小于胎龄儿出生后血清维生素B12及脑发育水平研究

doi:10.3877/cma.j.issn.1674-0785.2020.05.010

目的

检测小于胎龄儿、适于胎龄儿出生后血清维生素B12（VB12）、同型半胱氨酸（Hcy）水平的差异并对足月儿进行行为神经评定，探讨VB12、Hcy对胎儿发育的影响及小于胎龄儿脑发育水平。

方法

根据胎龄与出生体质量的关系，将符合入选条件的研究对象分为小于胎龄儿组（早产小于胎龄儿亚组、足月小于胎龄儿亚组）、适于胎龄儿组（早产适于胎龄儿亚组、足月适于胎龄儿亚组），检测其血清中VB12、Hcy水平，分析出生时血清VB12、Hcy水平与出生体质量、胎龄的关系，比较小于胎龄儿、适于胎龄儿组出生时血清VB12、Hcy的水平差异。采用新生儿20项行为神经评定法（NBNA）对生后2~3 d的足月小于胎龄儿亚组、足月适于胎龄儿亚组进行行为神经测定并比较2组差别。

结果

出生时血清VB12水平与出生体质量呈正相关（r=0.564，P<0.05）；血清Hcy水平与出生体质量呈负相关（r=-0.569，P<0.05）。早产适于胎龄儿亚组出生时血清VB12水平高于、Hcy水平低于早产小于胎龄儿亚组［VB12：（262.07±62.25） pg/ml vs （228.21±67.27） pg/ml］；Hcy：（8.47±3.81） μmol/L vs （17.53±10.56） μmol/L］，差异有统计学意义（P均<0.05）；足月适于胎龄儿亚组出生时血清VB12水平高于、Hcy水平低于足月小于胎龄儿亚组［VB12：（431.03±113.82） pg/ml vs （254.80±72.35） pg/ml］；Hcy：（ 4.61±2.88） μmol/L vs （13.60±9.29） μmol/L］，差异有统计学意义（P均<0.05）。与足月适于胎龄儿亚组相比，足月小于胎龄儿亚组NBNA总分、行为能力、被动肌张力、主动肌张力评分均明显降低（P均<0.05）。

结论

出生时血清VB12水平与出生体质量、胎龄呈正相关；血清Hcy水平与出生体质量、胎龄呈负相关；小于胎龄儿出生时血清VB12水平较适于胎龄儿低，Hcy水平较适于胎龄儿高，提示VB12可能影响胎儿生长发育。足月小于胎龄儿早期NBNA评分较足月适于胎龄儿明显减低，说明小于胎龄儿出生时行为神经能力已受到影响。

关键词: 小于胎龄儿, 维生素B12, 同型半胱氨酸, 行为神经评定, 脑发育

Objective

To investigate the differences in levels of serum vitamin B12 (VB12) and homocysteine (Hcy) between small for gestational age infants and appropriate for gestational age infants and perform behavioral neurological assessment of full term infants, in order to understand the impact of VB12 and Hcy on fetal development and brain development levels in small for gestational age infants.

Methods

According to the relationship between gestational age and birth weight, the subjects enrolled in the study were divided into a small for gestational age infant group (including subgroups of preterm small for gestational age infants and full-term small for gestational age infants) and an appropriate for gestational age infant group (including subgroups of preterm appropriate for gestational age infants and full-term appropriate for gestational age infants). The levels of VB12 and Hcy in serum were measured, and the relationship of serum VB12 and Hcy levels with birth weight and gestational age at birth were analyzed. The differences in serum levels of VB12 and Hcy were compared between small for gestational age infants and appropriate for gestational age infants. Neonatal behavioral neurological assessment (NBNA) was used for the assessment and comparison of behavioral neurological scores in the subgroup of full-term small for gestational age infants and subgroup of full-term appropriate for gestational age infants in 2 to 3 days after birth.

Results

The levels of serum vitamin B12 at birth were positively correlated with birth weight (r=0.564, P<0.05), while the levels of serum Hcy were negatively correlated with birth weight (r=-0.569, P<0.05). The subgroup of preterm appropriate for gestational age infants had significantly higher levels of serum VB12 and lower levels of serum Hcy compared to the subgroup of preterm small for gestational age infants [VB12: (262.07±62.25) pg/ml vs (228.21±67.27) pg/ml, P<0.05; Hcy: (8.47±3.81) μmol/L vs (17.53±10.56) μmol/L, P<0.05]. The subgroup of full-term appropriate for gestational age infants had significantly higher levels of serum VB12 and lower levels of serum Hcy compared with the subgroup of full-term small for gestational age infants [VB12: (431.03±113.82) pg/ml vs (254.80±72.35) pg/ml, P<0.05; Hcy: (4.61±2.88) μmol/L vs (13.60±9.29) μmol/L, P<0.05]. Compared with full-term appropriate for gestational age infants, full-term small for gestational age infants had significantly lower total NBNA score and scores of capacity, passive muscle tension, active muscle tension, and primitive reflexes (P<0.05).

Conclusion

The levels of serum vitamin B12 at birth positively correlate with birth weight and gestational age, while the levels of serum homocysteine negatively correlates with birth weight and gestational age. The levels of serum vitamin B12 in small for gestational age infants are lower than those of appropriate for gestational age infants, while the levels of serum homocysteine are higher than those appropriate for gestational age infants, which indicates that VB12 may affect fetal growth and development. Full-term small for gestational age infants have significantly lower NBNA scores than full-term appropriate for gestational age infants, indicating that the behavioral neuroscience capacity of small for gestational age infants is affected at birth.

Key words: Small for gestational age infant, Vitamin B12, Homocysteine, Neonatal behavioral neurological assessment, Brain development

表1 小于胎龄儿组、适于胎龄儿组一般情况比较

组别	例数	胎龄（周）	出生体质量（g）	身长（cm）	头围（cm）	胸围（cm）
小于胎龄儿组	100	36.36±2.81	1953.50±401.73	42.69±3.39	29.88±2.31	27.59±2.75
适于胎龄儿组	104	36.12±3.34	2671.97±716.68	45.85±3.60	31.95±2.30	30.58±3.11
t值	?	0.187	-6.939	-5.099	-4.990	-5.093
P值	?	0.851	<0.01	<0.01	<0.01	<0.01

表1 小于胎龄儿组、适于胎龄儿组一般情况比较

组别	例数	胎龄（周）	出生体质量（g）	身长（cm）	头围（cm）	胸围（cm）
小于胎龄儿组	100	36.36±2.81	1953.50±401.73	42.69±3.39	29.88±2.31	27.59±2.75
适于胎龄儿组	104	36.12±3.34	2671.97±716.68	45.85±3.60	31.95±2.30	30.58±3.11
t值	?	0.187	-6.939	-5.099	-4.990	-5.093
P值	?	0.851	<0.01	<0.01	<0.01	<0.01

表2 早产小于胎龄儿亚组、足月小于胎龄儿亚组、早产适于胎龄儿亚组、足月适于胎龄儿亚组一般情况比较

组别	例数（例）	胎龄（周）	出生体质量（g）	身长（cm）	头围（cm）	胸围（cm）
早产小于胎龄儿亚组	50	34.02±1.68	1693.60±375.99	41.06±3.52	28.91±2.48	26.54±3.10
早产适于胎龄儿亚组	52	33.29±2.18	2068.75±444.49^a	43.07±3.02^a	30.31±2.05^a	28.29±2.58^a
足月小于胎龄儿亚组	50	38.71±1.35	2213.40±216.43	44.80±1.60	31.95±3.72	28.78±1.65
足月适于胎龄儿亚组	52	38.96±1.18	3275.19±312.63^b	48.63±1.08^b	33.58±1.02^b	32.87±1.52^b
F值	?	171.235	194.688	84.784	62.523	72.110
P值	?	<0.05	<0.05	<0.05	<0.05	<0.05

表2 早产小于胎龄儿亚组、足月小于胎龄儿亚组、早产适于胎龄儿亚组、足月适于胎龄儿亚组一般情况比较

组别	例数（例）	胎龄（周）	出生体质量（g）	身长（cm）	头围（cm）	胸围（cm）
早产小于胎龄儿亚组	50	34.02±1.68	1693.60±375.99	41.06±3.52	28.91±2.48	26.54±3.10
早产适于胎龄儿亚组	52	33.29±2.18	2068.75±444.49^a	43.07±3.02^a	30.31±2.05^a	28.29±2.58^a
足月小于胎龄儿亚组	50	38.71±1.35	2213.40±216.43	44.80±1.60	31.95±3.72	28.78±1.65
足月适于胎龄儿亚组	52	38.96±1.18	3275.19±312.63^b	48.63±1.08^b	33.58±1.02^b	32.87±1.52^b
F值	?	171.235	194.688	84.784	62.523	72.110
P值	?	<0.05	<0.05	<0.05	<0.05	<0.05

表3 早产小于胎龄儿亚组、足月小于胎龄儿亚组、早产适于胎龄儿亚组、足月适于胎龄儿亚组生时血清VB12、Hcy水平比较

组别	例数	VB12（pg/ml）	Hcy（μmol/L）
早产小于胎龄儿亚组	50	228.21±67.27	17.53±10.56
早产适于胎龄儿亚组	52	262.07±62.25^a	8.47±3.81^a
足月小于胎龄儿亚组	50	254.80±72.35	13.60±9.29
足月适于胎龄儿亚组	52	431.03±113.82^b	4.61±2.88^b
F值	?	65.965	30.262
P值	?	<0.01	<0.01

表3 早产小于胎龄儿亚组、足月小于胎龄儿亚组、早产适于胎龄儿亚组、足月适于胎龄儿亚组生时血清VB12、Hcy水平比较

组别	例数	VB12（pg/ml）	Hcy（μmol/L）
早产小于胎龄儿亚组	50	228.21±67.27	17.53±10.56
早产适于胎龄儿亚组	52	262.07±62.25^a	8.47±3.81^a
足月小于胎龄儿亚组	50	254.80±72.35	13.60±9.29
足月适于胎龄儿亚组	52	431.03±113.82^b	4.61±2.88^b
F值	?	65.965	30.262
P值	?	<0.01	<0.01

表4 足月小于胎龄儿亚组、足月适于胎龄儿亚组出生后2~3 d行为神经评分结果比较

组别	例数	行为能力	被动肌张力	主动肌张力	原始反射	一般评估	总评分
足月小于胎龄儿亚组	50	9.22±1.04	6.26±0.45	5.83±0.49	4.91±0.52	5.65±0.49	31.87±1.60
足月适于胎龄儿亚组	52	11.46±0.71	7.38±0.70	7.42±0.58	5.69±0.47	5.85±0.37	37.77±2.03
t值	?	-5.617	-4.819	-5.938	-4.415	-1.560	-5.830
P值	?	<0.01	0.01	<0.01	<0.01	0.119	<0.01

表4 足月小于胎龄儿亚组、足月适于胎龄儿亚组出生后2~3 d行为神经评分结果比较

组别	例数	行为能力	被动肌张力	主动肌张力	原始反射	一般评估	总评分
足月小于胎龄儿亚组	50	9.22±1.04	6.26±0.45	5.83±0.49	4.91±0.52	5.65±0.49	31.87±1.60
足月适于胎龄儿亚组	52	11.46±0.71	7.38±0.70	7.42±0.58	5.69±0.47	5.85±0.37	37.77±2.03
t值	?	-5.617	-4.819	-5.938	-4.415	-1.560	-5.830
P值	?	<0.01	0.01	<0.01	<0.01	0.119	<0.01

图2 血清Hcy水平与出生体质量的相关性

图4 血清Hcy水平与胎龄的相关性

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Serum vitamin B12 and brain development levels in small for gestational age infants

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Serum vitamin B12 and brain development levels in small for gestational age infants