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目的探讨胃液稳定微泡试验(SMT)及表面活性蛋白A(SP-A)检测对新生儿呼吸窘迫综合征(RDS)的预测意义。方法110例胎龄24～36周,体重1 160—2 010 g,出生1 h内的早产儿为研究对象,抽取胃液1～2 ml行SMT,同时应用酶联免疫吸附法测定SP-A浓度。结果发生RDS早产儿的胃液稳定微泡数及SP-A浓度均低于未发生者[SMT:(5．7±2．4)个／mm2比(12．4±6．0)个／mm2,t=8．355,P<0．01;SP-A:(214．2±59．9)μg/L比(390．7±120．8)μg／L,t=10．232,P< 0．01]。胃液SMT、SP—A诊断RDS的最佳临界值分别为微泡数≤7个／mm2、SP-A≤220μg／L。SMT诊断RDS的敏感度、特异度、阳性预测值、阴性预测值及总准确率均高于SP-A测定(88．2％比67．6％,X2=4．19,P<0．05;89．5％比65．8％,X2=12．28,P<0．01;78．9％比46．9％,X2=9．21,P< 0．01;94．4％比82．0％,X2=5．14,P<0．05;89．1％比66．4％,X2=16．41,P<0．01)。结论胃液SMT是预测RDS快捷、简便、经济、可靠的手段。与SP-A测定相比,该法预测效果更加准确。
Objective To investigate the predictive value of gastric juice stable microbubble test (SMT) and surfactant protein A (SP-A) on neonatal respiratory distress syndrome (RDS). Methods 110 cases of gestational age from 24 to 36 weeks, body weight of 1 160-2 010 g, born within 1 h of premature children as the research object, the gastric juice 1 to 2 ml line SMT, ELISA-SP method was used to determine the concentration of SP . Results The number of stable gastric microbubbles and the concentration of SP-A in preterm infants with RDS were lower than those without (SMT: (5.7 ± 2.4) / mm2 (12.4 ± 6.0) / mm2 , t = 8.355, P <0.01; SP-A: (214.2 ± 59.9) μg / L <0.01]. The optimal thresholds for the diagnosis of RDS in gastric juice SMT and SP-A were the numbers of microvesicles ≤7 / mm2, and SP-A≤220μg / L, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of SMT diagnosis of RDS were higher than that of SP-A (88.2% vs. 67.6%, X2 = 4.19, P <0.05 ; 89.5% vs 65.8%, X2 = 12.28, P <0.01; 78.9% vs 46.9%, X2 = 9.21, P <0.01; 94.4% 82.0%, X2 = 5.14, P <0.05; 89.1% vs 66.4%, X2 = 16.41, P <0.01). Conclusion Gastric fluid SMT is a fast, easy, economical and reliable method to predict RDS. Compared with the SP-A determination, the method predicts the effect more accurately.