摘要
目的探讨血清皮质醇水平与早产儿动脉导管未闭（patent ductus arteriosus，PDA）的关系。方法选择2009年1月1日至12月31日间出生后即在福建省妇幼保健院新生儿科治疗的432例早产儿为研究队列，预采集其桡动脉血，以出生3d后诊断PDA的为PDA组，按照1：1匹配巢式病例对照研究的方法，选择同期住院的胎龄相近（相差小于1周）、有相同的孕母产前地塞米松应用史，同一日龄行超声心动图排除PDA的早产儿为对照组进行匹配，共38对。收集两组早产儿临床资料，并在行超声心动图的当天第2次采集桡动脉血。用化学发光法检测两组两次血标本的血清皮质醇水平，并采用Logistic回归分析方法分析PDA的危险因素。结果PDA组及对照组的性别比例、胎龄、分娩方式、出生窒息史、是否合并呼吸衰竭、败血症以及血清球蛋白、白蛋白值的差异无统计学意义（P均〉0．05）。PDA组出生时的血清皮质醇浓度为（261．9±229．6）nmol／L，低于对照组的（379．8±236．3）nmol／L，差异有统计学意义（t=2．20，P=0．03）。条件Logistic回归分析显示出生低血清皮质醇水平是早产儿发生PDA的危险因素（OR=0．916，95％CI：0．854～0．983，P：0．015）。在控制了出生血清皮质醇基础值、缺氧、感染、危重症等影响因素后，PDA组和对照组的第2次血清皮质醇浓度的校正均值（95％CI）分别为300．0nmol／L（232．4～367．4nmol／L）和263．6nmol／L（196．2～331．2nmol／L），两组比较差异无统计学意义（t=0．537，P=0．466）。结论出生低血清皮质醇水平是早产儿PDA的危险因素，而早产儿发生PDA不影响血清皮质醇水平。
Objective To determine the relationship between the levels of serum cortisol and patent duetus arteriosus（PDA） in preterm infants. Methods A 1 ： 1 matched nested case-control study was conducted. Thirty-eight pairs of preterm infants were selected from January 1 to December 31 in 2009. Thirty-eight preterm infants developed PDA. And we also selected 38 non-PDA preterm infants as the controls, who had the corresponding gestational age, same exposure to antenatal steroid and same echocardiography examination time. The serum cortisol concentrations of these infants were measured twice by chemiluminesence immunoassay. All data were analyzed via SPSS 13.0. Results No significant difference was found between PDA and control groups in demographic characteristics and influence factors for serum cortisol. The first mean level of serum cortisol in PDA group was （261.9± 229.6） nmol/L, significantly lower than that in control group [（379. 8± 236.3） nmol/L] （t = 2.20, P = 0.03）. Logistic regression analysis showed low serum cortisol concentrations at birth was risk factor for PDA in preterm infants（OR =0. 916,95 % CI： 0. 854- 0. 983, P= 0. 015）. The second adjusted mean levels （95 % CI） of serum cortisol in PDA and control groups were 300. 0 nmol/L（232. 4 -367.4 nmol/L） and 263.6 nmol/L （196.2-331.2 nmol/L）, respectively. There was no significant difference between the two groups （t=0. 537, P=0. 466）. Conclusions Low serum cortisol concentrations at birth is a risk factor for PDA in preterm infants, while the serum cortisol value may be not affected by PDA.
出处
《中华围产医学杂志》
CAS
2011年第2期106-110,共5页
Chinese Journal of Perinatal Medicine
基金
福建省医学创新课题项目（2009-CXB-30）
关键词
婴儿
早产
动脉导管未闭
氢化可的松
Infant, premature
Ductus arteriosus, patent
Hydrocortisone
