新生儿胎龄、出生体重与17α羟孕酮水平的多中心回顾性分析
신생인태령、출생체중여17α간잉동수평적다중심회고성분석
Multicenter investigation on the impact of newborn infants' gestational age and birth weight on the level of 17α-hydroxyprogesterone
  • 万方数据
    中华儿科杂志 중화인과잡지
    Chinese Journal of Pediatrics
    2014年 9期 706-709 ,共4页

    张芹%王本敬%陈亚平%姜东%陈瑛

    장근%왕본경%진아평%강동%진영

    孕龄%出生体重%肾上腺皮质疾病%新生儿筛查 孕齡%齣生體重%腎上腺皮質疾病%新生兒篩查
    잉령%출생체중%신상선피질질병%신생인사사
    Gestational age%Birth weight%Adrenal cortex diseases%Newborn screening
    目的 探讨新生儿出生胎龄、出生体重与17α羟孕酮水平的相关性,及其对先天性肾上腺皮质增生症筛查结果的影响.方法 研究对象为2010年8月至2013年11月江苏省吴江市、太仓市、张家港市、昆山市及苏州市区29家医院分娩的新生儿,有出生胎龄和出生体重记录的共118 050例,其中男62 490例、女55 560例;早产儿4 693例,足月新生儿113 300例,过期产儿57例;体重＜2500 g者4 172例,体重≥2 500 g新生儿113 878例.早产儿中早期早产儿(胎龄＜32周)189例,中期早产儿(胎龄≥32周且＜36周)2 277例,晚期早产儿(胎龄≥36周且＜37周)2 227例.滤纸干血片采用时间分辨荧光免疫分析法检测新生儿的足跟血17α羟孕酮浓度,回顾性分析新生儿胎龄、出生体重与17α羟孕酮水平的相关性,组间比较用非参数相关样本Wilcoxon检验,相关性分析采用Spearman检验.结果 经正态性检验,17α羟孕酮水平呈偏态分布,早期早产儿、中期早产儿、晚期早产儿、足月儿和过期产儿17α羟孕酮水平M(Q1,Q3)、第99百分位数依次降低,各组之间差异均有统计学意义[19.21(8.07,24.00),12.35(6.81,18.00),8.58(5.66,13.80),5.60(3.57,8.51),3.34(2.58,5.23)nmol/L;479.42,62.25,36.24,23.30,13.73 nmol/L;P均=0.000].超低出生体重儿、极低出生体重儿、低出生体重儿、正常出生体重儿、巨大儿17 α羟孕酮水平的M(Q1,Q3)、第99百分位数依次降低,各组之间差异均有统计学意义[5.24(3.24,8.96),11.30(6.84,22.95),8.50(5.28,14.90),5.66(3.61,8.62),5.38(3.40,8.11) nmol/L; 485.26,125.18,39.50,23.80,22.15 nmol/L;P均=0.000].新生儿17α羟孕酮水平与出生胎龄、体重均成负相关(r=-16.40、-10.10,P均=0.000);并呈二项式分布,公式分别为y=0.105 5x2-2.457 6x+ 17.689,R2=0.980 3和y =0.411x2-3.988x+ 14.75,R2 =0.983.早产儿和足月儿中＜2 500 g者17α羟孕酮水平均显著高于体重≥2 500 g新生儿[11.20(6.01,18.90)比9.05(5.85,14.90) nmol/L,9.76 (4.32,10.35)比5.59(3.56,8.48) nmol/L,均P=0.000].结论 新生儿17α羟孕酮水平与胎龄、出生体重成明显负相关;为提高肾上腺皮质增生症筛查的准确度和灵敏度、降低复查率,新生儿17α羟孕酮的切值应根据胎龄、出生体重进行调整.
    목적 탐토신생인출생태령、출생체중여17α간잉동수평적상관성,급기대선천성신상선피질증생증사사결과적영향.방법 연구대상위2010년8월지2013년11월강소성오강시、태창시、장가항시、곤산시급소주시구29가의원분면적신생인,유출생태령화출생체중기록적공118 050례,기중남62 490례、녀55 560례;조산인4 693례,족월신생인113 300례,과기산인57례;체중＜2500 g자4 172례,체중≥2 500 g신생인113 878례.조산인중조기조산인(태령＜32주)189례,중기조산인(태령≥32주차＜36주)2 277례,만기조산인(태령≥36주차＜37주)2 227례.려지간혈편채용시간분변형광면역분석법검측신생인적족근혈17α간잉동농도,회고성분석신생인태령、출생체중여17α간잉동수평적상관성,조간비교용비삼수상관양본Wilcoxon검험,상관성분석채용Spearman검험.결과 경정태성검험,17α간잉동수평정편태분포,조기조산인、중기조산인、만기조산인、족월인화과기산인17α간잉동수평M(Q1,Q3)、제99백분위수의차강저,각조지간차이균유통계학의의[19.21(8.07,24.00),12.35(6.81,18.00),8.58(5.66,13.80),5.60(3.57,8.51),3.34(2.58,5.23)nmol/L;479.42,62.25,36.24,23.30,13.73 nmol/L;P균=0.000].초저출생체중인、겁저출생체중인、저출생체중인、정상출생체중인、거대인17 α간잉동수평적M(Q1,Q3)、제99백분위수의차강저,각조지간차이균유통계학의의[5.24(3.24,8.96),11.30(6.84,22.95),8.50(5.28,14.90),5.66(3.61,8.62),5.38(3.40,8.11) nmol/L; 485.26,125.18,39.50,23.80,22.15 nmol/L;P균=0.000].신생인17α간잉동수평여출생태령、체중균성부상관(r=-16.40、-10.10,P균=0.000);병정이항식분포,공식분별위y=0.105 5x2-2.457 6x+ 17.689,R2=0.980 3화y =0.411x2-3.988x+ 14.75,R2 =0.983.조산인화족월인중＜2 500 g자17α간잉동수평균현저고우체중≥2 500 g신생인[11.20(6.01,18.90)비9.05(5.85,14.90) nmol/L,9.76 (4.32,10.35)비5.59(3.56,8.48) nmol/L,균P=0.000].결론 신생인17α간잉동수평여태령、출생체중성명현부상관;위제고신상선피질증생증사사적준학도화령민도、강저복사솔,신생인17α간잉동적절치응근거태령、출생체중진행조정.
    Objective To investigate the correlation of gestational age and birth weight with 17α-hydroxyprogesterone (17α-OHP) levels,and with results of adrenal hyperplasia newborn screening.Method Using time-resolved fluorescence immunoassay,the authors measured concentrations of heel blood 17α-OHP by newborn dried blood spots on filter paper which included 29 hospitals newborns of Wujiang,Taicang,Zhangjiagang,Kunshan,and Suzhou,where there were 118 050 infants in total who had accurate gestational age and birth weight (62 490 males,55 560 females).According to the classification by gestational age,there were 4 693 premature infants,113 300 term infants and 57 overdue infants.According to the classification by birth weight,there were 4 172 infants with weight ＜2 500 g,and 113 878 infants weight ≥ 2 500 g.And,in all premature infants,gestational age of 189 infants was ＜ 32 weeks,2 277 infants less than 36 weeks but ≥32 weeks,and 2 227 infants less than 37 weeks but not less than 36 weeks.Neonatal heel blood concentration of 17α-OHP was measured by dissociation enhanced lanthanide fluorescence immunoassay (DELFIA),and the correlation between 17α-OHP and gestational age or birth weight was retrospectively analyzed by using Spearman test.Result The distribution of 17α-OHP levels was skew.The 17α-OHP levels decreased significantly from very preterm births,moderately preterm,later period preterm to term infants [19.21 (8.07,24.00),12.35(6.81,18.00),8.58(5.66,13.80),5.60(3.57,8.51),3.34 (2.58,5.23) nmol/L; 479.42,62.25,36.24,23.30,13.73 nmol/L; P all =0.000].The 17α-OHP levels decreases from very low birth weight (VLBW),extremely low birth weight (ELBW),low birth weight (LBW),normal birth weight to maerosomia [5.24 (3.24,8.96),11.30 (6.84,22.95),8.50 (5.28,14.90),5.66 (3.61,8.62),5.38 (3.40,8.11) nmol/L; 485.26,125.18,39.50,23.80,22.15 nmol/L;P =0.000 for all comparison].Neonatal 17o-OHP levels and gestational age,body weight was significantly negatively correlated respectively-16.40 and-10.10 (P both =0.000)by using Spearman test.Neonatal 17α-OHP levels and gestational age,body weight were binomially distributed,and the formulae were y =0.105 5x2-2.457 6x + 17.689,R2 =0.980 3 andy =0.411x2-3.988x+14.75,R2 =0.983.Little preterm infants,preterm infants and term infants in low birth weight infants 17α-OHP levels were significantly higher than non-low birth weight infants [11.20 (6.01,18.90) vs 9.05 (5.85,14.90) nmol/L,9.76(4.32,10.35)vs 5.59(3.56,8.48) nmol/L,P all =0.000].Conclusion Neonatal 17α-OHP levels and gestational age,body weight was significantly negatively correlated; in order to improve the accuracy and sensitivity,cut-off value of neonatal 17α-OHP should be adjusted according to gestational age and weight.
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