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目的 探讨胎儿生长受限 (FGR)产妇血清及脐血胎盘生乳素 (HPL)的变化及其与胎盘损害的关系。方法 对 2 0 0 3年 1月至 2 0 0 4年 6月在汕大医学院第二附属医院妇产科分娩的 32例晚期妊娠FGR患者 (FGR组 )和 32例正常晚期妊娠产妇 (对照组 )采用化学发光法 (CLIA)检测血清及脐血HPL水平 ,并对两组产后胎盘胎膜组织进行病理学检查。结果 (1)FGR组产妇血清HPL水平 (2 76± 0 6 2 )mg/L显著低于对照组 (4 4 9±0 6 9)mg/L(P <0 0 1) ;FGR组脐血HPL水平 (2 98± 0 5 8)mg/L显著低于对照组脐血HPL水平 (4 78± 0 70 )mg/L(P <0 0 1)。 (2 )FGR组母血及脐血胎盘生乳素水平与新生儿体重呈显著正相关关系 (r =0 5 6 7及r =0 6 92 ,P <0 0 1)。 (3)FGR组中 2 1例有胎盘病理改变 (占 6 5 6 3% ) ,对照组中 6例有胎盘病理改变 (占18 75 % ) ,两组比较差异有显著性意义 (P <0 0 1)。 (4)FGR组胎盘有明显病理改变者母血及脐血HPL水平显著低于无病理改变者 (P <0 0 1)。结论 FGR时胎盘发生明显病理变化。胎盘损害可能导致母血及脐血中HPL水平降低 ,从而使胎儿生长发育不良。
Objective To investigate the changes of placental lactoprotein (HPL) and fetal placental damage in fetal growth restriction (FGR) maternal serum. Methods From January 2003 to June 2004, 32 cases of late-pregnancy FGR patients (FGR group) and 32 normal pregnant women of the third trimester (control group) were delivered at the Department of Obstetrics and Gynecology, Second Affiliated Hospital of Shantou University Medical College Group), serum and umbilical cord blood HPL levels were detected by chemiluminescence (CLIA), and pathological examination was performed on the fetal membranes of the two groups. Results (1) Serum HPL level in FGR group was significantly lower than that in control group (76 ± 106) mg / L (449 ± 0 6 9) mg / L (P <0.01) HPL level (2 98 ± 0 58) mg / L was significantly lower than that of control group (4 78 ± 0 70) mg / L (P 0 01). (2) There was a significant positive correlation between the level of lactogen in maternal blood and cord blood of FGR group and the weight of newborn (r = 0 567 and r = 0 6 92, P 0 01). (3) There were 21 cases of placenta pathological changes (6 5 6 3%) in FGR group and 6 cases of placenta pathological changes (18 75%) in control group, there was significant difference between the two groups (P <0 0 1). (4) There was a significant pathological change in placenta of FGR group, and the level of HPL in maternal blood and cord blood was significantly lower than those without pathological changes (P <0.01). Conclusions The pathological changes of placenta occurred during FGR. Placental damage may lead to lower levels of HPL in maternal blood and umbilical cord blood resulting in poor fetal growth.