CRH及其受体-1在分娩发动中的作用

Effect of CRH and CRH-R1 at labor onset

目的比较早产及足月分娩剖宫产产妇血清肾上腺皮质激素释放激素(CRH)水平及子宫下段中促肾上腺皮质激素释放激素受体-1(CRH-R1)的表达情况,分析其在分娩发动中的作用。方法按难免早产、足月分娩发动、足月分娩未发动分为3组,术前测定血清中CRH水平,于剖宫产中取子宫下段平滑肌,用免疫组化的方法检测CRH-R1在子宫下段的表达。结果3组间CRH水平差异无统计学意义(P>0.05),均为孕期较高水平。难免早产组、足月分娩发动组CRH-R1在子宫下段肌层中呈高表达状,其表达指数明显高于足月分娩未发动组(t值分别为5.000、6.295,均P<0.05)。难免早产组、足月分娩发动组CRHR1在子宫下段肌层中的表达差异无统计学意义(P>0.05)。结论 CRH为参与人类分娩启动因子之一。母体血浆CRH水平有望作为早产预测和预后指标,其作用的发挥还有赖于子宫体中CRH-R1的表达。

Objective To compare the level of serum corticotrophin-releasing hormone （CRH） and expression of corticotropin-releasing hormone receptor 1 （ CRH-R1 ） in lower uterine segment of pregnant women undergoing preterm and term birth cesarean section, and to analyze their role in laboronset. Methods Patients were divided into three groups according to inevitable premature birth, term labor onset and term labor without onset. Serum CRH level was tested before operation. In cesarean section myometrial samples were collected from the lower uterine segment to detect CRH-R1 expression with immunohistochemical method. Results CRH levels were not significantly different among three groups （ P 〉 0.05 ）, and they were at relatively high level during pregnancy. In the group of inevitable premature birth and the group of term labor onset CRH-R1 was highly expressed in the lower uterine segment muscle layer, and its expression index was obviously higher than that of the group of term labor without onset （t value was 5. 000 and 6. 295, respectively, both P 〈 0.05）. The expression of CRH-R1 in the lower uterine segment muscle layer was not significantly different between the group of inevitable premature birth and the group of term labor onset （P 〉 0.05）. Conclusion CRH is one of the initiators of labor onset. Maternal plasma level of CRH may be an index for premature forecast and prognosis, and the role of it depends on CRH-R1 expression in uterus.