肿瘤坏死因子在妊高征发病中的作用

Tumor Necrosis Factor in Pregnancies Associated with Pregnancy Induced Hypertension

目的：探讨肿瘤坏死因子（ＴＮＦ）在妊高征发病中的作用及其对胎儿生长的影响。方法：应用放射免疫法对正常晚期妊娠妇女１６例（对照组）及妊高征患者４６例（妊高征组）的血浆、羊水和新生儿脐血中ＴＮＦ进行检测。结果：分娩前妊高征组血浆ＴＮＦ水平较对照组高，以中、重度妊高征者增高显著（Ｐ＜０．０５）；产后７２小时妊高征组血浆ＴＮＦ水平下降，与对照组差异无显著性。对照组及轻度妊高征者新生儿脐血ＴＮＦ水平与母血接近，羊水ＴＮＦ水平明显低于母血（Ｐ＜０．０５）；中、重度妊高征者脐血和羊水ＴＮＦ水平均较母血低（Ｐ＜０．０５；Ｐ＜０．０１）。新生儿脐血、羊水中ＴＮＦ水平在两组间差异无显著性。在中、重度妊高征者中，合并胎儿生长迟缓者其羊水和新生儿脐血ＴＮＦ水平明显高于未合并胎儿生长迟缓者。结论：ＴＮＦ可能作为母体对胎儿抗原的异常免疫反应的重要介质，在妊高征的发病中起一定作用。

Objective: To determine TNF concentrations in maternal plasma, amniotic fluid and umbilical blood of normal term pregnant women and women with pregnancy induced hypertension (PIH). Methods: Sixteen normal term pregnant women as control and fourty six women with PIH were enrolled for study. Maternal plasma including antepartum and 72 hours after labor, amniotic fluid and umbilical blood TNF concentrations were measured with a sensitive radioimmunoassay. Results: Similar levels of TNF were found in the amniotic fluid and umbilical blood between the two groups. Before labor, maternal plasma TNF level in PIH was generally higher than that in the control, especially a higher level in the moderate and severe PIH ( P <0.05). However, the mean levels of plasma TNF were not significantly different between the two groups after labor. TNF levels in amniotic fluid were significantly lower than those in maternal plasma and umbilical blood. Amniotic fluid and umbilical blood TNF levels in PIH with intrauterine growth retardation (IUGR) were significantly higher than those in PIH without IUGR ( P <0.05). Conclusion: Our study demonstrated an increase of TNF level in maternal plasma with PIH. The results may show an abnormal maternal immune reaction to the fetus. An abnormal higher TNF level may have an effect on the pathogenesis of PIH.