Correlation Study Of Neonates' Traditional Chinese Medicine Constitution Classification And Cord Blood ACTH And COR Levels

ObjectiveTo investigate the distribution pattern of neonatal TCM constitution types,study the levels of adrenocorticotropic hormone(ACTH)and cortisol(COR)in neonatal umbilical cord blood and its related influencing factors,and analyze the relationship between neonatal TCM constitution types and the levels of ACTH and COR in neonatal umbilical cord blood.MethodsA cross-sectional study was conducted on 88 healthy full-term newborns born in the department of obstetrics and gynecology of the Air Force Medical Center,PLA(Air Force General Hospital,PLA)from October 2018 to February 2019.Umbilical cord blood was collected immediately after umbilical cord amputation,plasma was obtained after centrifugation,stored in a-80℃ refrigerator.After collecting 88 cases,using enzyme-linked immunosorbent experiment(ELISA)detection the level of ACTH,COR.The differences in the levels of ACTH and COR between different mode of parturition,gestational age,gender and body weight were compared.From 24 hours to 72 hours after the birth of the newborn,under the guidance of the senior title of professional Chinese medicine pediatrician,the neonatal TCM constitution identification table was used to identify the neonatal TCM constitution type.SPSS 20.0 software was used for statistical analysis,and P<0.05 was considered statistically significant.Results(1)Among the 88 neonates,the proportion of Gentleness type,Yang-excessiveness type,Yin-excessiveness type was 67.0%,27.3%,5.7%.(2)Different TCM constitution types of newborns have their own clinical feature.Among the three TCM constitution types,there were statistically significant differences in three aspects:appearance(including complexion,lip color,and tongue texture),mental reaction(including crying,crying frequency,and awakening degree),and skin condition(including skin,extremities temperature,and erythema).But,there were no significant differences in eye secretions,stool frequency,stool shape and sucking response.(3)There were statistically significant differences in the levels of ACTH and COR in the umbilical cord blood among the three constitutional types(P<0.01).Pairings comparison showed that the levels of ACTH and COR in umbilical cord blood of neonates in the Yin-excessiveness type group were significantly lower than those in the Yang-excessiveness type group and the Gentleness type group,and the differences were statistically significant.The level of ACTH in Yang-excessiveness type group was slightly higher than that in Gentleness type group,but the levels of cord blood ACTH and COR were no significant difference between the two groups.(4)The COR level of umbilical cord blood of vaginal delivery neonatal was higher than the cesarean section,and the difference was statistically significant(P<0.01).There was no statistically significant difference in the ACTH level of neonatal umbilical cord blood between different mode of parturition.(5)According to the gestational age of 37～39+6 weeks and 40～41+6 weeks,neonates were divided into two groups.The results showed that the COR level of umbilical cord blood of the relatively older neonates was higher than that of the relatively younger neonates,and the difference between the two groups was statistically significant(P<0.01),while there was no statistically significant difference in the level of ACTH between the two groups.(6)According to body weight:2500g～3000g,3001g～3500g,and 3501g-4000g,newborns were divided into 3 groups.The results showed that there were no significant differences between the three groups in the levels of ACTH and COR.(7)The newborns included in the study were divided into two groups according to gender.The results showed that there were no significant differences in the levels of ACTH and COR in neonatal cord blood of different genders.Conclusion(1)The distribution pattern of TCM constitution types in neonates is different from that of adults.The majority of neonatal constitution types is Gentleness type,and only about 1/3 are biased constitutions.In the biased constitutions,Yang-excessiveness type is the main substance,while Yin-excessiveness type is rare.(2)Yang-excessiveness type of the newborn,clinical manifestations are that the complexion,lip color and tongue texture are dark red,the skin is dry and peeling,rash is more,crying more,awakening degree is high,easy to wake.Yin-excessiveness type of the newborn,clinical manifestations are that complexion moist,lip color and tongue texture are more reddish or pale,no skin rash,no eye secretions,more quiet,do not love crying,crying low and easy to stop,limb temperature is cool.Gentleness type,clinical manifestations are relatively calm,complexion,lip color and tongue texture are ruddy and lustrous,skin scattered in a few rashes or no rash,crying moderate,easy to stop.(3)TCM constitution type,delivery mode and gestational age are the main influencing factors of COR level in healthy full-term neonates.The mode of parturition and gestational age are the influencing factors of COR level of umbilical cord blood in healthy full-term neonates.The COR level of vaginal delivery neonatal umbilical cord blood is higher than that of cesarean section,and the COR level of older neonates is higher than that of younger ones.Gender and birth weight are not the influencing factors of the level of ACTH and COR in umbilical cord blood of healthy infants.(4)Neonatal TCM constitution type is related to the level of cord blood ACTH and COR.The levels of ACTH and COR in umbilical cord blood of newborn with Yin-excessiveness type were significantly lower than those of newborn with Yang-excessiveness type and Gentleness type.Compared with other constitution types,the function of the HPA axis of the neonatal Yin-excessiveness type is relatively insufficient.