E_2、P、CRH在早产发病中的作用

The Effects of E_2,P,E_2/P and CRH on Premature Delivery

目的观察妊娠晚期孕妇外周血中雌二醇(E2)、孕酮(P)、促肾上腺皮质激素释放激素(corticotropin-releasing hormone,CRH)的变化及其在早产发病中的作用和它们之间的相互关系.方法选取正常妊娠组孕妇60例,先兆早产组孕妇63例(早产组21例,继续妊娠组42例),采集外周静脉血分离血浆,用免疫化学发光法测定E2、P,放射免疫法测定CRH水平.结果1)妊娠晚期正常孕妇血中的CRH质量浓度随着孕周增加而逐渐升高,而血E2质量浓度无明显变化,P质量浓度31～32周达到高峰,之后明显下降.2)正常妊娠组和先兆早产组各孕周组间血CRH、P比较差异均有统计学意义(P＜0.01),而正常妊娠组和先兆早产组妊娠29～30周和31～32周2个孕周组间血E2比较差异无统计学意义(P＞0.05),妊娠33～34周和35～36周2孕周组间比较差异有统计学意义(分别为P＜0.01和P＜0.05).3)早产组CRH、E2显著高于继续妊娠组,差异有统计学意义(P＜0.01).早产组P显著低于继续妊娠组,差异有统计学意义(P＜0.05).结论1)CRH可能是分娩发动的重要因素.2)CRH在早产发病中起重要作用,CRH的异常升高可能决定了分娩时间的提前.监测孕妇血CRH的变化有望成为预测早产的可靠指标.3)与E2相比,P在早产发动中发挥更重要的作用.

Objective To study the level and the action of E2, P and CRH in the onset of premature delivery; and investigate the effects of E2, P and CRH on premature delivery and the relationship among E2, P and CRH. Methods 63 pregnant women of threatened prematurity were enrolled as the threatened prematurity group, 60 normal pregnant women are selected as normal pregnant group. Three milliliters of venous blood were taken from all of the women. The levels of E2, P were detected by radioimmunoassay, CRH by fluoroimmunoassay. Results 1） In the third trimester, the CRH concentration in maternal plasma increased with advanced gestation. The E2 level had little change. However, the P concentration came to the peak at the 31- 32 menstrual weeks, then, it fell down markedly. 2） In the 29-30, 31-32, 33-34, 35-36 menstrual weeks the CRH, P levels in threatened prematurity groups were significantly different with normal pregnancy（P 〈 0.01 ）. In the 29-30 menstrual weeks, the Fa level was not significant（ P = 0. 648）; and so did 31- 32 weeks Fa level（ P = 0. 298）; in the 33- 34, 35- 36 menstrual weeks, the E2 levels in threatened prematurity groups were significantly higher than normal pregnancy（P 〈 0.01, P 〈 0.05）. 3） The CRH, E2 levels of premature delivery groups were much higher than continuous pregnancy（P〈 0.01 ）, however, the P level was much lower than continuous pregnant group （ P 〈 0.05 ）. Conclusion 1 ） CRH maybe an important factor in onset of delivery. 2） The maternal plasma CRH plays an important role in preterm delivery. Abnormally elevated level of CRH can predict preterm labor. 3） In premature delivery P is much more important than Fa.