胎盘11β-HSD与病理妊娠的研究进展

Research advancement of placental 11β-HSD in Pathological Pregnancy

病理妊娠包括胎儿生长受限、妊娠期高血压疾病、妊娠期糖尿病等,是严重威胁母婴健康的疾病。对病理妊娠机制的深入研究,有助于我们在临床上更好的诊治。妊娠期间胎盘分泌的糖皮质激素代谢酶11β-羟基类固醇脱氢酶(11β-HSD,11β-hydroxysteroid dehydrogenase)的异常表达被认为与病理妊娠有关。11β-HSD分为11β-HSD1和11β-HSD2两种亚型。胎盘11β-HSD2为避免胎儿暴露于过量的糖皮质激素水平提供了屏障作用,保证胎儿正常生长发育。胎盘11β-HSD2表达和活性降低与胎儿生长受限有关。胎盘11β-HSD2的活性在妊娠期高血压疾病患者中是降低的,妊娠期高血压疾病也可导致胎盘11β-HSD2活性的进一步降低。胎盘11β-HSD1表达增加与胰岛素抵抗有关,可能参与妊娠期糖尿病的发病。针对胎盘11β-HSD的活性调节将是病理妊娠治疗的重要措施之一。

Pathological pregnancy including fetal growth restriction（FGR）,preeclampsia,gestational diabetes mellitus（GDM）,is a disease with serious threat to maternal and fetal health.An in-depth study on the pathogenesis of pathological pregnancy will help to achieve a better clinical diagnosis and treatment.During human pregnancy,placenta secretes a number of 11β-hydroxysteroid dehydrogenase（11β-HSD）,which is thought to be relevant with pathological pregnancy.There are two subtypes of 11β-HSD：11β-HSD1 and 11β-HSD2.The placental 11β-HSD2 serves as a functional barrier to protect the fetus from excessive exposure to high levels of maternal cortisol to insure the normal fetal growth and development.The reduction of 11β-HSD2 expression and activity may correlate with FGR.11β-HSD2 activity is reduced in preeclampsia;vice versa,preeclampsia can further reduce 11β-HSD2 activity.Enhanced 11β-HSD1 activity correlates with insulin resistance and may contribute to GDM.Therefore,regulation of the placental 11β-HSD activity will be one of the important measures for the treatment of pathological pregnancy.