Creatine kinase and its MB isoenzyme in the third trimester and the peripartum period.

Forty-nine normal pregnant women were recruited late in the third trimester for serial determinations of creatine kinase (CK) and its MB isoenzyme fraction (CK-MB) at four different times: (1) on recruitment between 36 and 40 weeks' gestation, (2) on admission in active labor, (3) immediately after delivery, and (4) on the first postpartum day. In the patients with vaginal delivery (n = 43) total CK was significantly elevated at time 4 compared with times 1, 2 and 3 (P value < .0001). CK-MB fraction was also significantly elevated at time 4 compared with times 1, 2 and 3 (P value < .0001). In 35.7% of the patients at time 4, CK-MB was sufficiently elevated to give the laboratory interpretation of "borderline" or "consistent with a myocardial infarction," even though none of the patients had cardiac symptoms or complications. A review of the literature shows that CK-MB is found not only in myocardium but also in uterus and placenta. The implication of this study is that elevations in total CK and CK-MB should be used with caution during the peripartum period to diagnose myocardial ischemia or infarction.     

Rate of dyspareunia after delivery in primiparae according to mode of delivery

OBJECTIVES: The purpose of this study was to evaluate the influence of mode of delivery on sexual function. DESIGN: One thousand six hundred and thirteen questionnaires containing 16 questions about sexual behavior and dyspareunia before, during and after pregnancy were sent out to primiparous, ethnically homogeneous (fluent in German) patients who delivered in a large tertiary referral center between 6 months and 2(1/2) year before. The returned questionnaires were merged to clinical data from our obstetric database in an anonymous fashion. The patients were subdivided into four groups (A) "spontaneous without injuries (except minor labial laceration)", (B) "c-section", (C)"episiotomy or perineal laceration", and (D) "operative vaginal delivery". RESULTS: The response rate of primiparae was 41% (655/1613). Forty-seven percent of women resumed sexual intercourse (SI) within 8 weeks after delivery. Altogether 31% of the women did not experience any pain during the first SI post-partum whereas 49% of all patients noted significant pain (medium, considerable or severe), depending on the mode of delivery (p = 0.007). Persistence of dyspareunia longer than 6 months was 3.5% (4/115; group A), 3.4% (2/58; group B), 11% (34/316; group C), and 14% (20/114; group D). CONCLUSIONS: Recently, female sexuality may not have been prominent in any discussion concerning possible advantages and disadvantages of different modes of childbirth. Our results should be taken into consideration when counseling patients antenatally regarding mode of delivery.     

心肌损伤标记物在动脉导管未闭早产儿的变化和临床意义

目的 探讨早产儿动脉导管未闭(patent ductus arteriosus,PDA)对早产儿心肌的影响.方法 选择2010年5月1日至2011年1月31日入院治疗的110例胎龄28～36周的早产儿,在生后72 h和7d取血,测定血清肌钙蛋白T(cardiac troponin T,cTnT)和肌酸激酶MB同工酶(creatine kinase MB isoenzyme,CK-MB)水平,并行心脏超声心动图检查.根据超声心动图结果分为PDA组(44例)和对照组(66例).PDA组患儿接受布洛芬治疗后,再次行超声心动图检查,同时2组复查相关的血清学指标.统计学方法采用t或近似t检验、x2检验、多元线性回归和Spearman秩相关检验.结果 治疗前,PDA组的血清cTnT和CK-MB均高于对照组[(0.259±0.134)μg/L与(0.083±0.054)μg/L,t=9.557,P＜0.01;(7.31±2.69)μg/L与(5.71±1.88)μg/L,t=2.588,P＜0.05].治疗成功的34例PDA患儿cTnT和CK-MB较治疗前显著降低,分别降至(0.062±0.039)μg/L和(5.34±1.50)μg/L(t分别为9.268和5.974,P＜0.05);但与对照组cTnT、CK-MB相比差异均无统计学意义(P＞0.05).治疗失败的10例PDA患儿cTnT、CK-MB水平较治疗前稍有降低[分别为(0.193±0.049)μg/L和(6.93±1.63)μg/L,t分别为1.525和0.766,P均＞0.05],但仍明显高于对照组(t分别为9.068和4.055,P＜0.05).cTnT水平与机械通气时间、PDA、肺透明膜病呈正相关,不受性别、胎龄、体重的影响;而CK-MB与性别、胎龄、体重、机械通气时间及PDA均显著相关.在PDA组,cTnT水平与动脉导管直径呈正相关;而CK-MB与各项超声心动图指标均不相关.结论 有临床表现的PDA可造成早产儿心肌损伤,cTnT和CK-MB的动态变化与PDA病情程度相平行,动态监测cTnT和CK-MB有助于PDA并发心肌损伤的早期诊断和及时干预.     

闵行区宫颈疾病筛查模式效果的回顾性研究

目的:探索上海闵行地区宫颈疾病筛查最为经济可靠的模式。方法:以2008.07.01～2011.06.30录入电子病历信息管理系统(EHR)中的宫颈疾病筛查对象为研究对象(n=14 526),依社区健康教育督促(A组,n=2 507)、贫困妇女免费普查(B组,n=7 396)、因症就医机会性筛查(C组,n=4 623)3类筛查方式进行分组,通过队列研究比较3组间宫颈疾病筛查的效果。结果:所有研究对象中巴氏涂片≥Ⅲ级者占26.3%(3 781/14 526),B组高达29.20%(2 160/7 396),3组间构成比具有统计学差异(χ2=87.58,P<0.000 1)。因巴氏涂片≥Ⅲ级进一步行TCT+阴道镜+组织活检者共计3 491例,经组织病理学诊断为LSIL者占8.34%(291/3 491)、HSIL者占2.95%(103/3 491)、宫颈癌占1.17%(41/3 491);宫颈病变总体检出率各组间具有统计学差异(χ2=14.26,P=0.000 8),C组最高,达15.23%(141/926);不同级别宫颈病变检出率在各组间也具有统计学差异(χ2=14.52,P=0.02)。所有对象(剔除未能转诊的失随访者)中LSIL检出率为2.04%(291/14 236),HSIL检出率为0.72%(103/14 236),宫颈癌检出率为0.29%(41/14 236)。Logistic回归提示年龄增大及流动人口是筛查出HSIL及宫颈癌的风险因素,在C组对象中尤为明显。结论:贫困免费筛查以及因症就医机会性筛查对象是今后初筛人群选择的重点。机会性筛查因针对性更强,相对节约资源,或许能成为城市地区最为经济可靠的宫颈疾病长期筛查模式。     

Protection of immature myocardium by the addition of mannitol to crystalloid cardioplegic solution.

The current method of myocardial protection for the immature heart with crystalloid cardioplegic solution remains unsatisfactory. In pursuit of a better method, mannitol, mixed into the St. Thomas' Hospital cardioplegic solution, was investigated for its effect on myocardial protection. The experiment consisted of three groups of young dogs, six in each group. Animals were maintained under ischemia for 60 minutes followed by reperfusion for 30 minutes. Those perfused with the St. Thomas' Hospital cardioplegic solution alone (group A) had poorer results, namely, a lower recovery rate (80% only) of peak left ventricular systolic pressure (LVSP), decline in left ventricular compliance, a lower preservation level (70%) of the myocardial ATP content and moderate ultrastructural damage. By contrast, in animals perfused with the cardioplegic solution containing mannitol (20mmol/L of mannitol in group B; 50 mmol/L in group C), not only the recovery of peak LVSP was higher, 130% in group B and 109% in group C, but the preservation of myocardial ATP content was also higher, 94% and 82%, respectively. The ultrastructure was well-preserved in group B, but mildly distorted in group C. Slight elevation of LVEDP was also noted in group C. These results suggest that the myocardial protective effect of the St. Thomas Hospital cardioplegic solution for immature hearts can be improved with the addition of mannitol. However, the dose dependent effects of mannitol, not revealed in this study, warrant further research.     

Surgical resection of hepatocellular carcinoma in the cirrhotic liver.

A total of 80 patients with asymptomatic small hepatocellular carcinoma (HCC) associated with liver cirrhosis underwent a liver resection. The patients were divided into 4 groups according to the location of their tumor: group A (n = 9): left lateral segmentectomy or left hepatectomy, group B (n = 42): atypical partial hepatectomy on the lateral aspect of the right lobe, group C (n = 25): subsegmentectomy on either the anterior or the posterior surface of the right lobe, group D (n = 4): subsegmentectomy in the hilar area. There were two postoperative deaths (both in group D) and five cases of hospital mortality (1 case due to myocardial infarction in group C; 1 case due to bleeding esophageal varices in group B and 2 cases in group C; and 1 case due to fulminating hepatitis in group B). There was no any significant difference in tumor size, the preoperative serum bromosulfaphthalein retention rate or the postoperative peak serum conjugated bilirubin level among all the groups (p less than 0.05). The weights of the resected specimens were higher in groups A and B (259 +/- 58 g, 230 +/- 154 g) than in groups C and D (54 +/- 32 g, 37.5 +/- 15.0 g) (p less than 0.05). The amount of blood required for transfusion during surgery in group D (3,625 +/- 3,146 mL) was significantly greater than in the other three, groups (p less than 0.05); and was also greater in groups B and C (1,649 +/- 880 mL, 1,635 +/- 1,156 mL), than in group A (444 +/- 273 mL; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Prognostic value of Doppler-derived mitral deceleration time in postinfarction patients with left ventricular ejection fractions of 35% or more.

Short Doppler-derived mitral deceleration time of early filling has been proved to be an independent predictor of poor prognosis in patients with left ventricular dysfunction. However, the prognostic value of Doppler-derived mitral deceleration time in postinfarction patients without overt left ventricular dysfunction is poorly understood. A total of 27 survivors of acute myocardial infarction with left ventricular ejection fractions of 35% or more, as determined by radionuclide ventriculography, were prospectively studied. Doppler study was performed 5 to 7 days after the index infarction. The patients were divided into two groups. Group A included 10 patients whose mitral deceleration time was 125 msec or less and group B consisted of 17 patients whose mitral deceleration time was 125 msec or more. The two groups were similar in terms of age and gender distribution and there were no statistically significant differences in coronary risk factors, peak creatine kinase concentration, location of infarction, Killip classification, thrombolytic therapy, left ventricular ejection fraction, or medications. After a mean follow-up period of 30 months, the rate of congestive heart failure (New York Heart Association, NYHA, class II or above) was significantly higher in group A (5/10) than in group B (1/17) (p < 0.01). These results suggest that a short mitral deceleration time could be a useful early predictor of the potential development of future congestive heart failure in postinfarction patients with left ventricular ejection fractions of 35% or more.     

两组生源大学生入学时的血清抗精子抗体检测

目的:了解外招生源和内地生源的大学生入学体检时的血清抗精子抗体的状况。方法:640名大学新生按生源和性别分为4组:外招生男性组96例(A组),女性组115例(B组);内地生男性组256例(C组),女性组173例(D组)。结合新生入学体检获取血清,应用浅盘精子凝集试验(SAT)、浅盘精子制动试验(SIT)和间接免疫珠试验(iIBT),检测血清抗精子抗体。结果:A、B和D组分别检出SAT抗精子抗体阳性各2例,C组检出4例;这10例iIBT的免疫珠附着率为20%-55%。A-D组的SAT抗体阳性率分别为2.1%,1.7%,1.6%和1.2%。B组检出SIT阳性1例。A组与C组、B组与D组的SAT抗体阳性率比较无显著性差异(P>0.05)。结论:外招生源和内地生源的大学生,入学时可检出血清抗精子抗体,需对大学生开展生殖健康和性健康的教育。     

Hormonal function after ovarian transposition to the abdominal subcutaneous fat tissue

We previously reported a new technique for ovarian transposition to the abdominal subcutaneous fat tissue (OTAFT) following hysterectomy. The purpose of this study is to assess the hormonal function after OTAFT. From 1993 to 2000, OTAFT was performed in 27 patients (group A). Forty-two women underwent hysterectomy and retained ovaries without transposition (group B). In 19 cases, bilateral oophorectomy with hysterectomy was performed, and they received a hormone replacement therapy (HRT) (group C). Serum follicle-stimulating hormone (FSH) level of patients was monitored every 2-12 months, and the time of menopause (defined as FSH >40 mIU/mL two times consecutively) was determined in groups A and B. After a median follow-up of 65 months, cumulative ovarian survival did not show significant difference between group A and group B (HR = 0.52, 95% CI = 0.17-1.16; P= 0.10). In patients who were 40 years old or younger, ovarian function declined significantly in group A compared to group B (HR = 0.29, 95% CI = 0.02-0.91; P= 0.04). However, FSH level of postmenopausal patients in group A was not different from FSH level of patients in group C, but FSH level of postmenopausal patients in group B was significantly higher than FSH level of patients in group C (P= 0.002). Although the procedure of OTAFT may somewhat affect the ovarian function, the transposed ovary in postmenopausal women presumably still secrete a small amount of estrogen which is equivalent to an estrogen level by HRT.     

血浆B型氨基端利钠肽原对新生儿窒息后心力衰竭的诊断价值研究

目的探讨血浆B型氨基端利钠肽原(NT-proBNP)对新生儿窒息后心力衰竭的诊断价值。方法2014年1月至2015年3月平凉市人民医院儿科病房收治的窒息新生儿120例,根据有无心力衰竭分为心力衰竭组55例和无心力衰竭组65例。测定两组患儿NT-proBNP、心肌钙蛋白I(cTnI)、乳酸脱氢酶1(LDH1)、肌酸激酶同功酶(CK-MB)等。结果心力衰竭组NT-proBNP、LDH1、CK-MB和cTnI显著高于无心力衰竭组,差异有统计学意义(P0.05);非条件性Logistic回归方程结果显示NT-proBNP是新生儿窒息后发生心力衰竭的独立危险因素(OR=1.482,P0.05);NT-proBNP诊断新生儿窒息后发生心力衰竭的ROC曲线下面积为0.952,95%CI为0.908~0.995,P0.05;当截断值为13 181ng/L水平时,诊断灵敏度为90.20%,特异性为100.00%;三元线性回归分析显示LDH1和cTnI对NT-proBNP水平有影响,回归方程为NT-proBNP=-403.29+2.20×LDH1+271.04×cTnI。结论血浆NT-proBNP对新生儿窒息后心力衰竭有一定诊断价值,对于早期发现窒息并心力衰竭、指导治疗有重要的临床意义。     

The study of local fibrinolysis in abortion

The etiology of abortion, which is still a moot question, is now under intense investigation. The present study discussed the possible role of local fibrinolysis (villous tissue fibrinolysis) in the pathogenesis of abortion by studying tissue fibrinolytic activity in tissue culture as well as blood coagulation, fibrinolysis and the kinin system. Subjects studied include: 1) normal villous tissue (n=46), early pregnancy loss, whose fetal cardiac activity had once been identified (n=22) designated as Group A, and Group B whose fetal cardiac activity had never been identified (n=82). The villous tissues were cultured for 24 hours and then the urokinase (UK) inhibition activity in the medium was determined. 2) Threatened abortion resulted in abortion (poor prognosis, n=42) or the pregnancy continued (good prognosis, n=81). In these patients the following substances in plasma were determined: Prekallikrein, alpha 2-plasmin inhibitor, alpha 1-antitrypsin, alpha 2-macroglobulin, C1-inactivator, antithrombin-III, plasminogen, fibrinogen, fibrin degradation products (FDP). The results are: 1) UK inhibition activity (against UK 2.5 iu), normal villous tissue 26.3 +/- 14.6%, Group A 26.0 +/- 10.3%, Group B 9.6 +/- 10.7%, a significant difference between the normal villous tissue and Group B villous tissue was observed. This suggested that the increased villous tissue fibrinolytic activity due to decreased UK inhibition activity may be one of the causes of abortion. 2) Prekallikrein was significantly reduced in patients with abdominal pain. Also, a significant reduction in plasminogen and elevated C1-inactivator was observed in patients with poor prognosis. The significance of these findings was discussed.     

Asymmetrical septal hypertrophy in newborn infants of diabetic mothers

The objective of this paper is to determine the frequency and outcome of asymmetrical septal hypertrophy (ASH) in large-for-gestational-age infants (LGA) born to diabetic (DM) and nondiabetic mothers (NDM), and to establish the relationship between ASH and maternal diabetes control. A comparative study was design to assess ASH in infants born to DM and NDM. The study was conducted in the Departments of Neonatology and Pediatric Cardiology of the "Hospital de Gineco-Pediatria 48", Instituto Mexicano del Seguro Social from January to December 1997. Eighty-five full-term infants of DM (group A) and 85 LGA infants of NDM (group B) were included. As a control group (group C), we studied 85 healthy, full-term infants. In all cases a Doppler echocardiogram was obtained in the first 48 h after birth, and for the ASH infants, at 2 and 4 months. Chest X ray, electrocardiogram, and laboratory tests were performed as complementary studies. ASH was present in 38.8% of LGA infants of DM and in 7.1% of NDM. The difference was significant (p < 0.01). Interventricular septum (IVS) and IVS/ posterior wall of left ventricle ratio were significantly different between groups A and B with C. There was no correlation between Hb A1 level and the presence of ASH in group A. ASH is a common finding in infants of DM. We could not find a relationship between the degree of metabolic control during pregnancy and the incidence and severity of ASH.     

Outcome of primary percutaneous coronary intervention in octogenarians with acute myocardial infarction.

BACKGROUND/PURPOSE: Acute myocardial infarction (AMI) results in more complications and increased mortality in octogenarians compared to patients in younger age groups. This study investigated the short- and long-term outcomes in octogenarians after primary percutaneous coronary intervention (PCI). METHODS: During the study period from May 1997 to August 2004, 54 patients > or = 80 years old with ST-elevation myocardial infarction (STEMI) were eligible for primary PCI. Data collected included baseline clinical characteristics and usage of cardiovascular medications. Diagnostic coronary angiography and revascularization procedures were performed using standard practices. During hospitalization, the clinical course including serial changes in cardiac enzymes, adverse events associated with myocardial infarction or treatment, and inhospital or long-term mortality of patients were recorded. RESULTS: The mean age of the 54 patients (35 men, 19 women) was 82.8 +/- 2.5 years (range, 80-89 years). Among them, 27 (50%) had anterior infarction, six (11%) had anterolateral infarction, and 21 (39%) had inferior infarction, inclusive of three patients with accompanying right ventricular infarction. Among them, 20 (37%) patients were in Killip class I, nine (17%) were in class II, two (4%) in class III, and 23 (43%) in class IV. The mean delay from onset of symptoms to arrival in hospital was 220 +/- 167 minutes, and 189 +/- 169 minutes from hospital arrival to reperfusion. Diagnostic coronary angiography revealed that 48 (89%) patients had multivessel disease. Inhospital death occurred in 23 (43%) patients, with the leading causes of death being profound cardiogenic shock (61%), and free wall rupture (26%). CONCLUSION: Octogenarian patients who developed STEMI tended to have multivessel disease. These patients had a high inhospital mortality rate that was most likely to be due to cardiogenic shock.     

A cross-sectional comparison of clinical and endocrine parameters among phenotypes of polycystic ovarian syndrome in iranian population

Background and objective

Polycystic ovary syndrome (PCOS), as a major hormonal issue among reproductive age women, is categorized into four phenotypes regarding hyperandrogenism, oligo-anovulation and polycystic ovary morphology. This study aims to compare and predict the phenotypes based on metabolic and hormonal parameters.

Microsurgical fertilization procedures: The absence of stringent criteria for patient selection

Subzonal sperm insertion and partial zona dissection were applied in 250 in vitro fertilization cycles in couples (n = 200) with abnormal semen analyses; 61 clinical pregnancies were established (24% per egg retrieval). Patients were selected without using minimal cutoff criteria. The study included patients with 0% normal sperm forms (strict criteria), no motile sperm (but some live cells), and sperm counts which could be assessed only after centrifugation. Patients were categorized into three subsets. Group A (n = 116 cycles) failed to fertilize in a previous cycle. Group B (n = 40) was excluded from IVF due to the severity of sperm profiles, such as a maximum of 2% normal forms. Group C (n = 94) constitutes those patients for whom a standard cycle could possibly result in failure. Monospermic fertilization rates were 18% (A), 19% (B), and 24% (C). The incidences of embryo replacement were 63% (A), 53% (B), and 69% (C). Rates of clinical pregnancy were 22% (A), 23% (B), and 28% (C). The presence of one, two, or three semen abnormalities did not correlate with the outcome of microsurgical fertilization. Twenty-two percent of patients with combined oligoasthenoteratozoospermia became pregnant. Moreover, ongoing pregnancies were established in instances with 0% normal sperm forms and no progressively motile spermatozoa. It is concluded that stringent cutoff criteria may not be necessary when both partial zona dissection and subzonal sperm insertion are performed efficiently.     

The M.A.R. test role for a rapid detection of antisperm autoimmunization in infertile men

We examined 44 men from couples with negative or dubious P.C.T. which had not been caused by cervical pathology (infection, malformative pathology or insufficient mucus production) or seminal pathology (no infection present, normal seminal liquid and in some cases at the most a slight asthenospermia). 40,9% of the men were classified as immunized. This was established by the results of seric T.A.T. and other tests. The M.A.R. test has proved to be a good method for the screening of immunization in those with a low sperm-motility; in fact results proved either positive or strongly positive in 83,3% of immunized subjects. Considering as positive the M.A.R. tests which were "doubtfully positive", the final results proved positive in 94,4% of immunized subjects.     

Improvement of conventional transcutaneous bilirubinometry results in term newborn infants

This prospective study was performed to determine a way to improve conventional transcutaneous bilirubinometry results in healthy term newborn infants. In 118 infants during phototherapy (group A), and in 118 infants without phototherapy (group B), bilirubin determinations were done in duplicate using the Minolta AirShields Jaundice Meter type 101 (transcutaneous bilirubin index [TcB]), and the diazometric method on the Hitachi 717 Automated Analyzer (total reacting serum bilirubin [SeB]). In 112 infants (group C), bilirubin determinations were done in triplicate, using simple direct-reading photometry on the Moltronic Bilirubinometer (direct serum bilirubin [BiB]). A close correlation between TcB and SeB values was observed in group A ( r = 0.69; p < 0.001) and in group B ( r = 0.59; p < 0.001). The 95% confidence intervals of TcB readings corresponding to SeB were +/- 80.7 micromol/L in group A and +/- 76.9 micromol/L in group B, respectively. In group C, using a correctly calibrated BiB with adult sera containing bilirubin concentration in the range 271 to 344 micromol/L, the 95% confidence intervals of parallel TcB and BiB readings corresponding to SeB were +/- 28 micromol/L. Parallel determinations of the TcB and the BiB in healthy term newborn infants give results almost identical to those of bilirubin determination by the laboratory method.     

Menstrual and reproductive factors and the risk of myocardial infarction in women under fifty-five years of age

The relationship between menstrual and reproductive factors and subsequent risk of coronary heart disease was investigated in a hospital-based case-control study of 202 women with acute myocardial infarction and 374 control subjects admitted for a wide spectrum of acute conditions unrelated to any of the established risk factors for ischemic heart disease. No consistent association was observed with age at menarche or menopausal status, but women with a lifelong irregular menstrual cycle pattern were at significantly elevated risk of myocardial infarction (relative risk = 1.8, 95% confidence interval = 1.1 to 2.9). No clear trend in risk was evident with the number of livebirths, miscarriages, or induced abortions. However, women whose first pregnancy or livebirth occurred before age 20 years showed elevated risks of subsequent myocardial infarction compared with nulliparous ones (relative risks = 2.3; 95% confidence interval = 1.1 to 4.9), and there was a significant trend of increasing risk with earlier first birth. These associations were evident in both younger and middle-age women and were not explained by allowance for several identified potential confounding factors.     

宫内窘迫胎儿出生后心肌损伤情况的监测

目的 探讨无窒息的宫内窘迫胎儿出生后是否合并有心肌损伤,以及检测心肌损伤的生化敏感指标.方法 2009年7月至12月,随机选择中山大学附属第一医院分娩的、有宫内窘迫史的53例新生儿为宫内窘迫组,新生儿出生后Apgar评分1 min及5 min均＞7分.同期分娩的无宫内窘迫史的新生儿36例作为对照组,新生儿出生后Apgar评分1 min及5 min均为10分.胎儿娩出后立即抽取脐动脉血进行血气分析和生化指标测定.结果 (1)宫内窘迫组新生儿脐动脉血pH值及剩余碱分别为7.23±0.07及(-4.8±3.0)mmol/L,明显低于对照组的7.31±0.03及(-2.1±1.5)mmol/L,两组比较,差异有统计学意义(P＜0.05).宫内窘迫组新生儿脐动脉血乳酸水平为(5.2±2.3)mmol/L,明显高于对照组的(2.3±1.1)mmol/L,两组比较,差异有统计学意义(P＜0.01).宫内窘迫组新生儿脐动脉血氧分压及二氧化碳分压水平分别为(16.2±7.9)及(54.0±11.2)mm Hg(1mm Hg=0.133 kPa),对照组分别为(17.5±6.7)及(48.5±5.4)mm Hg,两组分别比较,差异均无统计学意义(P＞0.05).(2)宫内窘迫组新生儿脐动脉血肌酸激酶同工酶MB(CK-MB)水平为(48±59)U/L,对照组为(36±27)U/L,两组比较,差异有统计学意义(P＜0.05);宫内窘迫组新生儿脐动脉血肌酸激酶(CK)及脑钠肽(BNP)水平分别为(194±73)U/L及(519±309)ng/L,对照组分别为(162±95)及(481±216)ng/L,两组比较,差异无统计学意义(P＞0.05).(3)新生儿脐动脉血CKMB水平与脐动脉血pH值、剩余碱呈负相关性(r=-0.296及-0.318,P均＜0.05);BNP与乳酸水平呈正相关(r=0.278,P＜0.05);其余各变量间均无相关性(P＞0.05).结论 宫内窘迫的胎儿即使出生时无新生儿窒息的表现,也存在着不同程度的心肌损伤;脐血CK-MB水平变化可作为监测心肌损伤的敏感指标,心肌损伤的程度与胎儿酸中毒的程度有关.

Abstract：

Objective To investigate whether no asphyxia neonates with intrauterine distress are complicated with myocardial injury and determine the sensitive biochemical diagnostic parameters. Methods A total of 89 neonates born in the First Affiliated Hospital of Sun Yat-sen University from July 2009 to December 2009 were enrolled. Fifty-three fetal distress cases with Apgar score ＞ 7 at 1 and 5 minites were enrolled in the study group; while the rest 36 healthy neonates, whose Apgar score = 10 at 1 and 5 minites, were the control group. Umbilical artery blood samples of all cases were collected for blood gas analysis and biochemical measurement. Results(1)pH(7.23±0.07) and BE [(-4.8±3.0)mmol/L] in the study group were significantly lower than pH (7.31 ±0.03) and BE [(-2.1±1.5)mmol/L] in the control group (P＜0.05).The lactic acid of study group [(5.2±2.3)mmol/L] was higher than that of the control group [(2.3±1.1)mmol/L], and the difference was significant (P＜0.01). However, there was no significant difference between the two groups in PaO2[(16.2±7.9)mm Hg(1 mm Hg=0.133 kPa) vs. (17.5±6.7)mm Hg] and PaCO2[(54.0±11.2)mm Hg vs. (48.5±5.4) mm Hg; P＞0. 05]. (2) The level of CK-MB in neonates with fetal distress[(48 ±59) U/L] was significantly higher than that of healthy neonates [(36±27)U/L]. However, no significant difference was found in CK [(194±73)U/L vs. (162±95) U/L]and BNP levels[(519±309)ng/L vs.(481±216)ng/L;P ＞ 0.05]. (3) Spearman rank correlation analysis showed that CK-MB level was negatively correlated with pH(r=-0.296, P＜0.05) and BE (r=-0.318,P＜0.05) of umbilical artery blood,while BNP level was positively correlated with umbilical lactic acid (r=0.278, P＜0.05). No correlation was found between other parameters (P＞0.05).Conclusions Intrauterine distress without neonatal asphyxia had effect on fetal myocardial injury. CK-MB can be used as a sensitive parameter for monitoring the development of myocardial injury. The severity of myocardial injury was related to fetal acidosis.