·临床研究·

孕妇外周血胎儿有核红细胞计数变化及其在不良妊娠结局预测中的应用

刘丽平1，水丽君2，龚瑞龙1，曹江霞1，黄秋香1，张元珍3

(1武汉市妇女儿童医疗保健中心，武汉430016；2安徽医科大学第二附属医院；3武汉大学中南医院)

摘要：目的观察孕妇外周血胎儿有核红细胞计数的变化，探讨其在妊娠不良结局预测中的应用价值。方法收集87例孕12～18周孕妇的外周血，密度梯度离心法分离单个核细胞，采用PE-GPA /FITC-CD71单克隆抗体双色标记胎儿有核红细胞后进行流式细胞分析，追踪妊娠结局并进行分析。结果妊娠结局正常者外周血中胎儿有核红细胞百分比为0.89%±0.81%，妊娠结局不良者为3.25%±2.98%，两者相比，P<0.05。以胎儿有核红细胞百分比>3.79%作为截断值，预测妊娠不良结局的敏感度为76.9%、特异度为64.3%。结论与妊娠结局正常的孕妇相比，妊娠结局不良孕妇孕12～18周时外周血胎儿有核红细胞增多；对孕12～18周孕妇外周血胎儿有核红细胞进行计数有助于不良妊娠结局的预测，其敏感度及特异度均较高。

关键词：有核红细胞；胎儿有核红细胞；妊娠；孕妇；妊娠结局

doi：10.3969/j.issn.1002-266X.2015.43.012

中图分类号：R713 文献标志码：B

基金项目：湖北省武汉市卫生和计划生育委员会2014年立项课题。

收稿日期：(2015-07-13)

Fetus nucleated red blood cell count changes in peripheral blood of pregnant

women and its application in prediction of adverse pregnancy outcomes

LIULi-ping1, SHUI Li-jun, GONG Rui-long, CAO Jiang-xia, HUANG Qiu-xiang, ZHANG Yuan-zhen

(1WuhanMedicalandHealthCenterforWomen-Children,Wuhan430016,China)

Abstract:ObjectiveTo observe the fetus nucleated red blood cell (NRBC) count changes in the peripheral blood of pregnant women and to investigate its application in prediction of adverse pregnancy outcomes.MethodsBlood samples were obtained from 87 pregnant women with the gestational age from 12 to 18 weeks, peripheral blood mononuclear cells were isolated by density gradient centrifugation and then we analyzed the cells marked with PE-GPA/FITC-CD71 monoclonal antibodies on the flow cytometer. Tracking the pregnancy outcomes, and their correlation between fetus nucleated red blood cell measurement and adverse pregnancy outcomes was analyzed.ResultsThe percentage of fetus NRBC in women with normal pregnancy outcomes was 0.89%±0.81%, 3.25%±2.98% in women with adverse pregnancy outcomes, and there was a significant difference between these two groups(P<0.05). We took fetus NRBC percentage >3.79% as the cutoff value to predict adverse outcomes of pregnancy, the sensitivity was 76.9%, and the specificity was 64.3%.Conclusions Compared with women with normal pregnancy outcomes, women with adverse pregnancy outcomes have a higher amount of fetus NRBC in the peripheral blood during the gestational age of 12-18 weeks. Measurement of fetus NRBC in maternal peripheral blood has a predictive role in adverse pregnancy outcomes, with a higher sensitivity and specificity.

Key words: nucleated red blood cells; fetus nucleated red blood cells; pregnancy; pregnant women; pregnancy outcome

通信作者：张元珍

正常妊娠的维持有赖于母胎免疫平衡的建立与稳定[1]。一旦该平衡失调，则会产生免疫排斥反应[2]，引起病理性妊娠，导致不良妊娠结局，包括流产、早产、妊娠并发症、围产期胎儿死亡等[3]。1969年Walknowska等首次报道从孕妇外周血中提取胎儿细胞进行产前诊断。随后的研究[4,5]表明，胎儿有核红细胞是最好的产前诊断细胞来源。……