妊娠期肝内胆汁淤积症对出生结局正常新生儿HPA轴及肾上腺皮质功能的影响
首发时间:2009-07-17
摘要:目的 探讨妊娠期肝内胆汁淤积症(ICP)对出生结局正常的新生儿下丘脑-垂体-肾上腺轴(HPA)及肾上腺皮质功能的影响。方法 通过问卷调查收集32名ICP孕产妇和32名对照产妇的一般人口统计学信息、本次妊娠孕期健康状况、既往分娩史、分娩前心理焦虑和抑郁状况、分娩时应激自我评价。在新生儿娩出后即刻收集脐静脉血,记录新生儿出生结局,并用放免法检测脐血中皮质醇(CORT)、促肾上腺皮质激素(ACTH)和硫酸脱氢表雄酮(DHEAS)。结果 ICP组孕产妇在产前的心理焦虑和抑郁得分显著高于正常对照组(Z=2.24,P<0.05;Z=2.75,P<0.01),而分娩时母亲应激自评两组差异无统计学意义。ICP组脐血中皮质醇和ACTH水平均显著低于对照组(t=3.69,P=<0.01;t=4.59,P=<0.01),而DHEAS显著高于对照组(t=3.77,P<0.01)。两组的CORT/ACTH比值差异无统计学意义,但ICP组DHEAS/ACTH比值显著高于对照组(t=4.71,P<0.01),CORT/DHEAS比值显著低于对照组(t=5.36,P<0.01)。ICP孕产妇的甘胆酸水平与脐血中的DHEAS水平有显著正相关(r=0.47,P<0.01)。结论 ICP母亲分娩的出生结局正常的新生儿在出生时,HPA轴对应激的反应性下降,肾上腺皮质分泌DHEAS亢进,皮质醇与DHEAS存在分离现象,肾上腺皮质胎儿带可能存在功能损伤。
关键词: 妊娠期肝内胆汁淤症 皮质醇 促肾上腺皮质激素 硫酸脱氢表雄酮 下丘脑-垂体-肾上腺轴
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Impact of intrahepatic cholestasis of pregnancy on the function of hypothalamic-pituitary-adrenocortical axis and adrenal cortex of neonate with normal birth outcome
Abstract:To investigate the impact of intrahepatic cholestasis of pregnancy(ICP) on the function of the hypothalamic-pituitary-adrenocortical axis and adrenal cortex of neonate with normal birth outcome. Methods Demographic characteristics, health status of pregnancy, delivery history, prenatal anxiety and depression, perceived stress during delivery, and neonatal birth outcome of 32 ICP women and 32 controls were collected through the interviews and medical charts. Cortisal, adrenocorticotropic hormon(ACTH), and dehydroepiandrosterone sulfate(DHEAS) of cord blood after delivery were detected by radioimmunity. Results The score of prenatal anxiety and depression were significantly higher in ICP pregnancy women than that of the control(Z=2.24,P<0.05;Z=2.75,P<0.01) while perceived stress during delivery had no significantly difference between the two groups. Cortisol and ACTH in cord blood of the neonate of ICP pregnant women were both significantly lower than control(t=3.69,P<0.01;t=4.59,P<0.01) and DHEAS was significantly higher than control(t=3.77,P<0.01). Ratio of CORT/ACTH in neonatal cord blood had no significantly difference between ICP pregnant women and control, but ratio of DHEAS/ACTH in ICP pregnant women was significantly higher than control(t=4.71,P<0.01) while the ratio of CORT/DHEAS was significantly lower than control(t=5.36,P<0.01). There was significantly positive correlation between glycocholic acid of ICP pregnant women and DHEAS in neonatal cord blood(r=0.47,P<0.01). Conclusions Diasocidtion pheaomend was observed in the neonate with normal birth outcome of ICP women, in that the responsiveness of HPA axis was decreased while the secretion of DHEAS by adrenal cortex was increased, which indicated that there might be dysfunction of the fetal zones of the adrenal cortex.
Keywords: Intrahepatic cholestasis of pregnancy Cortisol Adrenocorticotropic hormone Dehydroepiandrosterone sulfate Hypothalamic-pituitary-adrenocortical axis
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妊娠期肝内胆汁淤积症对出生结局正常新生儿HPA轴及肾上腺皮质功能的影响
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