胎盘促肾上腺皮质激素释放激素的作用与调控

胎盘分泌的大量下丘脑内分泌激素促肾上腺素皮质激素释放激素，是妊娠期母体血浆促肾上腺素皮质激素释放激素的主要来源。胎盘促肾上腺素皮质激素释放激素可能通过与前列腺素、催产素、皮质激素和雌激素等内分泌激素的相互作用，对分娩启动起着重要的作用。妊娠期母体血浆促肾上腺素皮质激素释放激素水平与早产及某些妊娠期疾病关系密切。胎盘促肾上腺素皮质激素释放激素的分泌受促肾上腺素皮质激素释放激素结合蛋白、环磷酸腺苷、糖皮质激素、催产素、孕激素、雌激素、前列腺素、一氧化氮和某些神经递质等多因素的调控。     

尿皮素与妊娠的研究进展

尿皮素是新近发现的促肾上腺皮质激素释放激素肽类家族的一员 ,人类胎盘及其他妊娠附属物均可合成 ,具有扩张胎盘局部血管和增强子宫收缩力等作用。其在妊娠和分娩中起着重要作用 ,妊娠期母体血浆尿皮素与一些妊娠期疾病关系密切     

尿皮素与妊娠的研究进展

尿皮素是新近发现的促肾上腺皮质激素释放激素肽类家族的一员，人类胎盘及其他妊娠附属物均可合成，具有扩张胎盘局部血管和增强子宫收缩力等作用。其在妊娠和分娩中起着重要作用，妊娠期母体血浆尿皮素与一些妊娠期疾病关系密切。     

直接测定子宫内膜功能的生化检验:月经期间测定血清中子宫内膜分泌的主要蛋白PP14与排卵和黄体功能的关系

人类子宫受促性腺甾类激素的刺激会合成并分泌应答物质。除泌乳索和前列腺素外,还有两种子宫内膜分泌蛋白,其含量占妊娠期子宫内膜分泌蛋白的40%以上,分别命名为胎盘蛋白12(PP12)和胎盘蛋白14(PP14)。整个妊娠期羊水,胎儿和母体血清及其组织中均有PP14,有证据表明PP14仅来源于妊娠期子宫内膜的腺上皮,在排卵妇女的分泌晚期和经期观察到PP14浓度升高,在妊娠的前3个月浓度最高。本文旨在确定血清PP14水平与月经、排卵和黄体功能的关系。     

肾上腺激素的检测和临床应用

肾上腺激素可分为肾上腺皮质激素和肾上腺髓质激素。虽然肾上腺皮质分泌有糖皮质激素、盐皮质激素、孕激素、雄激素、雌激素等五大类 ,但肾上腺皮质激素通常指糖皮质激素和盐皮质激素 ,前者以皮质醇为代表 ,后者以醛固酮为代表。肾上腺髓质分泌的肾上腺素、去甲肾上腺素、多巴胺等统称为儿茶酚胺。虽然肾上腺能神经元和肾上腺外嗜铬体亦合成、分泌儿茶酚胺类激素 ,但通常亦以测定儿茶酚胺及其代谢产物以判定肾上腺髓质的功能。1　肾上腺皮质功能检查肾上腺皮质分泌糖皮质激素的机能受下丘脑—垂体系统的调节 ,下丘脑分泌促肾上腺皮质激素释…     

激活素A和抑制素A与复发性自然流产妊娠预后的相关性研究

复发性自然流产是临床常见疾病之一,其发生的原因复杂,如染色体异常、子宫畸形、胎盘功能不足、环境因素、母体感染等,个体差异较大.近年来一些研究发现妊娠妇女血浆激活素A水平高于非妊娠期.妊娠期激活素A主要来源于胎盘滋养层细胞,人类激活素A亚单位和激活素A受体、激活素A可能在早孕期子宫内膜蜕膜化、胚胎植入、滋养细胞种植、分化中起一定调节作用[1,2],并以旁分泌或自分泌方式参与胎盘局部调节轴中各种激素之间的生殖内分泌调节,从而影响妊娠的发展.     

多囊卵巢综合征与神经内分泌功能异常

多囊卵巢综合征是育龄妇女最常见的妇科内分泌疾病之一,是引起无排卵性不孕的主要原因,其内分泌异常表现为黄体生成素(促性腺激素释放激素)脉冲波持续快速升高,黄体生成素/重组绒促卵泡激素的比例失调,重组绒促卵泡激素水平下降,卵泡形成受损及高雄激素产生.通过增强下丘脑对黄体酮的敏感性,可以抑制黄体生成素持续快速升高,体内过多的雄激素分泌却减弱了下丘脑对黄体酮的敏感性,进而削弱了黄体酮对促性腺激素释放激素的减速调节,加速黄体生成素(促性腺激素释放激素)脉冲波持续升高.促性腺素分泌的异常、高雄激素的产生和卵巢功能障碍都可能是多囊卵巢综合征内分泌功能异常的重要原因.     

病因各异闭经病

正常月经来潮需依赖丘脑下部—脑垂体—卵巢功能的协调,和子宫内膜对性激素的周期性反应。简单点说,妇女的丘脑下部能分泌促性腺激素的释放激素,促使脑垂体分泌促卵泡成熟激素与黄体生成激素。在这两种激素协同作用下,使卵巢分泌雌激素、孕激素,然后排卵。雌激素与孕激素作用于子宫内膜,并使其发生周期     

妊娠糖尿病、老年糖尿病 特殊人群糖尿病预防措施

妊娠期糖尿病：暂时糖尿病 妊娠本身就是一个糖尿病的致病因子，妊娠期胎盘激素与母体的内分泌激素同时作用，使得孕妇体内胰岛素降解加速。此时，如果体内胰岛素分泌不能增加，同时又因怀孕摄入过多营养，就有可能发生妊娠期糖尿病。患有妊娠期糖尿病的孕妇，多数在分娩后血糖就会恢复正常，但也有30％的糖尿病孕妇患者在孕后5～10年，转为2型糖尿病。     

胎儿肾上腺系统在分娩发动中的作用研究进展

妊娠晚期胎儿肾上腺系统发育成熟后,胎儿肾上腺大量分泌脱氢表雄酮硫酸脂和皮质醇,在促进自身成熟的同时,引发了胎盘内分泌的一系列变化,如雌激素的生成、胎盘促肾上腺皮质激素释放激素的分泌等等;同时,胎儿来源的糖皮质激素与分娩发动本身也有着直接的联系;而且胎儿肾上腺成熟后,糖皮质激素分泌的不断增加在分娩发动撤退理论及前列腺素生成过程中也扮演了重要的角色.这些反应很有可能是诱发分娩的关键因素,因此,胎儿肾上腺系统的发育成熟参与了分娩发动的各个环节,与分娩发动关系密切.研究分娩发动的决定因素时于预测分娩启动的时间,降低孕产妇分娩风险,提高新生儿存活能力有重要意义.该文就胎儿肾上腺系统与分娩发动关系的研究现状作以综述.     

Maternal experiences of racism and violence as predictors of preterm birth: rationale and study design

Chronic psychological stress may raise the risk of preterm delivery by raising levels of placental corticotropin-releasing hormone (CRH). Women who have been the targets of racism or personal violence may be at particularly high risk of preterm delivery. The aims of this study are to examine the extent to which: (1) maternal experiences of racism or violence in childhood, adulthood, or pregnancy are associated with the risk of preterm birth; (2) CRH levels are prospectively associated with risk of preterm birth; and (3) CRH levels are associated with past and current maternal experiences of racism or violence. We have begun to examine these questions among women enrolled in Project Viva, a Boston-based longitudinal study of 6000 pregnant women and their children.     

妊娠期糖尿病患者硒水平的变化

目的:探讨硒与妊娠期糖尿病(GDM)的关系。方法:测定30例妊娠期糖尿病患者(GDM组)和30例正常妊娠者(对照组)血硒及胎盘硒含量。结果:①GDM组孕妇血硒及胎盘硒含量分别为(0.0620±0.0224)mg/L、(0.4854±0.0857)mg/kg,明显低于对照组的(0.0783±0.0209)mg/L、(0.5473±0.0842)mg/kg,差异有统计学意义(P<0.01)。②GDM组孕妇血硒与胎盘硒含量成显著正相关(r=0.639,P<0.001),对照组血硒与胎盘硒含量无明显相关。结论:妊娠期糖尿病患者硒缺乏可能与妊娠期糖尿病的发生有关。     

子痫前期患者血清及胎盘促肾上腺皮质激素释放激素水平的变化及意义

目的:了解子痫前期患者血清和胎盘组织促肾上腺皮质激素释放激素(CRH)的变化及其意义。方法:采用ELISA测定36例子痫前期患者(子痫前期组)和39例正常孕妇(对照组)血清和胎盘血清CRH浓度组织蛋白提取液中CRH浓度,并进行组间比较。结果:子痫前期患者血清CRH浓度为(5.661±2.895 0)pmol/L,与正常妊娠时血清CRH浓度(8.753 9±2.741 0)pmol/L比较呈显著下降(P<0.001),子痫前期患者胎盘组织中CRH相对浓度为(0.314 8±0.083 65)pmol/g蛋白与正常妊娠时(0.317 8±0.110 0)pmol/g蛋白比较则没有显著性差异(P>0.05)。结论:子痫前期患者血清CRH显著降低,是子痫前期的一个重要病理生理变化,可能与疾病的的发生、发展有关。     

血浆促肾上腺皮质激素释放激素与妊娠期疾病关系的临床研究

目的:探讨治疗早产药物,早产、贫血、肝功能损害及妊娠期胆汁淤积症对妊娠期血浆促肾上腺皮质激素释放激素(CRH)水平的影响。方法:以放射免疫方法测定正常妊娠以及早产等妊娠期疾病时母体CRH水平的变化。结果:各孕周早产孕妇血浆CRH较正常对照孕妇显著升高(P<0.05)。经有效药物治疗后,血浆CRH明显回落。贫血、肝功能损害及足月妊娠合并胆汁淤积症可使血浆CRH水平升高(P<0.05)。孕37周前妊娠合并胆汁淤积症对血浆CRH水平无影响(P>0.05)。结论:妊娠期血浆CRH水平与早产关系密切,有可能成为预测早产的有效指标。以血浆CRH水平预测早产时,应注意排除贫血及肝功能损害的影响。     

Non‐stress‐related factors associated with maternal corticotrophin‐releasing hormone (CRH) concentration

Kramer MS, Lydon J, Séguin L, Goulet L, Kahn SR, McNamara H, Genest J, Sharma S, Meaney MJ, Libman M, Dahhou M, Platt RW. Non‐stress‐related factors associated with maternal corticotrophin‐releasing hormone (CRH) concentration. Paediatric and Perinatal Epidemiology 2010. During pregnancy, most maternal corticotrophin‐releasing hormone (CRH) is secreted by the placenta, not the hypothalamus. Second trimester maternal CRH concentration is robustly associated with the subsequent risk of preterm birth, and it is often assumed that physiological and/or psychological stress stimulates placental CRH release. Evidence supporting the latter assumption is weak, however, and other factors affecting maternal CRH have received little attention from investigators. We carried out a case–control study nested within a large, multicentre prospective cohort of pregnant women to examine potential ‘upstream’ factors associated with maternal CRH concentration measured at 24–26 weeks of gestation. The predictors studied included maternal age, parity, birthplace (as a proxy for ethnic origin), pre‐pregnancy body mass index, height, smoking, bacterial vaginosis and vaginal fetal fibronectin (FFN) concentration. Women with high (above the median) plasma CRH concentration were significantly less likely to have been born in Sub‐Saharan Africa or the Caribbean, less likely to be overweight or obese, and more likely to be smokers. Associations with maternal birthplace and BMI persisted in logistic regression analyses controlling for potential confounding variables and when restricted to term controls. A strong (but imprecise and statistically non‐significant) association was also observed with high vaginal FFN concentration. Further studies are indicated both in animal models and human populations to better understand the biochemical and physiological pathways to CRH secretion and their aetiological role, if any, in preterm birth.     

分娩机制研究新进展

近年来有研究表明,孕激素"局部"或"功能"撤退,促肾上腺皮质激素释放激素及受体,催产素及其受体的变化与分娩发动有关.细胞因子和粘附分子在分娩的作用被逐渐认识并加以深入研究,并参与宫颈扩张机制.     

妊娠期血浆CRH与早产、贫血和肝功损害的临床研究

目的　探讨正常妊娠和早产、贫血、肝功能损害时血浆促肾上腺皮质激素释放激素 (corti cotropin releasinghormone ,CRH)的水平以及早产治疗前后CRH水平的变化。方法　以放射免疫方法测定正常妊娠以及早产等妊娠期疾病时母体血浆CRH水平的变化。结果　早产孕妇各孕周血浆CRH较正常对照孕妇明显升高 (P <0 .0 5 )。经有效药物治疗后 ,血浆CRH明显回落。妊娠期贫血、肝功能损害可使血浆CRH升高 (P <0 .0 5 )。结论　妊娠期血浆CRH水平与早产关系密切 ,有可能成为预测早产的有效指标。以血浆CRH水平预测早产时 ,应注意排除贫血及肝功能损害的影响     

胎盘早剥经阴道分娩临床病例探讨

目的:探讨胎盘早剥经阴道分娩的处理方法及观察指标,以期减少胎盘早剥对母体的损伤,为患者再次妊娠提供有利条件。方法:回顾性分析105例2007年7月～2010年3月在北京妇产医院产科经阴道分娩的胎盘早剥患者的临床资料。结果:新生儿轻度窒息5例,重度窒息6例,死胎15例(4例为双胎),死产3例(2例为放弃胎儿,1例孕27周);产后出血6例,DIC 2例,肺水肿1例,无孕产妇死亡。产程时间及孕产妇结局与胎盘早剥类型间无统计学相关性。胎盘早剥的不同类型与发病孕周间有统计学相关性,轻型早剥多发生于孕足月(≥37周),重型早剥以早产偏多(28～37周)。胎盘早剥发病孕周与围产儿预后间有统计学相关性。结论:胎盘早剥经阴道分娩,母婴预后与结束分娩的时间无关,而在于产程的严密监护。胎盘早剥患者选择阴道分娩时,应综合考虑孕龄、出血、凝血功能、胎儿宫内状况等。     

Embryo-derived platelet activating factor: interactions with the arachidonic acid cascade and the establishment and maintenance of pregnancy

Two classes of potent lipid mediators are produced by the mouse and human pre-embryo: platelet activating factor (PAF) and prostaglandins (PGs). This paper reviews the evidence for their production by the pre-embryo and for their role in embryo development and the successful establishment of pregnancy. The biosynthesis of PAF and arachidonic acid may be linked, the synthesis of PAF resulting in the generation of arachidonic acid with its subsequent conversion to prostaglandins. Pharmacological inhibitor studies show that a major site of action of PAF is the embryo itself, acting as an embryonic autocrine growth factor, whereas PGs appear to act primarily on maternal tissues although they do modulate some aspects of early embryo metabolism. It is the maternal tissues that are the primary source of PG production in early pregnancy. Maternal PGs have a variety of functions including involvement in the proinflammatory response of early pregnancy and the control of corpus luteum function. In the ewe, pregnancy is associated with an attenuation of oxytocin-induced production of the luteolysin, prostaglandin F2 alpha (PGF2 alpha). PAF can mimic the effect of pregnancy, preventing the release of PGF2 alpha in response to exogenous oxytocin and, when administered into the uterine lumen, extending the life span of the corpus luteum. Thus, embryo-derived PAF appears to have an essential role in the establishment of pregnancy by acting as an autocrine growth factor for the embryo and by exerting a variety of effects on maternal physiology, including modulating maternal prostaglandin secretion and action.