脐静脉促红细胞生成素和脐动脉pH值与胎盘形态学异常的关系。

Umbilical venous erythropoietin and umbilical arterial pH in relation to morphologic placental abnormalities.

作者信息

Maier R F, Günther A, Vogel M, Dudenhausen J W, Obladen M

机构信息

Department of Neonatology, Klinikum Rudolf Virchow, Free University of Berlin, Germany.

出版信息

Obstet Gynecol. 1994 Jul;84(1):81-7.

PMID:8008330

Abstract

OBJECTIVE

To investigate the relation between the biochemical markers of umbilical venous erythropoietin and umbilical arterial pH and morphologic placental abnormalities in fetal hypoxia.

METHODS

Placentas from 300 high-risk newborn infants (gestational age 24-42 weeks) were examined macroscopically and microscopically following standardized criteria. The morphologic findings were correlated with the erythropoietin concentration in umbilical venous blood and with umbilical arterial pH at birth. Venous hematocrit and circulating nucleated red blood cells were measured in 112 of these infants during the first 6 hours of life.

RESULTS

The umbilical venous erythropoietin concentration correlated significantly (r = 0.74) with the number of circulating nucleated red blood cells. In 26 placentas without morphologic abnormalities, the median (and 25th and 75th percentiles) erythropoietin concentration was 35.2 mU/mL (19.2-48.7) and umbilical arterial pH was 7.30 (7.20-7.33). The erythropoietin concentration was elevated significantly when placental examination showed evidence of acute villous circulatory disturbance (61.3 mU/mL; 24.2-125.1), fetal vasculopathy (85.6 mU/mL; 23.7-119.7), or chorioamnionitis with fetal reaction (51.3 mU/mL; 27.7-118.7). The erythropoietin concentration varied significantly with the stage of placental meconium phagocytosis; it was 62.7 mU/mL (16.3-125.9) if meconium phagocytosis was classified as recent, 128.2 mU/mL (44.4-1483.2) if it was classified as a few hours old, and 66.2 mU/mL (46.3-140.1) if it was classified as a few days old. Umbilical arterial pH was not altered significantly with different morphologic placental abnormalities.

CONCLUSIONS

Fetal erythropoietin production is stimulated by hypoxia after a few hours' delay and leads to increased erythropoiesis. Placental examination combined with measurement of umbilical venous erythropoietin and umbilical arterial pH provides information about earlier fetal hypoxia.

摘要

目的

探讨胎儿缺氧时脐静脉促红细胞生成素的生化标志物与脐动脉pH值及胎盘形态学异常之间的关系。

方法

对300例高危新生儿（孕周24 - 42周）的胎盘按照标准化标准进行宏观和微观检查。将形态学检查结果与出生时脐静脉血中促红细胞生成素浓度及脐动脉pH值进行相关性分析。对其中112例婴儿在出生后6小时内测量静脉血细胞比容和循环中有核红细胞数量。

结果

脐静脉促红细胞生成素浓度与循环中有核红细胞数量显著相关（r = 0.74）。在26例无形态学异常的胎盘中，促红细胞生成素浓度中位数（及第25和第75百分位数）为35.2 mU/mL（19.2 - 48.7），脐动脉pH值为7.30（7.20 - 7.33）。当胎盘检查显示有急性绒毛循环障碍（61.3 mU/mL；24.2 - 125.1）、胎儿血管病变（85.6 mU/mL；23.7 - 119.7）或伴有胎儿反应的绒毛膜羊膜炎（51.3 mU/mL；27.7 - 118.7）时，促红细胞生成素浓度显著升高。促红细胞生成素浓度随胎盘胎粪吞噬阶段有显著变化；若胎粪吞噬分类为近期，其浓度为62.7 mU/mL（16.3 - 125.9）；若分类为几小时前，浓度为128.2 mU/mL（44.4 - 1483.2）；若分类为几天前，浓度为66.2 mU/mL（46.3 - 140.1）。不同胎盘形态学异常时脐动脉pH值无显著改变。