胎儿生长受限的孕妇脂质过氧化与脐动脉血流相关性探讨

The study of correlations between umbilical artery blood flow and gestational lipid peroxidation with fetal growth restriction

目的:探讨脂质过氧化作用在胎儿生长受限(FGR)发病机制中可能发挥的作用以及FGR孕妇脂质过氧化作用与脐动脉血流阻力变化的相关性。方法:以正常孕妇为对照,选择孕32周后诊断为FGR,经应用L-精氨酸和扩容等治疗后超声多普勒脐动脉血流S/D比值恢复正常的足月分娩的单胎妊娠孕妇38例为研究对象,分别对孕晚期治疗前和孕足月临产前的经抹洗新鲜中段尿液进行抗原标记酶联免疫法测定8-异前列腺素F2α(8-iso-PGF2α)的水平,并分析相关的临床指标和妊娠结局。结果:FGR组孕晚期尿液8-iso-PGF2α水平显著高于正常妊娠组,差异有统计学意义(P<0.05);FGR孕妇经临床治疗后,孕足月时尿液8-iso-PGF2α水平仍显著高于正常妊娠组,且显著高于自身对照的孕晚期组,差异有统计学意义(P<0.05);FGR组孕晚期在治疗前血细胞比容(HCT)、脐动脉血流收缩期峰值与舒张期峰值的比值(S/D)、血流阻力指数(RI)和血流脉动指数(PI)明显高于正常妊娠组(P<0.05),但分别与尿液8-iso-PGF2α水平无显著相关性(P>0.05)。结论:FGR孕妇孕期体内的脂质过氧化作用明显增强;FGR孕妇脐动脉血流阻力明显增高,可能与脂质过氧化作用增强无关。

Aim：To investigate the role of lipid peroxidation （LPO） in the pathological mechanism of fetal growth restriction （FGR）, and to analyze the correlation of LPO and the blood flow resistance change of umbilical artery（UA） in the pregnant women with FGR. Methods： Healthy pregnant women were used as controls. The pregnant women after 32 gestational weeks were diagnosed with FGR, served as FGR group in which the ratio of velocity of systole and diastole （S/D） of the UA blood flow returned to normal after being cured through L-arginine, volumic therapy and other ways. All of the 38 cases were experienced mature singleton pregnancy. The S/D value was measured by the ultrasonic Doppler tech- nique. The fresh urine samples of all cases were respectively collected before therapy in late pregnancy and before natural term. Then, enzyme-linked immunosorbent assay （ELISA） was used to determine 8- iso-prostaglandinF2~ （8-iso-PGF2~） levels in the urine samples. Moreover, the relative clinical indexes and pregnant outcomes between normal and pregnant women with FGR were also compared. Results： In FGR group, the urine 8-iso-PGF2~ levels in late pregnancy were higher than those in normal pregnant group （ P 〈 O. 05 ）. After treatment, the urine 8-iso-PGF2~ levels in term pregnancy were still higher than their levels in late pregnancy and normal pregnant group （ P 〈 O. 05 ） ; Before therapy, the values of hem- atocrit （HCT）, S/D, resistance index （RI） and pulsatility index （PI） o＇f UA blood flow in FGR group were higher than control group （P 〈 O. 05 ）, but all of the values do not correlate with the urine 8-iso- PGF2~ levels in the late pregnancy （ P 〉 O. 05 ）. Conclusion： LPO was enhanced in pregnant women with FGR; the blood flow resistance of UA is increased, which might have no relation to the enhancement of LPO in pregnant women with FGR.