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

Changes of maternal serum cortisol and corticosteroid binding globulin levels in idiopathic preterm labor

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(P<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.

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 admis- sion. 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.