Goland R S, Wardlaw S L, Blum M, Tropper P J, Stark R I
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032.
Am J Obstet Gynecol. 1988 Oct;159(4):884-90. doi: 10.1016/s0002-9378(88)80162-5.
Corticotropin-releasing hormone was measured in the plasma of 110 pregnant women and in the umbilical cord plasma of 25 premature infants and 43 infants born at term. Mean maternal plasma corticotropin-releasing hormone was undetectable (less than 41 pg/ml) until mid-second trimester, rose to a mean of 204 +/- 24 pg/ml by 30 weeks' gestation, to 326 +/- 41 by 35 weeks, and then rose sharply near term, with a mean of 2930 pg/ml at 38 to 40 weeks' gestation. Sequential measurements in seven pregnant women confirmed that plasma corticotropin-releasing hormone rose in a predictable pattern, with a dramatic increase in the final weeks of pregnancy. There was little hour-to-hour variability in maternal plasma concentrations. Corticotropin-releasing hormone was also detectable in umbilical cord plasma; mean corticotropin-releasing hormone was 194 +/- 44 in the preterm infants and 150 +/- 19 in the term infants. The corticotropin-releasing hormone extracted from both the maternal and fetal circulation was biologically active in vitro and caused the dose-dependent release of adrenocorticotropic hormone and beta-endorphin from cultured rat anterior pituitary cells. A significant correlation was found between maternal plasma corticotropin-releasing hormone and cortisol levels the morning after betamethasone administration, a finding that supports a physiologic role for maternal plasma corticotropin-releasing hormone. We conclude that the placenta secretes large amounts of biologically active corticotropin-releasing hormone into both the maternal and fetal circulation during pregnancy. We demonstrate that this corticotropin-releasing hormone is secreted into the maternal plasma in a reproducible pattern during normal term pregnancy and suggest that sequential corticotropin-releasing hormone measurements may prove to be of clinical utility. In addition, placental corticotropin-releasing hormone may be an important modulator of the hypothalamic-pituitary-adrenal axis during pregnancy.
对110名孕妇的血浆以及25名早产儿和43名足月儿的脐血血浆中的促肾上腺皮质激素释放激素进行了测定。孕中期之前，母体血浆促肾上腺皮质激素释放激素平均水平无法检测到（低于41 pg/ml），到妊娠30周时升至平均204±24 pg/ml，35周时为326±41 pg/ml，然后在接近足月时急剧上升，妊娠38至40周时平均为2930 pg/ml。对7名孕妇的连续测量证实，血浆促肾上腺皮质激素释放激素呈可预测的模式上升，在妊娠最后几周急剧增加。母体血浆浓度在数小时内变化很小。脐血血浆中也可检测到促肾上腺皮质激素释放激素；早产儿的促肾上腺皮质激素释放激素平均水平为194±44，足月儿为150±19。从母体和胎儿循环中提取的促肾上腺皮质激素释放激素在体外具有生物活性，可使培养的大鼠垂体前叶细胞剂量依赖性地释放促肾上腺皮质激素和β-内啡肽。在给予倍他米松后的次日早晨，母体血浆促肾上腺皮质激素释放激素与皮质醇水平之间存在显著相关性，这一发现支持了母体血浆促肾上腺皮质激素释放激素的生理作用。我们得出结论，胎盘在孕期向母体和胎儿循环中分泌大量具有生物活性的促肾上腺皮质激素释放激素。我们证明，在正常足月妊娠期间，这种促肾上腺皮质激素释放激素以可重复的模式分泌到母体血浆中，并表明连续测量促肾上腺皮质激素释放激素可能具有临床应用价值。此外，胎盘促肾上腺皮质激素释放激素可能是孕期下丘脑-垂体-肾上腺轴的重要调节因子。
