Moya F R, Grannum P A, Widness J A, Clemons G K, Copel J A, Hobbins J C
Department of Pediatrics, Yale University, New Haven, Connecticut.
Obstet Gynecol. 1993 Sep;82(3):353-8.
To determine whether plasma erythropoietin is increased in fetuses with anemia due to Rh isoimmunization.
Hemoglobin and erythropoietin were measured in samples obtained by funipuncture from 15 fetuses with Rh isoimmunization (gestational age 26.2 +/- 5.0 weeks, mean +/- standard deviation) and from 13 control fetuses (23.1 +/- 6.7 weeks). Hemoglobin and erythropoietin also were determined in umbilical cord blood collected at birth from 20 term fetuses delivered by elective cesarean.
Fetuses with Rh isoimmunization had lower hemoglobin and higher plasma erythropoietin measurements than mid-gestation controls (6.1 +/- 3.9 versus 10.7 +/- 1.5 g/dL and 105.5 +/- 168.1 versus 12.5 +/- 3.1 mU/mL, P < .05, respectively). Hemoglobin and plasma erythropoietin increased with gestational age in control fetuses. There was an inverse association between hemoglobin and plasma erythropoietin in control and Rh-isoimmunized fetuses (r = -0.56, P < .005). Using multiple linear regression, hemoglobin and gestational age were associated independently with plasma erythropoietin (overall F2,25 = 12.3, multiple r2 = 0.49, P < .001). Despite marked decreases in hemoglobin, fetuses below 24 weeks' gestation had minimal increases in plasma erythropoietin compared to fetuses above that gestational age. Mildly anemic Rh-isoimmunized fetuses (hemoglobin 11.6 +/- 2.0 g/dL) delivered vaginally had significantly higher erythropoietin levels in umbilical cord plasma than Rh-isoimmunized fetuses with comparable hemoglobin (10.9 +/- 3.5 g/dL) delivered by elective cesarean without labor (1246 +/- 856 versus 106 +/- 66 mU/mL, respectively, P < .05).
Fetuses with anemia at mid to late gestation respond with increases in plasma erythropoietin, but these changes are substantially attenuated before 24 weeks' gestation.
确定因Rh血型免疫而贫血的胎儿血浆促红细胞生成素是否增加。
对通过脐静脉穿刺从15例Rh血型免疫胎儿（孕龄26.2±5.0周，均值±标准差）和13例对照胎儿（23.1±6.7周）获取的样本进行血红蛋白和促红细胞生成素检测。还对20例择期剖宫产分娩的足月胎儿出生时采集的脐带血中的血红蛋白和促红细胞生成素进行了测定。
与孕中期对照胎儿相比，Rh血型免疫胎儿的血红蛋白较低，血浆促红细胞生成素水平较高（分别为6.1±3.9与10.7±1.5 g/dL以及105.5±168.1与12.5±3.1 mU/mL，P<0.05）。对照胎儿的血红蛋白和血浆促红细胞生成素随孕龄增加。对照胎儿和Rh血型免疫胎儿的血红蛋白与血浆促红细胞生成素呈负相关（r = -0.56，P<0.005）。采用多元线性回归分析，血红蛋白和孕龄与血浆促红细胞生成素独立相关（总体F2,25 = 12.3，复相关系数r2 = 0.49，P<0.001）。尽管血红蛋白显著降低，但孕龄低于24周的胎儿与高于该孕龄的胎儿相比，血浆促红细胞生成素升高幅度极小。经阴道分娩的轻度贫血Rh血型免疫胎儿（血红蛋白11.6±2.0 g/dL）脐带血浆中的促红细胞生成素水平显著高于择期剖宫产未经历分娩的血红蛋白水平相当的Rh血型免疫胎儿（血红蛋白10.9±3.5 g/dL）（分别为1246±856与106±66 mU/mL，P<0.05）。
孕中晚期贫血的胎儿血浆促红细胞生成素增加，但这些变化在孕24周前大幅减弱。
