例脐动脉血流缺失（零血流）的胎儿生长受限（IUGR）胎儿以及26例脐动脉舒张末期血流逆行（反向血流）的IUGR胎儿，测定其促红细胞生成素、血红蛋白、血细胞比容、血小板计数、有核红细胞、乳酸、脐动脉和静脉血气。对大脑中动脉（搏动指数）和静脉导管[（S - a）/D和（S - a）/平均V]进行彩色多普勒测量。零血流组促红细胞生成素浓度（中位数：128.0 mU/mL；范围：60.3 - 213 mU/mL）显著低于反向血流组（中位数：202.5 mU/mL；范围：166 - 1182 mU/mL）。零血流组[3.28 mmol/L（范围；2.3 - 4.7 mmol/L）]和反向血流组[5.6 mmol/L（范围：3.8 - 7.5 mmol/L）]的乳酸浓度中位数存在显著差异。反向血流胎儿的血小板计数中位数显著低于零血流胎儿（74对155/μL），有核红细胞计数也显著更低（63对342/100白细胞）。
因慢性胎盘功能不全导致严重IUGR且脐动脉血流缺失或反向的胎儿促红细胞生成素水平升高。
