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目的探讨产前母血胎儿有核红细胞(Hb F)、甲胎蛋白(AFP)水平与胎母输血综合征的相关性。方法回顾性分析2015年5月-2016年12月期间小榄人民医院收治的胎母输血综合征患者30例作为观察组,依据新生儿结局分为不良组(21例)和良好组(9例),同期选取新生儿健康的孕妇30例作为对照组,所有研究对象通过红细胞酸洗脱试验法(KB)检测母血Hb F水平,采用酶联免疫吸附法(ELISA)检测母血AFP水平,采用胎儿生物物理相评分(BPS)评估胎儿宫内缺氧程度,采用阿氏评分Apgar评估新生儿窒息程度,采用Pearson相关性分析法分析母血Hb F、AFP水平与BPS和Apgar得分的关系,采用Logistic回归性分析法分析上述因素与新生儿结局的关系,统计分析所有研究对象母血Hb F、AFP水平、新生儿窒息和不良结局(贫血、死亡等)情况。结果观察组患者母血Hb F、AFP水平明显高于对照组(P<0.05),BPS和Apgar得分明显低于对照组(P<0.05);Pearson相关性分析法结果显示,母血Hb F水平与BPS和Apgar得分呈负相关(r_1=-0.704,P<0.05;r_2=-0.683,P<0.05),母血AFP水平与BPS和Apgar得分呈负相关(r_3=-0.652,P<0.05;r4=-0.631,P<0.05);不良组患者母血Hb F、AFP水平明显高于良好组前者BPS和Apgar得分明显低于后者(P<0.05);Logistic回归性分析法结果显示,母血Hb F、AFP水平是胎母输血综合征新生儿不良结局的独立危险因素(P<0.05)。结论产前母血Hb F、AFP水平与胎母输血综合征的病情和预后有关,可有效反映胎儿宫内缺氧和新生儿窒息程度,同时也是胎母输血综合征新生儿不良结局的独立危险因素,检测上述因子水平有利于医师进一步了解胎母输血综合征的病情和评估预后。
Objective To investigate the relationship between prenatal maternal blood fetal hemoglobin (Hb F), alpha fetoprotein (AFP) and maternal blood transfusion syndrome. Methods A retrospective analysis of 30 cases of maternal blood transfusion syndrome admitted to Siu Lam People’s Hospital between May 2015 and December 2016 was used as the observation group. According to the neonatal outcome, the patients were divided into two groups according to the neonatal outcome: 21 cases in poor group and 9 cases in good group. ) .30 healthy pregnant women were selected as the control group in the same period. All subjects were tested for serum Hb F level by erythrocyte acid elution test (KB), and maternal serum AFP level by enzyme-linked immunosorbent assay (ELISA) Fetal biophysical assessment (BPS) was used to evaluate the degree of fetal hypoxia. Apgar scores were used to evaluate neonatal asphyxia. Pearson correlation analysis was used to analyze the relationship between Hb F, AFP levels and BPS and Apgar scores. Logistic regression analysis was used to analyze the relationship between the above factors and neonatal outcomes. Hb F, AFP levels, neonatal asphyxia and adverse outcomes (anemia, death, etc.) were statistically analyzed in all subjects. Results The levels of Hb F and AFP in maternal blood were significantly higher in the observation group than those in the control group (P <0.05), and those in the BPS and Apgar groups were significantly lower than those in the control group (P <0.05). Pearson correlation analysis showed that the levels of Hb F Negatively correlated with BPS and Apgar scores (r_1 = -0.704, P <0.05; r_2 = -0.683, P <0.05). AFP levels in maternal blood were negatively correlated with BPS and Apgar scores (r_3 = -0.652, r4 = -0.631, P <0.05). The scores of Hb F and AFP in maternal blood were significantly lower in the poor group than those in the good group (P <0.05). Logistic regression analysis showed that female Blood Hb F and AFP levels were independent risk factors for neonatal unwanted maternal blood transfusion syndrome (P <0.05). Conclusions The levels of Hb F and AFP in prenatal maternal blood are related to the prognosis and prognosis of maternal blood transfusion syndrome, which can effectively reflect the degree of fetal hypoxia and neonatal asphyxia and are also independent risk factors of neonatal unwanted maternal blood transfusion syndrome Factors, the detection of these factors is conducive to the doctor to further understand the maternal blood transfusion syndrome and assess the prognosis.