Knapen M F, van der Wildt B, Sijtsma E G, Peters W H, Roelofs H M, Steegers E A
Department of Obstetrics and Gynecology, University Hospital St. Radboud, Nijmegen, Netherlands.
Early Hum Dev. 1999 Mar;54(2):129-35. doi: 10.1016/s0378-3782(98)00094-2.
Recent data suggest that levels of glutathione S-transferase Alpha 1-1 in umbilical cord plasma may be a good indicator of neonatal hepatocellular integrity. In order to fully understand the significance of this new marker we compared the values of glutathione S-transferase Alpha 1-1 (GSTA1-1) with that of the well known liver function markers alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in arterial and corresponding venous umbilical cord blood of 93 patients. In addition, in 49 of these patients maternal venous blood was also studied. Both arterial and venous umbilical cord GSTA1-1 and AST levels were significantly higher than corresponding maternal venous levels, whereas ALT levels were not. Arterial umbilical cord GSTA1-1 correlated significantly with the corresponding AST and ALT levels (R = 0.46, P < 0.0001 and R = 0.41, P < 0.0001, respectively). Arterial umbilical cord AST correlated significantly with corresponding ALT levels (R = 0.58, P < 0.0001). Arterial umbilical cord plasma GSTA1-1 levels were significantly lower in the cesarean delivery group as compared to the vaginal birth group, whereas no difference was noted for AST or ALT. Arterial umbilical cord AST and GSTA1-1 levels correlated significantly with base deficit (R = 0.29, P = 0.005; R = 0.29, P = 0.005, respectively), whereas ALT did not (R = 0.06, P = 0.54). Arterial umbilical cord AST, ALT, and GSTA1-1 levels correlated significantly with birthweight. In conclusion, GSTA1-1 levels as assessed in neonatal umbilical cord blood, being unrelated to maternal levels, seem to be a more sensitive marker for early neonatal hepatocellular integrity as compared to ALT or AST and even might detect impaired hepatocellular integrity due to the vaginal birth process. Umbilical cord GSTA1-1 may provide a valuable indicator of neonatal condition immediately after birth, the clinical relevance of which needs to be further established.
近期数据表明，脐血中谷胱甘肽S-转移酶α1-1的水平可能是新生儿肝细胞完整性的良好指标。为了全面了解这一新标志物的意义，我们比较了93例患者脐动脉血和相应脐静脉血中谷胱甘肽S-转移酶α1-1（GSTA1-1）的值与知名肝功能标志物丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）的值。此外，还对其中49例患者的母体静脉血进行了研究。脐动脉血和脐静脉血中的GSTA1-1及AST水平均显著高于相应的母体静脉血水平，而ALT水平则不然。脐动脉血GSTA1-1与相应的AST及ALT水平显著相关（分别为R = 0.46，P < 0.0001和R = 0.41，P < 0.0001）。脐动脉血AST与相应的ALT水平显著相关（R = 0.58，P < 0.0001）。与阴道分娩组相比，剖宫产组的脐动脉血浆GSTA1-1水平显著较低，而AST或ALT水平则无差异。脐动脉血AST和GSTA1-1水平与碱缺失显著相关（分别为R = 0.29，P = 0.005；R = 0.29，P = 0.005），而ALT则不然（R = 0.06，P = 0.54）。脐动脉血AST、ALT和GSTA1-1水平与出生体重显著相关。总之，新生儿脐血中评估的GSTA1-1水平与母体水平无关，与ALT或AST相比，似乎是早期新生儿肝细胞完整性更敏感的标志物，甚至可能检测到因阴道分娩过程导致的肝细胞完整性受损。脐血GSTA1-1可能为出生后即刻的新生儿状况提供有价值的指标，其临床相关性有待进一步确立。
