Bon C, Raudrant D, Poloce F, Champion F, Golfier F, Pichot J, Revol A
Service de biochimie, Hôtel-Dieu, 1, place de l'Hôpital, 69288, Lyon cedex 02, France.
Pathol Biol (Paris). 2007 Mar;55(2):111-20. doi: 10.1016/j.patbio.2006.04.009. Epub 2006 Jul 3.
Intra-uterine growth retardation (IUGR) is a frequent pathology in obstetrics characterized by high heterogeneity. Fetal smallness is sometimes constitutional, but can also be accompanied by fetal distress and vital risks for the infant. In 35 pregnancies complicated by IUGR of different etiologies, we measured on fetal blood obtained by cordocentesis, biochemical variables characteristic of the fetuses' respiratory and metabolic status. The aim of the study was to identify the discriminative biological alterations, related to growth retardation and fetal distress.
The studied population includes 27 cases of severe IUGR, of gestational age 30,2+/-4,6 weeks of gestation (WG) (divided into 20 cases of isolated IUGR and 7 cases of IUGR associated with malformative syndrome), as well as 8 cases of moderate IUGR, of gestational age 26+/-4,5 WG; all fetuses had normal karyotypes. A group of 73 normal fetuses, of gestational age 26,3+/-5,7 WG, constituted a reference population. PH, pCO(2), bicarbonate concentration, pO(2) and SaO(2), as well as glucose, pyruvate, lactate, free fatty acids, aceto-acetate, beta-hydroxybutyrate and cholesterol concentrations were measured on umbilical venous blood (UVB).
In case of severe but isolated growth retardation, UVB analysis showed the frequency of acid-base and gasometric disturbances: acidemia and hypoxemia (65% of cases), hypercapnia (60% of cases). Metabolic abnormalities were shown: decrease in glycemia (35% of cases), increase in pyruvatemia and lactatemia (40% of cases), increased free fatty acids serum concentration; a diminution of umbilical venous cholesterol level, the most frequent abnormality, can be seen in 70% of fetuses. In case of severe IUGR associated with malformative syndrome, UVB acid-base and metabolic changes were rarely seen; however, UVB cholesterol level is low in some cases. In case of growth retardation classified as moderate, modifications are relatively not frequent and essentially gasometric.
In about 60% of cases of severe and isolated IUGR, there is a risk of fetal distress, related to an alteration of the transplacental transfer of respiratory gases and nutritional substrates; chronic fetal malnutrition can be involved, with an impact on the growth of the fetus. In case of IUGR associated with malformative syndrome, fetal smallness is probably a result of intrinsic fetal damage, without nutritional origin.
宫内生长受限（IUGR）是产科常见的一种病理情况，具有高度异质性。胎儿生长过小有时是先天性的，但也可能伴有胎儿窘迫及对婴儿的生命危险。在35例因不同病因并发IUGR的妊娠中，我们对通过脐静脉穿刺获取的胎儿血液进行检测，测量了胎儿呼吸和代谢状态的生化指标。本研究的目的是确定与生长受限和胎儿窘迫相关的有鉴别意义的生物学改变。
研究人群包括27例重度IUGR患者，孕周为30.2±4.6周（分为20例单纯IUGR和7例合并畸形综合征的IUGR），以及8例中度IUGR患者，孕周为26±4.5周；所有胎儿核型均正常。一组73例孕周为26.3±5.7周的正常胎儿作为对照人群。检测脐静脉血（UVB）中的pH值、pCO₂、碳酸氢盐浓度、pO₂、SaO₂，以及葡萄糖、丙酮酸、乳酸、游离脂肪酸、乙酰乙酸、β-羟丁酸和胆固醇浓度。
在重度但单纯生长受限的情况下，UVB分析显示酸碱和气体分析紊乱的发生率：酸血症和低氧血症（65%的病例）、高碳酸血症（60%的病例）。还显示出代谢异常：血糖降低（35%的病例）、丙酮酸血症和乳酸血症升高（40%的病例）、血清游离脂肪酸浓度升高；脐静脉胆固醇水平降低是最常见的异常，70%的胎儿可见。在合并畸形综合征的重度IUGR病例中，UVB酸碱和代谢变化很少见；然而，某些病例中UVB胆固醇水平较低。在中度生长受限的情况下，变化相对不常见，主要是气体分析方面的。
在约60%的重度且单纯IUGR病例中，存在胎儿窘迫风险，这与呼吸气体和营养底物的胎盘转运改变有关；可能涉及慢性胎儿营养不良，影响胎儿生长。在合并畸形综合征的IUGR病例中，胎儿生长过小可能是胎儿内在损伤的结果，而非营养原因。
