胎儿窘迫与孕妇静脉血及脐血中内源性阿片肽水平的关系(英文)

Relationship between fetal distress and endogenous opioid peptides levels of the venous blood and the umbilical blood in pregnant women

背景:内源性阿片肽是一类重要的介质与调质,参与机体多种生理和病理过程,其与新生儿脑病的关系受到广泛关注。目的:探讨内源性阿片肽与胎儿窘迫发生的关系。设计:以健康孕妇为研究对象,病例-对照的对比观察。单位:解放军第二军医大学长征医院妇产科病房。对象:选择在第二军医大学长征及长海医院住院分娩并符合纳入标准的正常妊娠健康孕妇40例(对照组)及发生胎儿窘迫的健康孕妇43例(胎儿窘迫组)。方法:采用放射免疫法测定40例对照组孕妇及胎儿窘迫组孕妇静脉血及其新生儿脐血中阿片肽(β-内啡肽、强啡肽A1-13和亮啡肽)的水平,同时行脐动脉血血气分析。主要观察指标:两组孕妇静脉血及脐血中内源性阿片肽的水平及相关性。结果:胎儿窘迫组新生儿脐血中β-内啡肽、强啡肽强啡肽A1-13和亮啡肽水平犤(453±68),(242±33),(498±68)ng/L犦明显高于对照组犤(251±39),(103±22),(322±40)ng/L犦(t=2.713,2.762,P<0.01;t=2.132,P<0.05)。脐动脉血血气分析:pH为7.0±0.1,氧分压为(1.7±0.6)kPa,二氧化碳分压为(8.9±0.7)kPa;其中β-内啡肽水平与脐血pH,氧分压呈显著负相关(r=-0.418,-0.437,P<0.01),与二氧化碳分压呈显著正相关(r=0.442,P<0.01);强啡肽A1-13水平与脐血pH及氧分压呈负相关(r=-0.337,-0.383,P<0.05),与二氧化碳分压呈显著正相关(r=0.346,P<0.05)。两组血浆中3种肽水平比较,差异无显著性意义(P>0.05)。结论:内源性阿片肽参与了胎窘的病理过程与胎儿窘迫的发生发展密切相关,对胎儿出生后早期康复干预具有量化数据参考价值。

BACKGROUND:Endogenous opioid peptide is an important medium and regulator that participate in many physical and pathologic processes of the body.Its relationship with fetal encephalopathy has attracted much attraction. OBJECTIVE:To evaluate the role of endogenous opioid peptides (EOP) in fetal distress.DESIGN:A case control observatory study based on healthy pregnant women.SETTING:Wards of the Department of Obstetrics and Gynecology of Changzheng Hospital Affiliated to Second Military Medical University of Chinese PLA.PARTICIPANTS:Eighty three healthy women who were hospitalised in Changzheng Hospital and Changhai Hospital affiliated to the Second Military Medical University of Chinese PLA and met the inclusion criteria.Among them,40 were normal healthy pregnant women(the control group) and 43 were healthy pregnant women with fetal distress(the fetal distress group).METHODS:Radioimmunoassay was used to measure the levels of blood EOP(β endorphin,dynorphin A1- 13 and leu enkephalin) of the venous blood of the pregnant women in fetal distress group and the control group and the EOP level in the umbilical blood of the newborns.Also,blood gas analysis of the blood from the umbilical artery was conducted.MAIN OUTCOME MEASURES:The levels of EOP in the venous blood of two groups of pregnant women and the umbilical blood of newborns and the correlation of EOP level with fetal distress. RESULTS:The levels of the umbilical artery blood EOP(β endorphin,dynorphin A1- 13 and leu enkephalin) in the fetal distress group[(453 ± 68) ng/L,( 242± 33) ng/L,and( 498± 68) ng/L respectively] were significantly higher than those in the control group[(251± 39) ng/L,( 103 ± 22) ng/L and( 322± 40) ng/L respectively( t=2.713, 2.762,P< 0.01; t=2.132,P< 0.05) ].The umbilical artery blood gas analysis: pH was(7.0± 0.1) ,PO2 was(1.7± 0.6) kPa,PCO2 was(8.9± 0.7) kPa. The levels of β endorphin were negatively correlated with pH and PO2 of the umbilical artery blood(r=- 0.418 and - 0.437,P< 0.01),but they were positively correlated with PCO2(r=0.442,P< 0.05).The level of dynorphin A1- 13 was negatively correlated with pH and PO2(r=- 0.337, - 0.383,P< 0.05), but it was positively correlated with PCO2(r = 0.346,P< 0.05).There was no significant difference among the three kinds of blood EOP of the two groups(P >0.05).CONCLUSION:EOP participates in the pathological progress of the fetal distress and was closely correlated with the occurrence and development of the fetal distress.This finding has a reference value for early rehabilitation and intervention after the fetal was born that can be tested quantitatively.