【摘要】 目的 探讨胎儿肺动脉血流指数，如肺动脉搏动指数(PI)及阻力指数(RI),以及新生儿脐血中肺表面活性蛋白(SP)-A、-B水平，对重度子痫前期(sPE)合并妊娠期糖尿病(GDM)孕妇的围生儿肺成熟度的评估价值。方法 选择2018年1月至2019年10月，于吉林大学第二医院分娩的sPE合并GDM孕妇的60例围生儿为研究对象。根据新生儿出生胎龄，将其分为A组(n=22,出生胎龄≥37周),B组(n=20,35周≤出生胎龄<37周)和C组(n=18,出生胎龄<35周)。采用Kruskal Wallis H秩和检验及Mann-Whitney U检验，对3组胎儿肺动脉PI及RI,新生儿脐血中肺SP-A、-B水平，以及新生儿生后1 min Apgar评分及出生体重，分别进行总体比较及两两比较；采用χ~2检验，对3组新生儿呼吸窘迫综合征(NRDS)发生率，进行总体比较及两两比较；采用Spearman秩相关分析法，对3组受试儿PI、RI、SP-A、SP-B、生后1 min Apgar评分及出生体重分别与出生胎龄进行相关性分析。本研究经吉林大学第二医院伦理委员会批准[审批文号：2019年研审第(111)号],并与所有受试儿监护人签署临床研究知情同意书。结果 (1) A、B、C组胎儿肺动脉PI及RI、新生儿脐血肺SP-A及SP-B水平总体比较，差异均有统计学意义(P<0.05);其任意2组的两两比较，差异亦均有统计学意义(P<0.05),并且随着出生胎龄增加，胎儿肺动脉PI及RI降低，新生儿脐血中肺SP-A、-B水平增高。(2)A组与B组新生儿的生后1 min Apgar评分及出生体重[9分(9～9分)、3 010 g(2 777～3 802 g)与9分(8～9分)、2 680 g(2 000～3 427 g)],均分别高于C组的8分(8～8分)、1 660 g(1 500～2 005 g),而NRDS发生率(4.5%、20.0%),则均分别低于C组的66.7%,并且差异均有统计学意义(A组vs C组：Z=28.242、30.202,χ~2=17.415;B组vs C组：Z=19.433、21.111,χ~2=8.464;P均<0.001)。A组与B组上述3项指标比较，差异均无统计学意义(P>0.05)。(3)胎儿肺动脉PI及RI均与出生胎龄呈负相关关系(r_s=—0.780、—0.856,P均<0.001);新生儿脐血中肺SP-A、-B水平，生后1 min Apgar评分及出生体重，均与出生胎龄呈正相关关系(r_s=0.842、0.872、0.689、0.820,P均<0.001)。结论 胎儿肺动脉PI及RI,以及新生儿脐血中肺SP-A、-B水平，可作为评估sPE合并GDM孕妇的围生儿肺成熟度的指标。更多还原

【Abstract】 Objective To investigate clinical values of pulsatility indexes(PI) and resistance indexes(RI) of fetal pulmonary artery, and pulmonary surfactant protein(SP)-A, SP-B levels in neonatal umbilical cord blood to evaluate perineonate lung maturity when pregnant women complicated with severe preeclampsia(sPE) and gestational diabetes mellitus(GDM). Methods A total of 60 perineonates of pregnant women complicated with sPE and GDM delivered in the Second Hospital of Jilin University from January 2018 to October 2019 were selected as research objects. According to gestational age at birth of neonates, they were divided into group A(n=22, gestational age at birth≥37 weeks), group B(n=20, 35 weeks≤ gestational age at birth<37 weeks) and group C(n=18, gestational age at birth<35 weeks). Levels of PI and RI of fetal pulmonary artery, SP-A and SP-B in neonatal umbilical cord blood, and 1 min Apgar scores and neonatal birth weight of three groups were overall compared by Kruskal Wallis H rank sum test, and further compared by Mann-Whitney U test. Chi-square test was used for overall and further comparison of incidences of neonatal respiratory distress syndrome(NRDS) among three groups. The correlation between PI, RI, SP-A, SP-B, Apgar score at 1 min after birth, neonatal birth weight and gestational age at birth in three groups were analyzed by Spearman rank correlation analysis. The procedures in this study were approved by Ethics Committee of the Second Hospital of Jilin University [Approval No. 2019 Yan Shen No.(111)]. All guardians of subjects signed clinical research informed consents. Results(1) There were significant differences in levels of PI and RI of fetal pulmonary artery, and SP-A and SP-B in neonatal umbilical cord blood among three groups, also between any two groups(P<0.05), and levels of PI and RI gradually decreased and SP-A and SP-B gradually increased with the increase of gestational age.(2) Apgar score at 1 min after birth and neonatal birth weight in group A and group B were 9 scores(9-9 scores) and 3 010 g(2 777-3 802 g), 9 scores(8-9 scores) and 2 680 g(2 000-3 427 g), respectively, which were significantly higher than those of 8 scores(8-8 scores) and 1 660 g(1 500-2 005 g) in group C; while the incidences of NRDS in group A and group B(4.5% and 20.0%) were significantly lower than that in group C(66.7%), respectively, and all the differences were statistically significant(group A vs group C: Z=28.242, Z=30.202, χ~2=17.415; group B vs group C: Z=19.433, Z=21.111, χ~2=8.464; all P<0.001). There were no significant differences between group A and group B in these three indexes.(3) The PI and RI of fetal pulmonary artery were negatively correlated with gestational age(r_s=-0.780, r_s=-0.856, all P<0.001). Pulmonary SP-A and SP-B levels in neonatal umbilical cord blood, Apgar score at 1 min after birth and neonatal birth weight were positively correlated with gestational age(r_s=0.842, r_s=0.872, r_s=0.689, r_s=0.820, all P<0.001). Conclusions PI and RI of fetal pulmonary artery, and pulmonary SP-A and SP-B levels in neonatal umbilical cord blood, could be used as indexes to evaluate perineonate lung maturity when pregnant women complicated with sPE and GDM.更多还原