新生儿血清中17-羟孕酮水平的影响因素研究

Factors related to serum 17-OHP level in neonates

摘要:

目的探讨新生儿血清17-羟孕酮（17-OHP）浓度的影响因素。方法选取2014 年1 月-2015年12 月在西南医科大学附属医院分娩的1 585 例新生儿作为研究对象，所有新生儿均排除先天性肾上腺皮质增生症者。采用时间分辨荧光免疫分析法检测17-OHP浓度，比较不同性别、胎龄、出生体重、分娩方法、胎儿数量、采血日龄、血糖水平、血pH 值、有无出现感染、窒息、溶血性黄疸等特征的新生儿血清17-OHP浓度，采用多元线性回归来分析各临床特征与血清17-OHP浓度的关系。结果全部新生儿的血清17-OHP浓度为0～136.8 nmol/L，平均（16.68±6.83）nmol/L。胎龄为≤28 周、29～32 周、33～36 周、37～41 周、≥42 周的新生儿血17-OHP的浓度分别为（24.23±2.18）、（22.34±3.23）、（18.56±4.54）、（16.10±5.72）及（14.18±2.56）nmol/L，极低出生体重儿、低出生体重儿、正常出生体重儿、巨大儿的新生儿血17-OHP 的浓度分别为（23.87±2.25）、（21.84±3.36）、（16.17±6.08）及（14.43±3.18）nmol/L，各组比较差异有统计学意义（P <0.05）。多元线性回归结果表明，17-OHP浓度与多个因素有关，按作用从大到小依次为胎龄、出生体重、血pH 值、血糖、窒息、感染、采血日龄、溶血性黄疸、分娩方法、胎儿数量。结论新生儿血清17-OHP的浓度受到胎龄、出生体重、酸碱平衡、血糖水平等多个因素的影响，故临床上要全面关注这些因素来综合判断血17-OHP 的水平。

Abstract:

Objective To investigate the related factors of serum level of 17-hydroxyprogesterone (17-OHP) in neonates. Methods Totally 1,585 neonates without congenital adrenal hyperplasia who were born in the Affiliated Hospital of Southwest Medical University between January 2014 and December 2015 were enrolled for the research objects. The serum level of 17-OHP was detected by time-resolved fluoroimmunoassay, then compared among the cases with different clinical characteristics including gender, gestational age, birth weight, mode of delivery, number of fetus, time of blood sampling, blood glucose level, blood pH, presence of infection, asphyxia and hemolytic jaundice. Multiple linear regression was performed to analyze the relationships between the serum level of 17-OHP and the clinical characteristics. Results The serum 17-OHP level of all neonates was 0-136.8 nmol/L with the average level of (16.68 ±6.83) nmol/L. The serum levels of 17-OHP in the neonates with gestational age of≤28 w, 29-32 w, 33-36 w, 37-41 w, and ≥42 w were respectively (24.23 ±2.18), (22.34±3.23), (18.56 ±4.54), (16.10 ±5.72) and (14.18 ±2.56) nmol/L, there were statistically significant differences among the groups (P < 0.05). The serum level of 17-OHP in the neonates with very low birth weight, low birth weight, normal birth weight and macrosomia were respectively (23.87 ±2.25), (21.84 ±3.36), (16.17 ±6.08) and (14.43 ±3.18) nmol/L, there were statistically significant differences among the groups (P < 0.05). Multiple linear regression analysis showed that serum level of 17-OHP was influenced mostly by gestational age, followed by birth weight, blood pH, blood glucose,asphyxia, infection, time of blood sampling, hemolytic jaundice, mode of delivery and number of fetus (P < 0.05). Conclusions Serum level of 17-OHP is influenced by gestational age, birth weight, acid-base balance, blood sugar level and other factors; therefore doctors should pay attention to these factors to comprehensively evaluate serum level of 17-OHP.