Division of Endocrinology, Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
Am J Obstet Gynecol. 2012 Mar;206(3):236.e1-8. doi: 10.1016/j.ajog.2011.12.004. Epub 2011 Dec 16.
Spontaneous labor at term involves the activation of placental corticotropin-releasing hormone and the fetal adrenal axis, but the basis for extreme preterm labor is unknown. Our objective was to determine whether placental corticotropin-releasing hormone is activated in extreme preterm labor.
One thousand five hundred six mothers delivering at less than 28 weeks' gestation were enrolled. Each mother/infant pair was assigned to the category that described the primary reason for hospitalization. Observers who had no knowledge of patient categorization assessed placenta microbiology, histology, and corticotropin-releasing hormone expression. These were correlated with the primary reason for hospitalization.
Among infants delivered at less than 28 weeks' gestation, spontaneous (vs induced) delivery was associated with less placental corticotropin-releasing hormone expression and more frequent signs of placental inflammation and infection.
Inflammation and infection, rather than premature activation of the fetal adrenal axis, should be the major focus of research to prevent extremely preterm human birth.
足月自然分娩涉及胎盘促肾上腺皮质激素释放激素和胎儿肾上腺轴的激活，但极早产的发病基础尚不清楚。本研究旨在确定极早产中是否存在胎盘促肾上腺皮质激素释放激素的激活。
共纳入了 1506 例孕 28 周以下分娩的母亲。每对母婴均被分配到描述主要住院原因的类别中。不了解患者分类的观察者评估了胎盘微生物学、组织学和促肾上腺皮质激素释放激素的表达。这些与主要住院原因相关。
在孕 28 周以下分娩的婴儿中，自发性（与诱导性相比）分娩与胎盘促肾上腺皮质激素释放激素表达减少以及更频繁的胎盘炎症和感染迹象相关。
对于预防人类极早产，炎症和感染而非胎儿肾上腺轴的过早激活，应成为主要的研究重点。
