母血皮质醇及皮质醇结合蛋白水平在特发性早产发生及分娩中的变化_医学论文.docVIP

母血皮质醇及皮质醇结合蛋白水平在特发性早产发生及分娩中的变化_医学论文 母血皮质醇及皮质醇结合蛋白水平在特发性早产发生及分娩中的变化_医学论文 作者：刘晓琴，吴玲，赵亚娟，李瑾 【摘要】 　　目的： 本实验通过母体血清皮质醇，皮质醇结合蛋白(CBG)的变化，研究母体HPA轴在特发性早产发生中的作用. 方法： 随机收集30例特发性早产患者为研究对象，分为先兆组和难免组，以同孕期要求引产的正常妊娠孕妇12例作为对照，采用放射免疫方法，测量母体血清皮质醇、CBG水平. 结果： 先兆组母血皮质醇水平与对照组相比有升高的趋势，但两组间无统计学差异；难免组与对照组、先兆组皮质醇水平相比明显升高，有统计学差异(0.01)；三组间母血CBG浓度无明显变化；皮质醇/CBG比值变化与母血皮质醇水平变化类似. 结论： 母血皮质醇水平与早产结局有关，可作为难免早产的标志和保胎疗效的判断指标. 【关键词】 早产；皮质醇；皮质醇结合蛋白 　　【Abstract】 AIM: To explore the changes of maternal serum cortisol and corticosteroid binding globulin (CBG) levels in the onset of preterm labor and to determine the effect of maternal stress, HPA axis and active cortisol concentration on the onset of preterm labor. METHODS: The samples were obtained from 30 idiopathic preterm labor patients. They were divided into 2 groups: threatened preterm labor(TPL)group (n=18) and inevitable preterm labor(IPL) group (n=12).12 control patients were obtained according to comparable gestational age, parity,and education etc. Maternal serum samples were collected after admission. Cortisol and CBG concentrations were determined by radioimmunoassay. RESULTS: Maternal serum CBG concentrations among the 3 groups had no difference. Maternal cortisol concentrations between TPL and control groups had no difference. Maternal cortisol concentration of IPL was significantly higher than that in the other 2 groups. The changes of the ratio of cortisol/CBG were similar to those of cortisol levels among the 3 groups. CONCLUSION: Its HPA axis has no effect on the onset of preterm labor and the threshold value of activation is higher in pregnancy. The level of cortisol in materal serum is a mark of IPL and tocolysis prediction. 　　【Keywords】 preterm labor cortisol corticosteroid binding globulin 　　0 引言 　　特发性早产是指排除了各种内外科合并症及临床感染，无明显诱因发生的早产. 一般认为早产的发生与母体胎儿应激有关. Lockwood［1］认为无论是躯体性应激或心理应激都有可能激活母体胎儿HPA轴，使皮质醇分泌增加，刺激胎盘促肾上腺皮质激素释放激素(corticotropinreleasing hormone, CRH)的合成和分泌. 胎盘CRH与分娩关系密切，在异常妊娠及分娩中起着重要作用，可能是分娩的始动因素. 有资料表明，自发性早产患者在症状出现前10 wk，母血