摘要
用血滤片测量17-羟孕酮(17-OHP)含量的方法广泛用于先天性肾上腺增生症(CAH)的筛查。如果在妊娠中有早产的可能,则在胎儿出生前用类固醇治疗来促进肺部成熟,但这样会抑制胎儿肾上腺,还会影响对这种先天性肾上腺增生症的筛查。笔者对160名胎龄为25-35周新生儿,在其生后72-96 h,用血滤片法测量其17-OHP,将其中50名出生前没有接受类固醇治疗的新生儿与110名出生前接受类固醇治疗者进行比较。1个疗程的类固醇疗法是:地塞米松12 mg,间隔24 h 静脉注射2次。其中30例接受了半个疗程治疗。
Measurement of 17 - hydroxyprogesterone (17-OHP) from filter- paper blood is widely used to screen for congenital adrenal hyperplasia (CAH) . However, in pregnancies with an expected preterm delivery, prenatal treatment with steroids to induce pulmonary maturation could suppress the fetal adrenals and interfere with this screening. In 160 infants who were born between 25 and 35 wk of gestation, we measured 17 - OHP in filter-paper blood at 72 - 96 h and compared the values between those who had not received antenatal steroids (n = 50) and those who had (n = 110). A single course of steroids was two 12 -mg injections of betamethasone given within a 24 - h interval: 30 infants received a half single course, 45 received a full single course, and 35 receivedmultiple courses. Results are expressed as medians (25th per-centile; 75th percentile). Blood 17-OHP diifered significantly among groups: 23. 7 (14. 2; 30. 7) nmol/L, 26. 1 (15.0; 50.1) nmol/L, 20.1 (13.8; 29.1) nmol/L, and 14. 9 (9. 5; 26. 2) nmol/L (for, respectively, no steroid, half a single course, a full single course, and multiple courses; p < 0. 05, multiple comparisons with the Kruskal-Wallis test) . However, only infants who were treated with multiple antenatal courses of steroids had lower blood 17 - OHP than those who were untreated (p < 0. 05 with the Mann-Whitney U test) . In multiple regression analysis, steroid treatment and intrauterine growth retardation were significant negative predictors of blood 17-OHP, whereas respiratory distress syndrome was a significant positive predictor (multiple R = 0. 50, p < 0. 001). Multiple courses of steroids in preterm infants decrease 17-OHP values by -30% in filter-paper blood, thus raising the risk of falsenegative results in screening programs for CAH.
