促肾上腺皮质激素释放激素受体-1与分娩发动的关系

Study on the relationship between Corticotropin-Releasing Hormone Receptor 1 and onset of labor

目的:比较不同孕周分娩发动前后行剖宫产的产妇子宫下段肌组织中促肾上腺皮质激素释放激素受体-1(CRH-R1)的表达差异,分析其在分娩发动中的作用。方法:选取剖宫产产妇32例为剖宫产组,剖宫产组分为产程发动组16例和产程未发动组16例,产程发动组又分为早产组8例和足月组8例,产程未发动组分为足月组8例和过期妊娠组8例,各组产妇术前均未使用过催产素类促子宫收缩药物,排除全身性疾病及妊娠高血压疾病等并发症,术中取子宫下段肌层肌肉,行CRH-R1免疫组化染色。结果:CRH-R1在产程发动组中与产程未发动组中表达差异有统计学意义(P<0.05),CRH-R1在早产组和足月产程发动组剖宫产产妇子宫下段肌组织中表达差异无统计学意义(P>0.05)。CRH-R1在足月组与过期组剖宫产产妇子宫下段肌组织中表达差异无统计学意义(P>0.05)。结论:目前对于分娩动因尚无定论,子宫下段形成是分娩发动和产程顺利进展的必要条件,该研究提示CRH-R1在分娩启动学说中可能具有促子宫下段成熟作用,而早产组表达水平与足月组差异无统计学意义,为进一步研究其配体CRH血浆表达水平是否可以作为预测早产以及判断疗效的指标提供了线索,研究CRH和CRH-R1及其他相关因子在子宫体肌、胎膜及蜕膜的表达,有助于更好地理解分娩发动的机制。

Objective： To investigate the differential expression of CRH -R1 in uterine myometrium from the pregnant undergoing lower segment cesarean, attempting to seek for a new molecular indicator in the research of onset of labor. Methods： The study included 32 patients undergoing caesarean section, 16 cases of in laboring （ group 1 ）, 16 cases of before laboring （ group 2）, myometrial samples were collected from the lower segment. Immunohistochemical staining for CRH - R1 were performed by SP. Results： In the our study, CRH - R1 H - Score of groupl was much higher than group2 （ P 〈 0. 05 ）, CRH - R1 H - Score was not significantly different between postterm pregnant and term pregnant in group 2, CRH - R1 H - Score was also not significantly different between preterm pregnant and term pregnant in group 1. Conclusion： There is no accepted conclusion on the onset of laboring at present, our investigation has suggested that CRH - RI play an important role on the onset of laboring, and the serum titer of CRH which is the ligand of CRH - R1, may be an index which can forecast preterm and therapeutic effects.