抑制素A和激活素A与胎儿生长受限的关系

Levels of Inhibin A and Activin A in Gravida with Fetal Growth Restriction

目的:探讨抑制素A、激活素A在胎儿生长受限(FGR)发病中的作用。方法:选择2008年10月—2009年12月在苏州大学附属第一医院分娩的产妇46例,其中分娩FGR新生儿者23例(FGR组),同期住院分娩正常出生体质量新生儿者23例(对照组)。用酶联免疫吸附法测定母血及脐血抑制素A、激活素A的水平。对2组胎盘组织进行HE染色;用免疫组织化学法分析胎盘组织抑制素α、βA亚基表达部位及水平。结果:FGR组孕妇血清及脐血抑制素A、激活素A水平均高于正常对照组(P<0.05);所有孕妇血清抑制素A、激活素A均与新生儿出生体质量、皮下脂肪厚度呈负相关(均P<0.05)。FGR组胎盘绒毛发育欠佳,绒毛血管扩张不良;抑制素α、βA亚基表达较正常对照组高(均P<0.05)。母儿血清抑制素A、激活素A之间均无相关性。胎盘组织抑制素α、βA亚基分别与孕妇血清抑制素A、激活素A水平呈正相关(均P<0.05)。孕妇血清抑制素A、激活素A的ROC曲线下面积分别为0.862和0.782。结论:抑制素A、激活素A在胎儿宫内生长发育过程中起重要的调节作用,可通过检测母血抑制素A、激活素A来间接评价胎儿生长发育或胎盘功能状态。

Objective： To analyze the levels of inhibin A and activin A in maternal blood and cord blood of pregnant women with fetal growth restriction （FGR）, so as to evaluate the effects of two factors on fetal development. Methods：Maternal antepartum blood, umbilical vein blood and placenta were collected from forty- six pregnant women in obstetrical department of our hospital, including 23 FGR cases and 23 normal pregnancy cases. Serous levels of inhibin A and activin A were measured using ELISA. HE stain was performed on the placental tissue sections. Expressions of inhibin and activin subunit-α, --βA were analyzed by immunohistochemistry. Results：Serous levels of inhibin A and activin A in maternal blood and umbilical blood of the FGR group were significantly higher than those in the control group （P〈0.05）. The levels of inhibin A and activin A were negatively correlated with the birth weight and subcutaneous fat thickness （P〈0.05）. Inhibin/ activin subunit--α, --βA were mainly expressed in syneytiotrophoblast, while expressions of two subunits in the FGR group were significantly higher than those in the control group （P〈0.05）. There were not relationships in levels of inhibin A and activin A between fetal blood and maternal blood. Expressions of inhibin/activin--α, --βA subunits were positively correlated with maternal levels （P〈0.05）. Area under ROC curve of inhibin A was 0.862,and area under ROC curve of activin A was 0.782. Conclusions：Inhibin A and activin A play important roles in adjusting fetus growth and placenta development. The maternal serum levels of inhibin A and activin A can be used as clinical references to evaluate fetal growth and nlacental function.