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目的:探讨应激及其应对方式与早产和胎儿脐血硫化去氢表雄酮(DHEAs)含量的相关性。方法:研究对象来源于2003年6月至2005年3月在镇江第四人民医院产科分娩的单胎初产妇,早产组46例,正常产对照组42例;采用生活事件量表(LES)及防御方式量表(DSQ)在孕第28周时进行自我评定,以各因子分值作为观察数据;两组脐血DHEAs含量采用ELISA方法检测。结果:早产组恶性生活事件频度和强度均高于对照组(早产组频度1.2±0.7,强度56.2±4.0;对照组频度1.0±0.0,强度44.4±1.1,t=1.49、2.96,P<0.01),早产组不成熟型防御方式得分(4.2±0.1)高于对照组(3.6±0.1,t=4.13,P<0.01)、中间型防御方式也高于对照(早产组3.9±0.1,对照组3.6±0.1,t=2.03,P<0.05),DHEAs含量亦然(早产组0.72±0.02,对照组0.33±0.03,t=2.26,P=0.03)。早产因子、负性事件强度分值与脐血DHEAs含量呈正相关,偏回归系数分别为0.35和0.62,t值分别为2.20和4.49,P<0.05。结论:心理应激及其应对方式与早产的发生相关,早产脐血DHEA的较高含量可能是心理应激与早产发生的病理生理中介途径之一。
Objective: To investigate the correlation between stress and coping style and the content of DHEAs in preterm and fetus. Methods: The subjects were from single-fetus delivery in obstetric department of Zhenjiang Fourth People’s Hospital from June 2003 to March 2005, 46 cases of preterm labor group and 42 cases of normal control group. Life events scale (LES) and DSQ was self-assessed at the 28th week of pregnancy, and the scores of each factor were used as the observation data. The DHEAs levels of cord blood were detected by ELISA. Results: The frequency and intensity of malignant life events in preterm group were higher than those in control group (preterm birth frequency 1.2 ± 0.7, intensity 56.2 ± 4.0; control frequency 1.0 ± 0.0, intensity 44.4 ± 1.1, t = 1.49, 2.96, P (P <0.01). The score of immature defense in preterm group was higher (4.2 ± 0.1) than in control group (3.6 ± 0.1, t = 4.13, P <0.01) The control group was 3.6 ± 0.1, t = 2.03, P <0.05). The DHEAs content was also the same (preterm group 0.72 ± 0.02, control group 0.33 ± 0.03, t = 2.26, P = 0.03). Preterm birth factors, negative event intensity scores and cord blood DHEAs content was positively correlated partial regression coefficients were 0.35 and 0.62, t values were 2.20 and 4.49, P <0.05. Conclusion: The psychological stress and its coping style are related to the occurrence of prematurity. The higher content of DHEA in premature umbilical cord blood may be one of the pathophysiological intermediates of psychological stress and premature labor.