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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和亮啡肽水平犤(453±68),(242±33),(498±68)ng/L犦明显高于对照组犤(251±39),(103±22),(322±40)ng/L犦(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。
BACKGROUND: Endogenous opioid peptide is an important mediator and mediator, and participates in many physiological and pathological processes of the body. The relationship between endogenous opioid peptide and neonatal encephalopathy has drawn extensive attention. Objective: To investigate the relationship between endogenous opioid peptide and fetal distress. Design: Healthy pregnant women as the research object, case-control comparison observation. Unit: Second Military Medical University Changzheng Hospital obstetrics and Gynecology ward. PARTICIPANTS: Forty pregnant women (control group) and 43 healthy pregnant women with fetal distress (fetal distress group) were enrolled in this study. They were hospitalized in Changzheng and Changhai Hospital of Second Military Medical University and met the inclusion criteria. Methods: The levels of opioid peptide (β-endorphin, dynorphin A1-13 and leupeptin) in pregnant women and fetal distress group were determined by radioimmunoassay Umbilical artery blood gas analysis. MAIN OUTCOME MEASURES: The levels and correlations of endogenous opioid peptides in venous blood and umbilical cord blood of two groups of pregnant women. Results: The level of β-endorphin, dynorphin dynorphin A1-13 and leupeptin in neonatal fetal distress group were (453 ± 68), (242 ± 33) and (498 ± 68) ng / L 犦 was significantly higher than that of the control group (± 251 ± 39), (103 ± 22), (322 ± 40) ng / L 犦 (t = 2.713,2.762, P <0.01; t = 2.132, P <0.05). Umbilical arterial blood gas analysis: pH 7.0 ± 0.1, oxygen partial pressure (1.7 ± 0.6) kPa, partial pressure of carbon dioxide (8.9 ± 0.7) kPa; which β-endorphin levels and umbilical cord blood pH, oxygen partial pressure was (R = -0.418, -0.437, P <0.01), and positively correlated with partial pressure of carbon dioxide (r = 0.442, P <0.01) (R = -0.337, -0.383, P <0.05), and positively correlated with partial pressure of carbon dioxide (r = 0.346, P <0.05). There was no significant difference in plasma levels of three peptides between the two groups (P> 0.05). CONCLUSION: The involvement of endogenous opioid peptide in the pathological process of fetal embolism is closely related to the occurrence and development of fetal distress, and has the value of quantitative data for early rehabilitation after fetus birth.