Ellis M Jane, Livesey John H, Inder Warrick J, Prickett Timothy C R, Reid Rosemary
Department of Endocrinology, Christchurch Hospital, New Zealand.
Am J Obstet Gynecol. 2002 Jan;186(1):94-9. doi: 10.1067/mob.2002.119188.
The purpose of this study was to compare the patterns and timing of the increases in plasma levels of corticotropin-releasing hormone and unconjugated estriol during human pregnancy.
Corticotropin-releasing hormone and unconjugated estriol were measured in serial samples that were collected from preterm subjects and from spontaneous term control subjects who were selected randomly from a study cohort of 297 women.
Gestational increases in log corticotropin-releasing hormone and log unconjugated estriol concentrations were best described by linear and cubic polynomial functions, respectively. Plasma unconjugated estriol levels were similar in preterm and term singleton pregnancies at equivalent gestation, whereas corticotropin-releasing hormone was elevated earlier in premature subjects. Mean corticotropin-releasing hormone levels relative to term control subjects (n = 40 women) were shifted forward 16.5 +/- 8.1 days (P =.027, singleton preterm, spontaneous labor; n = 16) and 33.0 +/- 7.9 days (P <.001, singleton preterm, obstetric intervention; n = 10). The corresponding shifts in unconjugated estriol values were -3.8 +/- 2.0 days and -2.7 +/- 5.6 days (both not significant). The prematurity of delivery showed a significant regression on shifts in corticotropin-releasing hormone (P =.004 and P <.001) but not in unconjugated estriol for the 2 groups. The ability to predict prematurity was not significantly improved by regression on corticotropin-releasing hormone and unconjugated estriol shift values together.
The patterns and timing of gestational changes in corticotropin-releasing hormone and unconjugated estriol differ in humans. The usefulness of corticotropin-releasing hormone as a biochemical preterm marker in singleton pregnancies is not enhanced by the additional measurement of plasma unconjugated estriol.
本研究旨在比较人类妊娠期间促肾上腺皮质激素释放激素和未结合雌三醇血浆水平升高的模式和时间。
对从297名女性研究队列中随机选取的早产受试者和足月自然分娩对照受试者的系列样本进行促肾上腺皮质激素释放激素和未结合雌三醇测定。
对数促肾上腺皮质激素释放激素和对数未结合雌三醇浓度的孕期升高分别用线性和三次多项式函数能得到最佳描述。在相同孕周时，早产和足月单胎妊娠的血浆未结合雌三醇水平相似，而促肾上腺皮质激素释放激素在早产受试者中升高得更早。相对于足月对照受试者（n = 40名女性），促肾上腺皮质激素释放激素的平均水平在单胎早产、自然分娩组中提前了16.5 +/- 8.1天（P =.027），在单胎早产、产科干预组中提前了33.0 +/- 7.9天（P <.001，n = 10）。未结合雌三醇值的相应变化分别为-3.8 +/- 2.0天和-2.7 +/- 5.6天（均无统计学意义）。两组中，分娩早产情况与促肾上腺皮质激素释放激素的变化呈显著回归关系（P =.004和P <.001），但与未结合雌三醇无此关系。同时对促肾上腺皮质激素释放激素和未结合雌三醇变化值进行回归分析，预测早产的能力并无显著提高。
人类促肾上腺皮质激素释放激素和未结合雌三醇孕期变化的模式和时间不同。在单胎妊娠中，额外测量血浆未结合雌三醇并不能提高促肾上腺皮质激素释放激素作为生化早产标志物的效用。
