妊娠肝内胆汁淤积症患者血浆尿皮素水平下降的临床意义  

Decreased Maternal Plasma Urocortin Level in Intrahepatic Cholestasis of Pregnancy

作　　者：张丽[1,2] 孙琴[1] 王晓东[1] 周凡[1] 高冰心[1] 

机构地区：[1]四川大学华西第二医院妇产科出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [2]中国医学科学院中国协和医科大学北京协和医院妇产科

出　　处：《四川大学学报（医学版）》2015年第2期263-266,共4页Journal of Sichuan University(Medical Sciences)

基　　金：四川省科技厅科技支撑计划项目(No.2009SZ0016)资助

摘　　要：目的观察妊娠肝内胆汁淤积症（ICP）患者孕34~37周血浆尿皮素（UCN）水平及其胎盘受体促肾上腺皮质激素释放激素受体-2（CRHR-2）表达,探讨ICP患者血浆UCN水平下降的临床意义。方法纳入正常妊娠妇女及ICP患者各20例。通过酶联免疫法（ELISA）测定ICP组与正常对照组不同孕周（34、35、36、37周）血浆UCN水平,并采用免疫组织化学技术观察其胎盘组织UCN受体CRHR-2表达情况。结果正常妊娠组孕34周〔（79.47±11.35）pg/mL）〕、35周〔（83.00±12.67）pg/mL〕、36周〔（80.28±11.48）pg/mL〕、37周〔（84.24±13.62）pg/mL〕血浆UCN水平随孕周增加升高趋势不明显（F=0.67,P〉0.05）;与正常妊娠比较,ICP患者孕34周〔（68.53±16.95）pg/mL,t=2.40,P〉0.05〕、35周〔（64.19±22.50）pg/mL,t=3.26,P=0.05〕、36周〔（50.06±13.98）pg/mL,t=7.47,P=0.05〕、37周〔（47.91±15.65）pg/mL,t=7.83,P=0.05〕血浆UCN水平随孕周增加呈下降趋势（F=6.78,P=0.05）,尤其是35周后明显下降,且明显低于正常水平。胎盘组织绒毛合体滋养层细胞、绒毛血管内皮细胞胞浆内均有CRHR-2表达;ICP胎盘组织CRHR-2表达IOD值（111.83±35.02）与正常妊娠（101.09±27.21）无明显差异（t=0.29,P〉0.05）。结论 ICP胎盘-胎儿单位神经应激肽UCN表达下降可能与其不良妊娠结局相关。Objective To measure the plasma level of urocortin and the placenta expression of its receptor corticotropin-releasing hormone receptor（CRHR）-2in the patients with intrahepatic cholestasis of pregnancy（ICP）.Methods This study enrolled 20 patients with ICP and 20 normal pregnant women（control group）.The plasma level of urocortin at different gestational age（34-37weeks）was measured by enzyme-linked immunosorbent assay（ELISA）,and the placenta expression of CRHR-2 was investigated by immunohistochemical technique.Results The plasma urocortin levels at different gestational age in normal pregnany were（79.47±11.35）pg/mL at34 weeks,（83.00±12.67）pg/mL at 35 weeks,（80.28±11.48）pg/mL at 36 weeks,and（84.24±13.62）pg/mL at 37 weeks,respectively.No upward tendency was observed along with the increase of gestational age（F=0.67,P〉0.05）.Compared with normal pregnany,ICP patients had novel down trend of the plasma urocortin levels（F=6.78,P〈0.05）,which were（68.53±16.95）pg/mL at 34 weeks,（64.19±22.50）pg/mL at 35 weeks,（50.06±13.98）pg/mL at 36 weeks,（47.91±15.65）pg/mL at 37 weeks,CRHR-2staining was found in syncytiotrophoblast and feto-placental vascular endothelium cells of placenta,and there was no statistical differences found for integral optical density value of CRHR-2staining between control（101.09±27.21）and ICP（111.83±35.02）groups（P〉0.05）.Conclusion The urocortin-mediated stress compensation insufficiency may be involved in the fetal outcomes in ICP.

关 键 词：胆汁淤积症 肝内 胎儿 缺氧 尿皮素 促肾上腺皮质激素释放激素受体 

分 类 号：R714.25[医药卫生—妇产科学]