Buhimschi Catalin S, Turan Ozhan M, Funai Edmund F, Azpurua Humberto, Bahtiyar Mert-Ozan, Turan Sifa, Zhao Guomao, Dulay Antonette, Bhandari Vineet, Copel Joshua A, Buhimschi Irina A
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Obstet Gynecol. 2008 Mar;111(3):715-22. doi: 10.1097/AOG.0b013e3181610294.
Fetal adaptation to stress is regulated in part by the pituitary-adrenocortical system. The stress hormones dehydroepiandrosterone sulfate (DHEAS) and cortisol have opposing effects: cortisol suppresses while DHEAS enhances immune functions. We sought to estimate the impact of intraamniotic inflammation on fetal adrenal gland volume and cortisol-to-dehydroepiandrosterone sulfate ratio (fetal stress ratio) in pregnancies complicated by preterm birth.
Fifty-one consecutive singleton fetuses of mothers who had an indicated amniocentesis to rule out infection were analyzed. Intraamniotic inflammation was assessed by proteomic profiling of amniotic fluid for the biomarkers of the Mass Restricted score. The Mass Restricted score ranges from 0 (biomarkers absent) to 4 (all biomarkers present), with Mass Restricted scores of 3 or 4 indicating severe intraamniotic inflammation. Fetal adrenal gland volume was assessed by three-dimensional ultrasonography and corrected for estimated fetal weight. Interleukin-6 (IL-6), cortisol, and DHEAS were measured by immunoassay.
Women with intraamniotic inflammation delivered earlier (27.8+/-3.4 weeks, n=16, compared with 32.3+/-3.0 weeks, n=35, P<.001), and their fetuses had higher cord blood IL-6 (P=.011) and higher corrected adrenal gland volumes (P=.027). Cord blood IL-6 levels were in direct relationship with corrected adrenal volume (r=0.372, P=.019), fetal cortisol (r=0.428, P=.010), and DHEAS (r=0.521, P<.001). However, fetuses exposed to intraamniotic inflammation had an overall lower fetal stress ratio (P=.034). These results maintained after adjusting for gestational age, uterine contractions, and steroid exposure.
Fetuses exposed to intraamniotic inflammation have higher adrenal gland volumes and lower cortisol-to-DHEAS ratios, suggesting that the fetal adrenocortical axis plays a role in the intrauterine adaptation to inflammation.
胎儿对压力的适应部分受垂体 - 肾上腺皮质系统调节。应激激素硫酸脱氢表雄酮（DHEAS）和皮质醇具有相反的作用：皮质醇抑制免疫功能，而DHEAS增强免疫功能。我们试图评估羊膜腔内炎症对早产合并妊娠中胎儿肾上腺体积和皮质醇与硫酸脱氢表雄酮比值（胎儿应激比值）的影响。
对51例因羊水穿刺以排除感染而接受检查的母亲的单胎胎儿进行连续分析。通过对羊水进行蛋白质组学分析以检测质量限制评分的生物标志物来评估羊膜腔内炎症。质量限制评分范围为0（无生物标志物）至4（所有生物标志物均存在），质量限制评分为3或4表明存在严重的羊膜腔内炎症。通过三维超声检查评估胎儿肾上腺体积，并根据估计的胎儿体重进行校正。通过免疫测定法测量白细胞介素 - 6（IL - 6）、皮质醇和DHEAS。
发生羊膜腔内炎症的女性分娩时间更早（27.8±3.4周，n = 16，相比之下32.3±3.0周，n = 35，P <.001），并且她们的胎儿脐带血IL - 6水平更高（P =.011），校正后的肾上腺体积更大（P =.027）。脐带血IL - 6水平与校正后的肾上腺体积（r = 0.372，P =.019）、胎儿皮质醇（r = 0.428，P =.010）和DHEAS（r = 0.521，P <.001）呈直接相关。然而，暴露于羊膜腔内炎症的胎儿总体胎儿应激比值较低（P =.034）。在对胎龄、子宫收缩和类固醇暴露进行校正后，这些结果依然成立。
暴露于羊膜腔内炎症的胎儿肾上腺体积更大，皮质醇与DHEAS比值更低，这表明胎儿肾上腺皮质轴在子宫内对炎症的适应中发挥作用。
