Hematologic profile of neonates with growth restriction is associated with rate and degree of prenatal Doppler deterioration
Hematologic profile of neonates with growth restriction is associated with rate and degree of prenatal Doppler deterioration
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DOI：
10.1002/uog.12322
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发表时间：
2013-01-01
影响因子：
7.1
通讯作者：
Turan, O. M.
中科院分区：
文献类型：
--
作者：
Baschat, A. A.;Kush, M.;Turan, O. M.
目的探讨出生时血液学参数与胎儿生长受限（FGR）多普勒异常产前进展之间的关系。方法 该研究是对 FGR 患者（腹围<第 5 个百分位且脐动脉搏动指数 (UA-PI) 升高）的二次分析，在分娩前至少进行了 3 次检查。根据诊断和分娩之间的时间间隔以及UA、大脑中动脉和静脉导管多普勒异常的程度，产前进展分为快速、中度或缓慢。检查了诊断到分娩间隔、多普勒 Z 评分、进展和出生时血液学参数之间的关联。结果 130 名患者中，54 名（41.5%）名快速恶化，51 名（39.2%）名中度恶化，25 名（19.2%）名缓慢恶化，分别在诊断后 4、6 和 9 周内分娩。中度和快速恶化的最强关联与低血小板计数（r2分别= 0.37和0.70；P < 0.0001）。在中度恶化的患者中，血小板计数与 UA-PI 呈负相关（rho=-0.44，P=0.001），并且当舒张末期速度不存在时血小板计数最低。随着病情快速进展，血小板计数与有核红细胞计数呈负相关（rho=-0.51，P < 0.001），但不再与 UA-PI 呈负相关。结论 我们的观察结果表明 FGR 的产前临床进展与出生时血液学异常之间存在关系。加速心血管恶化与血小板计数减少有关，这可以通过胎盘消耗或红细胞生成和血小板生成功能障碍来解释。版权所有 (c) 2012 ISUOG。由约翰·威利父子有限公司出版
Objective To examine the relationship between hematologic parameters at birth and prenatal progression of Doppler abnormalities in fetal growth restriction (FGR). Methods The study was a secondary analysis of FGR patients (abdominal circumference < 5th percentile and umbilical artery pulsatility index (UA-PI) elevation) with at least three examinations prior to delivery. Prenatal progression was classified as rapid, moderate or slow based on the interval between diagnosis and delivery and the extent of UA, middle cerebral artery and ductus venosus Doppler abnormalities. Associations between diagnosis-to-delivery interval, Doppler Z-scores, progression and hematologic parameters at birth were examined. Results Of 130 patients, 54 (41.5%) had rapid, 51 (39.2%) moderate and 25 (19.2%) slow deterioration, delivering within 4, 6 and 9 weeks of diagnosis, respectively. The strongest association of moderate and rapid deterioration was with a low platelet count (r2=0.37 and 0.70, respectively; P < 0.0001). In patients with moderate deterioration, platelet count correlated inversely with UA-PI (rho=-0.44, P=0.001) and was lowest when end-diastolic velocity was absent. With rapid progression, platelet count correlated inversely with nucleated red blood cell count (rho=-0.51, P < 0.001) but no longer with UA-PI. Conclusion Our observations suggest a relationship between prenatal clinical progression of FGR and hematologic abnormalities at birth. Accelerating cardiovascular deterioration is associated with decreased platelet count, which can be explained by placental consumption or dysfunctional erythropoiesis and thrombopoiesis. Copyright (c) 2012 ISUOG. Published by John Wiley & Sons, Ltd.