脐血微量元素及氧化/抗氧化因子水平与新生儿呼吸窘迫综合征发病的相关性研究

doi:10.12372/jcp.2025.24e0424

摘要/Abstract

摘要：

目的评估早产儿脐血微量元素及氧化/抗氧化因子水平与新生儿呼吸窘迫综合征（NRDS）发病的相关性，为NRDS的发病机制研究及防治策略提供新思路。方法以2022年12月至2023年12月在新生儿科住院的胎龄<34周早产儿为研究对象。采用火焰原子吸收法测定微量元素水平，酶联免疫吸附法测定氧化因子丙二醛（MDA）及抗氧化因子超氧化物歧化酶（SOD）水平。比较NRDS组与对照组上述指标的差异，采用受试者工作曲线（ROC）判定各指标预测NRDS发病的价值。结果 NRDS组脐血铜水平、锌水平显著低于对照组（P均<0.05）。NRDS组SOD水平低于对照组，MDA水平高于对照组（P均<0.05）。NRDS组SOD/MDA比值显著低于对照组(P<0.001)。脐血锌、铜、SOD、MDA、SOD/MDA预测NRDS发病的AUC分别为0.728、0.917、0.627、0.780、0.824。结论脐血微量元素铜、锌水平降低及氧化/抗氧化因子失衡可能参与早产儿呼吸窘迫综合征发病。

关键词: 呼吸窘迫综合征, 微量元素, 超氧化物歧化酶, 丙二醛, 新生儿

Abstract:

Objective To determine the trace elements and oxidative/antioxidant factors in cord blood of premature infants, and to clarify their value in predicting the onset and evaluation of neonatal respiratory distress syndrome (NRDS). Methods Premature infants with gestational age less than 34 weeks who were hospitalized in the neonatal department from Dec. 2022 to Dec. 2023 were selected as the subjects. The levels of trace elements were determined by flame atomic absorption spectroscopy, and the levels of oxidative factor malondialdehyde (MDA) and antioxidant factor superoxide dismutase (SOD) were measured by surface linked immunosorbent assay. The differences in the above indicators between the NRDS group and the control group were compared. The value of each indicator in predicting the onset of NRDS were determined by the receiver operative curve (ROC). Results The cord blood copper levels and zinc levels in the NRDS group were significantly lower than those in the control group. The SOD level in the NRDS group was lower than that in the control group, and the MDA level was higher than that in the control group. Meanwhile, the SOD/MDA ratio in the NRDS group was significantly lower than that in the control group. The area under the curve of zinc, copper, SOD, MDA, and SOD/MDA in cord blood predicting the onset of NRDS were 0.728, 0.917, 0.627, 0.780, and 0.824, respectively. Conclusions The decrease in levels of trace elements copper and zinc in cord blood and the imbalance of oxidative/antioxidant factors are involved in the pathogenesis of neonatal respiratory distress syndrome.

Key words: respiratory distress syndrome, trace elements, superoxide dismutase, malondialdehyde, neonate

黄静, 刘晓晨, 高雄, 李晓文, 李广红, 李禄全. 脐血微量元素及氧化/抗氧化因子水平与新生儿呼吸窘迫综合征发病的相关性研究[J]. 临床儿科杂志, 2025, 43(3): 204-210.

HUANG Jing, LIU Xiaochen, GAO Xiong, LI Xiaowen, LI Guanghong, LI Luquan. The value of measuring trace elements and oxidative/antioxidant factors in umbilical blood in predicting the onset and evaluation of neonatal respiratory distress syndrome[J]. Journal of Clinical Pediatrics, 2025, 43(3): 204-210.

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项目	NRDS组(n=48)	对照组(n=56)	统计量	P
男性[n(%)]	28(58.3)	30(53.6)	χ²=0.24	0.626
胎龄（ x±s）/周	30.02±2.4	30.71±4.43	t=0.97	0.333
出生体重（ x±s）/g	1 356.04±394.29	1 453.41±212.85	t=1.60	0.113
小于胎龄儿[n(%)]	2(4.2)	3(5.4)	χ²=0.00	1.000
入院日龄[M(P₂₅~P₇₅)]/h	1.75(1~2)	1.48(1~1.86)	Z=1.83	0.067
宫内窘迫[n(%)]	9(18.8)	9(16.1)	χ²=0.13	0.719
1分钟Apgar评分（ x±s）	6.56±2.5	8.21±1.46	t=4.18	<0.001
5分钟Apgar评分（ x±s）	8.42±1.33	9.41±0.8	t=4.67	<0.001
窒息[n(%)]	12(25)	9(16.1)	χ²=1.28	0.258
自然分娩[n(%)]	10(20.8)	7(12.5)	χ²=1.31	0.252
羊水污染[n(%)]	5(10.4)	6(10.7)	χ²=0.00	0.961
胎膜早破[n(%)]	17(35.4)	26(46.4)	χ²=1.29	0.256
妊娠期高血压[n(%)]	5(10.4)	7(12.5)	χ²=0.11	0.740
妊娠期糖尿病[n(%)]	12(25)	21(37.5)	χ²=1.86	0.172
妊娠期肝内胆汁淤积症[n(%)]	3(6.3)	0(0)	χ²=1.72	0.190
产前使用糖皮质激素[n(%)]	43(89.6)	50(89.3)	χ²=0.00	0.961
孕期补充钙剂和维生素D[n(%)]	44(91.7)	55(98.2)	χ²=1.20	0.273
入院时pH值	7.37±0.12	7.36±0.08	t=0.07	0.941
入院时PaO₂（ x±s）/mmHg	91.45±38.39	98.32±35.92	t=0.94	0.351
入院时PaCO₂（ x±s）/mmHg	39.70±12.33	45.75±16.8	t=2.06	0.042
入院时HCO^-₃（ x±s）/mmol·L^-1	22.42±3.13	24.22±2.78	t=3.11	0.002
入院时乳酸（ x±s）/mmol·L^-1	2.36±1.39	1.81±0.73	t=2.56	0.012

项目	NRDS组(n=48)	对照组(n=56)	t值	P
钙/mmol·L^-1	1.54±0.30	1.59±0.41	0.78	0.437
锌/mmol·L^-1	14.77±3.86	18.21±4.73	4.02	<0.001
铁/mmol·L^-1	64.16±61.66	57.89±40.68	0.62	0.536
铜/mmol·L^-1	5.93±1.85	12.11±4.56	8.78	<0.001
镁/mmol·L^-1	0.87±0.14	0.92±0.19	1.43	0.155
超氧化物歧化酶/U·mL^-1	37.39±7.42	41.20±7.81	2.54	0.013
丙二醛/mmol·L^-1	14.17±4.40	10.11±2.35	5.98	<0.001
超氧化物歧化酶/丙二醛	2.90±1.10	4.26±1.15	6.12	<0.001

项目	曲线下面积	灵敏度	特异度	约登指数	阳性预测值	阴性预测值
锌水平（≤16.35 mmol·L^-1）	0.728	0.665	0.770	0.395	0.638	0.761
铜水平（≤8.45mmol·L^-1）	0.917	0.750	0.979	0.729	0.770	0.977
超氧化物歧化酶（≤35.15 U·mL^-1）	0.627	0.804	0.479	0.280	0.676	0.643
丙二醛（≥11.65 mmol·L^-1）	0.780	0.768	0.729	0.497	0.714	0.764
超氧化物歧化酶/丙二醛(≤3.865)	0.824	0.661	0.896	0.557	0.683	0.878