妊娠期肝内胆汁淤积症对正常新生儿HPA轴及肾上腺皮质功能的影响

Effect of intrahepatic cholestasis of pregnancy on the functions of hypothalamic-pituitary-adrenocortical axis and adrenal cortex in normal neonates

目的探讨妊娠期肝内胆汁淤积症(ICP)对正常新生儿下丘脑-垂体-肾上腺轴(HPA)及肾上腺皮质功能的影响。方法问卷调查收集32名ICP孕产妇(ICP组)和32名对照孕产妇(对照组)的人口统计学信息、分娩前心理焦虑和抑郁状况、分娩时应激自我评价。在新生儿娩出后即刻收集脐静脉血,记录出生结局,并用放射免疫法检测脐血中皮质醇(CORT)、促肾上腺皮质激素(ACTH)和硫酸脱氢表雄酮(DHEAS)的含量。结果ICP组产前心理焦虑和抑郁得分显著高于对照组(P<0.05,P<0.01),分娩时应激自评两组差异无显著性。ICP组脐血中CORT和ACTH水平均显著低于对照组(P<0.01,P<0.01),而DHEAS显著高于对照组(P<0.01)。ICP组DHEAS/ACTH比值显著高于对照组(P<0.01),CORT/DHEAS比值显著低于对照组(P<0.01)。ICP孕产妇的甘胆酸水平与脐血中的DHEAS水平存在显著正相关(r=0.47,P<0.01)。结论ICP可导致新生儿HPA轴的反应性下降,DHEAS分泌亢进,CORT与DHEAS存在分离现象,肾上腺皮质胎儿带可能存在功能损伤。

Objective To study the effect of intrahepatie cholestasis of pregnancy （ICP） on the functions of the hypothalamie-pituitary-adrenocortical （HPA） axis and adrenal cortex in normal neonates. Methods Demographic characteristics, prenatal anxiety and depression, and perceived stress during delivery were investigated in 32 ICP women and 32 controls. The cord blood levels of cortisal, adrenocorticotropic hormone （ACTH）, and dehydroepiandrosterone sulfate （DHEAS） were measured by the radioimmunity technique in normal neonates immediately after birth. Results The scores of prenatal anxiety and depression in ICP women were significantly higher than those in controls （ P 〈 0.05 and P〈0.01, respectively）. There were no significant differences in the perceived stress during delivery between the two groups. The cord blood levels of cortisol and ACTH in neonates from ICP women were significantly lower （ P 〈 0.01 ） , while the DHEAS level was significantly higher （P 〈 0.01 ） than in neonates from controls. The DHEAS/ACTH ratio was significantly higher （ P 〈 0.01 ）, while the cortisol/DHEAS ratio was significantly lower in the ICP group （ P 〈 0.01 ） than in the control group. The glycocholic acid level in ICP women was positively correlated with the DHEAS level in neonatal cord blood （r = 0.47, P 〈 0. 01 ）. Conclusions There may be a dissociation between cortisol and DHEAS in neonates with normal birth outcome from ICP women. ICP may result in a decreased responsiveness of HPA axis and an increased secretion of DHEAS by adrenal cortex in these neonates. This suggests that there might be dysfunction of the fetal zones of the adrenal cortex.