羊膜腔灌注治疗胎儿生长受限对IGF-Ⅰ,Ⅱ及IGFBP-3的影响

The effect of amnioinfusion treatment to the fetal growth restriction on IGF-Ⅰ,Ⅱ and IGFBP-3

目的通过对比羊膜腔灌注术及静脉输液分别治疗胎儿生长受限(fetal growth restriction,FGR)后母体血清、羊水及新生儿脐血中IGF-Ⅰ,Ⅱ及IGFBP-3水平的差异来阐明胰岛素样生长因子系统与FGR的关系,并为羊膜腔灌注治疗的可行性及科学性提供理论基础。方法选取2007年6月～2010年12月在广州医学院附属广州市第一人民医院产科住院的临床诊断的中期FGR孕妇60例,随机分为羊膜腔灌注治疗组30例(实验组)及静脉输液治疗组30例(对照组);分别测定两组孕妇分娩时的母血、羊水及脐血中的IGF-Ⅰ、Ⅱ及IGFBP-3的浓度并对比它们的差异;记录两组孕妇分娩时新生儿的身长、体重及胎盘重量并对比它们的差异。结果与对照组相比较,实验组的IGF-Ⅰ,Ⅱ水平有明显的上升,而IGFBP-3水平在羊水及脐血中均下降,在母血中无明显差异;实验组的新生儿身长、体重及胎盘重量明显高于对照组。结论羊膜腔灌注治疗FGR与母体静脉输注氨基酸及能量合剂治疗FGR相比较,前者是治疗FGR的更为有效的方法,可通过母血中IGF-Ⅰ及羊水中IGF-Ⅰ、Ⅱ及IFGBP-3水平的检测来评估疗效。

Objective ： By comparing the difference of IGF - Ⅰ , IGF -Ⅱ , IGFBP - 3 levels in maternal serum, ammiotie fluid and infant umbilical cord after amnioinfusion and intravenous infusion to the fetal growth restrieton respeetively to further velueidate the relationship between the insulin - like growth factor system and fetal growth restriction. To provide the theoretical basis for the feasibility and science of the amnioinfusion to the fetal growth restriction. Methods ： Seleeted the 60 medium - term pregnant women with FGR by clinical diagnosis in the Affilieated Guangzhou First People＇s Hospital of Guangzhou Medical College Obstetric from June 2007 - December 2010 and randomly assigned to amnioinfusion treatment group 30 patients （experimental group） and intravenous fluid therapy group 30 patients （control group）. When two groups of pregnant women dilivering, respectively detected the levels of IGF - Ⅰ,Ⅱ and IGFBP -3 in the maternal blood, amniotic fluid and cord blood and compared their differences. After delivery, recorded the neonatal birth height and weight and placental weight of the two FGR groups and compared their differences. Results ： Compared with the control group, IGF - Ⅰ ,Ⅱ levels in experimental group significantly increased, while IGFBP - 3 levels in amniotic fluid and cord blood were decreased, no significant difference in maternal blood. The neonatal length, weight and placental weight of experimental groups were significantly higher. Conclusion ： Amnioinfusion compared with the maternal intavwnous infusion of amino acids and energy mixture to treat the FGR, the former is a more effective method of the treatment to FGR, and we can evaluate the efficacy of the the therapy by detecting the IGF- Ⅰ levels in maternal and IGF- Ⅰ ,Ⅱ , IGFBP- 3 levels in amniotic fluid.