Coleman M A, France J T, Schellenberg J C, Ananiev V, Townend K, Keelan J A, Groome N P, McCowan L M
Department of Obstetrics and Gynaecology and the Research Centre in Reproductive Medicine, University of Auckland School of Medicine, Auckland, New Zealand.
Am J Obstet Gynecol. 2000 Sep;183(3):643-8. doi: 10.1067/mob.2000.106592.
The aim of this study was to determine prospectively whether serum concentrations of corticotropin-releasing hormone, corticotropin-releasing hormone-binding protein, and activin A (1) predict preterm birth within 10 days of hospital admission or at <37 weeks' gestation among women with symptoms of preterm labor and (2) are affected by glucocorticoid therapy.
Serum concentrations of corticotropin-releasing hormone and activin A were measured in 94 women with symptoms of preterm labor between 24 and 34 weeks' gestation, and delivery outcomes were monitored. Corticotropin-releasing hormone-binding protein concentrations were measured in 71 of these women. In a subgroup of 15 women the serum analytes were assayed in conjunction with estriol before and 12 to 24 hours after administration of dexamethasone.
Forty-six percent (6/13) of the women who were delivered within 10 days of hospital admission had a raised serum corticotropin-releasing hormone level, but the predictive relationship was not significant (chi(2) = 1.7; P =.2). Among the 31 women (including the 6 previously mentioned) who were delivered at <37 weeks' gestation, 39% (12/31) had a raised corticotropin-releasing hormone level. Although a raised corticotropin-releasing hormone concentration was positively associated with delivery at <37 weeks' gestation (chi(2) = 9; P =.003), the predictive diagnostic value was poor, with sensitivity, specificity, and positive and negative predictive values of 39%, 90%, 67%, and 75%, respectively. The serum concentrations of corticotropin-releasing hormone-binding protein and activin A were unrelated to gestational age at delivery. Dexamethasone markedly lowered the serum estriol level (P <.001) but had no effect on concentrations of corticotropinreleasing hormone, corticotropin-releasing hormone-binding protein, and activin A.
Serum concentrations of corticotropin-releasing hormone, corticotropin-releasing hormone-binding protein, and activin A are not clinically useful for the prediction of preterm delivery among women with symptoms of preterm labor and are not affected by administration of glucocorticoids.
本研究的目的是前瞻性地确定促肾上腺皮质激素释放激素、促肾上腺皮质激素释放激素结合蛋白和激活素A的血清浓度是否能（1）预测入院10天内或妊娠<37周的早产，这些孕妇有早产症状；（2）是否受糖皮质激素治疗的影响。
对94名妊娠24至34周有早产症状的孕妇测定促肾上腺皮质激素释放激素和激活素A的血清浓度，并监测分娩结局。对其中71名孕妇测定促肾上腺皮质激素释放激素结合蛋白浓度。在15名孕妇的亚组中，在给予地塞米松前和给药后12至24小时同时检测血清分析物和雌三醇。
入院10天内分娩的孕妇中有46%（6/13）血清促肾上腺皮质激素释放激素水平升高，但预测关系不显著（χ²=1.7；P=0.2）。在妊娠<37周分娩的31名孕妇（包括上述6名）中，39%（12/31）促肾上腺皮质激素释放激素水平升高。虽然促肾上腺皮质激素释放激素浓度升高与妊娠<37周分娩呈正相关（χ²=9；P=0.003），但其预测诊断价值较差，敏感性、特异性、阳性预测值和阴性预测值分别为39%、90%、67%和75%。促肾上腺皮质激素释放激素结合蛋白和激活素A的血清浓度与分娩时的孕周无关。地塞米松显著降低血清雌三醇水平（P<0.001），但对促肾上腺皮质激素释放激素、促肾上腺皮质激素释放激素结合蛋白和激活素A的浓度无影响。
促肾上腺皮质激素释放激素、促肾上腺皮质激素释放激素结合蛋白和激活素A的血清浓度对有早产症状的孕妇早产预测在临床上无实用价值，且不受糖皮质激素给药的影响。
