摘要
目的研究脐血糖化血红蛋白(HbA1c)与新生儿血糖水平、出生体重的关系,为临床早期干预提供依据。方法192例妊娠期糖尿病母亲新生儿,根据出生时脐血HbA1c水平不同分为N1组(HbA1c<3.46%,47例)、N2组(HbA1c 3.46%~4.25%,112例)、N3组(HbA1c>4.25%,33例)。在生后即刻抽取脐静脉血送检血糖、HbA1c水平,同时取脐血和足底血检测快速血糖水平,记录出生体重;分别于生后12、24、36、48 h检测新生儿的微量血糖水平。比较三组新生儿脐血HbA1c、血糖水平,生后不同时间(12、24、36、48 h)血糖水平,脐血实验室血糖水平、脐血快速血糖水平、足底快速血糖水平,BWR、出生体重恢复时间;分析新生儿脐血HbA1c水平与脐血血糖水平、生后不同时间血糖水平、出生体重比值(BWR)、出生体重恢复时间的相关性;分析新生儿脐血与足底血血糖水平的相关性。结果N1组新生儿脐血HbA1c为(3.25±0.18)%,脐血血糖水平为(3.4±0.3)mmol/L,N2组新生儿分别为(3.68±0.17)%、(3.6±0.4)mmol/L,N3组新生儿分别为(4.41±0.22)%、(3.8±0.6)mmol/L。N3组新生儿脐血HbA1c、血糖水平高于N1组、N2组,N2组高于N1组,差异具有统计学意义(P<0.05);三组新生儿生后12、24、36、48 h血糖水平比较差异无统计学意义(P>0.05)。Pearson相关分析显示:新生儿脐血HbA1c水平与脐血血糖水平呈正相关(r=0.402,P<0.05),与生后12、24、36、48 h血糖水平无相关性(P>0.05)。N1组新生儿脐血实验室血糖、脐血快速血糖和足底快速血糖水平分别为(3.4±0.3)、(3.4±0.5)、(3.4±0.6)mmol/L,N2组新生儿分别为(3.6±0.4)、(3.6±0.5)、(3.6±0.4)mmol/L,N3组新生儿分别为(3.8±0.6)、(3.8±0.4)、(3.8±0.5)mmol/L。N3组新生儿脐血实验室血糖、脐血快速血糖和足底快速血糖水平高于N1组、N2组,N2组高于N1组,差异具有统计学意义(P<0.05)。Pearson相关分析显示:新生儿脐血实验室血糖水平与脐血快速血糖水平、足底快速血糖水平均呈正相关(r=0.842、0.810,P<0.05),脐血快速血糖水平与足底快速血糖水平呈正相关(r=0.825,P<0.05)。N3组新生儿BWR(0.83±0.06)低于N1组的(1.16±0.05)和N2组的(1.02±0.08),N2组低于N1组,差异具有统计学意义(P<0.05);三组新生儿出生体重恢复时间比较差异无统计学意义(P>0.05)。Pearson相关分析显示:新生儿脐血HbA1c水平与新生儿BWR呈负相关(r=-0.617,P<0.05),与出生体重恢复时间无相关性(P>0.05)。结论脐血HbA1c可反映胎儿宫内发育的大致状况和出生时的血糖水平,但不能作为生后血糖水平变化和体重变化的预估指标。对妊娠期糖尿病母亲新生儿需密切监测48 h血糖变化,防止低血糖发生。可用无创脐血查快速血糖代替足底血血糖的测定,减少新生儿的创伤。
Objective To study the correlation of glycosylated hemoglobin(HbA1c)in umbilical cord blood with neonatal blood glucose level and birth weight,so as to provide evidence for early clinical intervention.Methods A total of 192 infants of diabetic mothers were divided into N1 group(HbA1c<3.46%,47 cases),N2 group(HbA1c 3.46%-4.25%,112 cases),and N3 group(HbA1c>4.25%,33 cases)according to their umbilical cord blood HbA1c levels at birth.Umbilical vein blood was taken immediately after birth to test blood glucose and HbA1c levels,while umbilical cord blood and plantar blood were taken to test rapid blood glucose levels and birth weight was recorded;the micro glucose levels of neonates were measured at 12,24,36 and 48 h after birth.The HbA1c and blood glucose levels in umbilical cord blood,blood glucose levels at different times(12,24,36,and 48 h)after birth,laboratory blood glucose in umbilical cord blood,fast blood glucose in umbilical cord blood,and plantar fast blood glucouse,BWR,birth weight recovery time were compared among the three groups.The correlation between umbilical cord blood HbA1c and umbilical cord blood glucose,blood glucose level at different times after birth,birth weight ratio(BWR),and birth weight recovery time were analyzed.The correlation between the blood glucose level of umbilical cord blood and plantar blood was analyzed.Results The umbilical cord blood HbA1c in the N1 group was(3.25±0.18)%,the blood glucose in umbilical cord blood was(3.4±0.3)mmol/L,those in the N2 group were(3.68±0.17)%and(3.6±0.4)mmol/L,and those in the N3 group were(4.41±0.22)%and(3.8±0.6)mmol/L.The HbA1c and blood glucose in umbilical cord blood in N3 group was higher than that of N1 and N2 group,and the N2 group was higher than the N1 group.The differences were statistically significant(P<0.05).There was no statistically significant difference in blood glucose levels among the three groups at 12,24,36,and 48 h after birth(P>0.05).Pearson correlation analysis showed that the HbA1c in umbilical cord blood was positively correlated with the umbilical cord blood glucose(r=0.402,P<0.05),but had no correlation with blood glucose at 12,24,36,and 48 h after birth(P>0.05).The laboratory blood glucose in umbilical cord blood,fast blood glucose in umbilical cord blood and plantar fast blood glucose of neonates in N1 group were(3.4±0.3),(3.4±0.5)and(3.4±0.6)mmol/L,those in the N2 group were(3.6±0.4),(3.6±0.5)and(3.6±0.4)mmol/L,and those in the N3 group were(3.8±0.6),(3.8±0.4)and(3.8±0.5)mmol/L.The laboratory blood glucose in umbilical cord blood,fast blood glucose in umbilical cord blood and plantar fast blood glucose in the N3 group were higher than those in the N1 group and the N2 group,and the N2 group was higher than the N1 group,and the differences were statistically significant(P<0.05).Pearson correlation analysis showed that the laboratory blood glucose in umbiilical cord blood was positively correlated with fast blood glucose in umbiilical cord blood and plantar fast blood glucose(r=0.842,0.810,P<0.05).The fast blood glucose in umbilical cord blood was positively correlated with the plantar fast blood glucose(r=0.825,P<0.05).The neonatal BWR(0.83±0.06)of N3 group was lower than(1.16±0.05)of N1 group and(1.02±0.08)of N2 group,and the N2 group was lower than the N1 group.The differences were statistically significant(P<0.05).There was no statistically significant difference in birth weight recovery time among the three groups(P>0.05).Pearson correlation analysis showed that the neonatal HbA1c in umbilical cord blood was negatively correlated with neonatal BWR(r=-0.617,P<0.05),but not correlated with birth weight recovery time(P>0.05).Conclusion Umbilical cord blood HbA1c can reflect the general status of fetal intrauterine development and blood glucose level at birth,but it cannot be used as a predictor of postnatal changes in blood glucose levels and body weight.Infants of diabetic mothers should be closely monitored for 48 h to prevent hypoglycemia.Non-invasive umbilical cord blood test can be used to replace the determination of planar blood glucose to reduce neonatal trauma.
作者
史洁丽
刘桂芬
SHI Jie-li;LIU Gui-fen(Maternal and Child Health Hospital of Songjiang District,Shanghai 201600,China)
出处
《中国实用医药》
2022年第21期26-29,共4页
China Practical Medicine
关键词
脐血糖化血红蛋白
新生儿
血糖
出生体重
Umbilical cord blood glycosylated hemoglobin
Neonates
Blood glucose
Birth weight
