抗氧化活性、红细胞压积输血与早产儿的预后
Antioxidant activity, packed cell transfusions, and outcome in premature infants.
作者信息
Silvers K M, Gibson A T, Russell J M, Powers H J
机构信息
University Department of Paediatrics, University of Sheffield, Western Bank.
出版信息
Arch Dis Child Fetal Neonatal Ed. 1998 May;78(3):F214-9. doi: 10.1136/fn.78.3.f214.
AIM
To evaluate the relative importance of biochemical markers of antioxidant status, gestational age, and parameters of neonatal care in the clinical outcome of premature infants.
METHOD
A prospective, observational, longitudinal study of the association between these factors was conducted. Blood was collected from an in situ arterial line within two hours of birth and at intervals thereafter, when blood was drawn for routine clinical purposes. Outcome was assessed as death, or survival with or without bronchopulmonary dysplasia (BPD). One hundred and forty four babies of 22 to 39 weeks of gestation, who required intensive care at the Jessop Hospital for Women, between January 1993 and April 1994, were recruited.
RESULTS
Low gestational age at birth was the most important predictor of mortality and the development of BPD. Having corrected for gestational age, low plasma antioxidant activity at birth was an independent risk factor for mortality. Plasma vitamin C at birth was significantly higher in the babies who died compared with those with a good outcome, but this effect was not sustained after correcting for gestational age. Repeated measures of Analysis of Variance revealed a postnatal increase in antioxidant activity, caeruloplasmin, retinol, cholesterol corrected alpha tocopherol, and red blood cell superoxide dismutase (SOD) activity. Vitamin C, on the other hand, declined in all groups after birth. Logistic regression analysis revealed that the greater the number of packed cell transfusions received during intensive care, and the higher the concentration of vitamin C on the second day of life, the greater the risk of developing BPD.
CONCLUSIONS
After correcting for the effect of gestational age, low plasma antioxidant activity at birth was an independent risk factor for mortality. Frequent blood cell transfusions over the first week of life are associated with an increased risk of developing BPD. This association may be causal.
目的
评估抗氧化状态的生化标志物、胎龄及新生儿护理参数在早产儿临床结局中的相对重要性。
方法
对这些因素之间的关联进行了一项前瞻性、观察性纵向研究。出生后两小时内从原位动脉导管采血，此后在因常规临床目的采血时定期采血。结局评估为死亡，或存活伴或不伴支气管肺发育不良（BPD）。招募了1993年1月至1994年4月间在杰索普妇女医院需要重症监护的144名孕22至39周的婴儿。
结果
出生时低胎龄是死亡率和BPD发生的最重要预测因素。校正胎龄后，出生时低血浆抗氧化活性是死亡的独立危险因素。死亡婴儿出生时的血浆维生素C显著高于结局良好的婴儿，但校正胎龄后这种效应未持续。重复测量方差分析显示出生后抗氧化活性、铜蓝蛋白、视黄醇、胆固醇校正α-生育酚和红细胞超氧化物歧化酶（SOD）活性增加。另一方面，出生后所有组的维生素C均下降。逻辑回归分析显示，重症监护期间接受的浓缩红细胞输注次数越多，出生后第二天维生素C浓度越高，发生BPD的风险越大。
结论
校正胎龄影响后，出生时低血浆抗氧化活性是死亡的独立危险因素。出生后第一周频繁输血与发生BPD的风险增加相关。这种关联可能是因果关系。
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