CAJ | 학술논문

背景:内源性阿片肽是一类重要的介质与调质,参与机体多种生理和病理过程,其与新生儿脑病的关系受到广泛关注.目的:探讨内源性阿片肽与胎儿窘迫发生的关系.设计:以健康孕妇为研究对象,病例-对照的对比观察.单位:解放军第二军医大学长征医院妇产科病房.对象:选择在第二军医大学长征及长海医院住院分娩并符合纳入标准的正常妊娠健康孕妇40例(对照组)及发生胎儿窘迫的健康孕妇43例(胎儿窘迫组).方法:采用放射免疫法测定40例对照组孕妇及胎儿窘迫组孕妇静脉血及其新生儿脐血中阿片肽(β-内啡肽、强啡肽A1-13和亮啡肽)的水平,同时行脐动脉血血气分析.主要观察指标:两组孕妇静脉血及脐血中内源性阿片肽的水平及相关性.结果:胎儿窘迫组新生儿脐血中β-内啡肽、强啡肽强啡肽A1-13和亮啡肽水平[(453±68),(242±33),(498±68)ng/L]明显高于对照组[(251±39),(103±22),(322±40)ng/L](t=2.713,2.762,P＜0.01;t=2.132,P＜0.05).脐动脉血血气分析:pH为7.0±0.1,氧分压为(1.7±0.6)kPa,二氧化碳分压为(8.9±0.7)kPa;其中β-内啡肽水平与脐血pH,氧分压呈显著负相关(r=-0.418,-0.437,P＜0.01),与二氧化碳分压呈显著正相关(r=0.442,P＜0.01);强啡肽A1-13水平与脐血pH及氧分压呈负相关(r=-0.337,-0.383,P＜0.05),与二氧化碳分压呈显著正相关(r=0.346,P＜0.05).两组血浆中3种肽水平比较,差异无显著性意义(P＞0.05).结论:内源性阿片肽参与了胎窘的病理过程与胎儿窘迫的发生发展密切相关,对胎儿出生后早期康复干预具有量化数据参考价值.
배경:내원성아편태시일류중요적개질여조질,삼여궤체다충생리화병리과정,기여신생인뇌병적관계수도엄범관주.목적:탐토내원성아편태여태인군박발생적관계.설계:이건강잉부위연구대상,병례-대조적대비관찰.단위:해방군제이군의대학장정의원부산과병방.대상:선택재제이군의대학장정급장해의원주원분면병부합납입표준적정상임신건강잉부40례(대조조)급발생태인군박적건강잉부43례(태인군박조).방법:채용방사면역법측정40례대조조잉부급태인군박조잉부정맥혈급기신생인제혈중아편태(β-내배태、강배태A1-13화량배태)적수평,동시행제동맥혈혈기분석.주요관찰지표:량조잉부정맥혈급제혈중내원성아편태적수평급상관성.결과:태인군박조신생인제혈중β-내배태、강배태강배태A1-13화량배태수평[(453±68),(242±33),(498±68)ng/L]명현고우대조조[(251±39),(103±22),(322±40)ng/L](t=2.713,2.762,P＜0.01;t=2.132,P＜0.05).제동맥혈혈기분석:pH위7.0±0.1,양분압위(1.7±0.6)kPa,이양화탄분압위(8.9±0.7)kPa;기중β-내배태수평여제혈pH,양분압정현저부상관(r=-0.418,-0.437,P＜0.01),여이양화탄분압정현저정상관(r=0.442,P＜0.01);강배태A1-13수평여제혈pH급양분압정부상관(r=-0.337,-0.383,P＜0.05),여이양화탄분압정현저정상관(r=0.346,P＜0.05).량조혈장중3충태수평비교,차이무현저성의의(P＞0.05).결론:내원성아편태삼여료태군적병리과정여태인군박적발생발전밀절상관,대태인출생후조기강복간예구유양화수거삼고개치.
BACKGROUND: Endogenous opioid peptide is an important medium and regulator that participate in many physical and pathologic processes of the body. Its relationship with fetal encephalopathy has attracted much attraction.OBJECTIVE: To evaluate the role of endogenous opioid peptides (EOP) in fetal distress.DESIGN: A case-control observatory study based on healthy pregnant women.SETTING: Wards of the Department of Obstetrics and Gynecology of Changzheng Hospital Affiliated to Second Military Medical University of Chinese PLA.PARTICIPANTS: Eighty-three healthy women who were hospitalised in Changzheng Hospital and Changhai Hospital affiliated to the Second Military Medical University of Chinese PLA and met the inclusion criteria. Among them, 40 were normal healthy pregnant women(the control group) and 43 were healthy pregnant women with fetal distress(the fetal distress group).METHODS: Radioimmunoassay was used to measure the levels of blood EOP(β-endorphin, dynorphin A1- 13 and leu-enkephalin) of the venous blood of the pregnant women in fetal distress group and the control group and the EOP level in the umbilical blood of the newborns. Also, blood gas analysis of the blood from the umbilical artery was conducted.MAIN OUTCOME MEASURES: The levels of EOP in the venous blood of two groups of pregnant women and the umbilical blood of newborns and the correlation of EOP level with fetal distress.RESULTS: The levels of the umbilical artery blood EOP(β-endorphin,dynorphin A1-13 and leu-enkephalin) in the fetal distress group[(453± 68 ) ng/L, (242 ± 33)ng/L, and(498 ± 68)ng/L respectively] were significantly higher than those in the control group[ (251 ± 39) ng/L, (103± 22 )ng / L and(322 ± 40 )ng / L respectively ( t = 2. 713,2. 762, P＜ 0.01; t = 2. 132, P ＜ 0.05 ) ]. The umbilical artery blood gas analysis;pH was (7.0 ± 0. 1 ) , PO2 was ( 1.7 ± 0.6) kPa, PCO2 was (8.9 ± 0. 7) kPa.The levels of β-endorphin were negatively correlated with pH and PO2 of the umbilical artery blood(r= -0.418 and -0.437, P ＜ 0.01), but they were positively correlated with PCO2( r = 0. 442, P ＜ 0. 05) . The level of dynorphin A1-13 was negatively correlated with pH and PO2( r = -0. 337,-0.383, P ＜ 0.05), but it was positively correlated with PCO2(r= 0. 346, P ＜ 0. 05). There was no significant difference among the three kinds of blood EOP of the two groups( P ＞ 0.05).CONCLUSION: EOP participates in the pathological progress of the fetal distress and was closely correlated with the occurrence and development of the fetal distress. This finding has a reference value for early rehabilitation and intervention after the fetal was born that can be tested quantitatively.