严重妊娠剧吐患者的Ⅰ型胶原 N 端肽水平。
Maternal type 1collagen N-terminal telopeptide levels in severe hyperemesis gravidarum.
机构信息
Department of Obstetrics and Gynecology, Health Sciences University, Sivas Sarkısla Government Hospital, Sivas, Turkey.
Department of Obstetrics and Gynecology, Health Sciences University, Kayseri Education and Research Hospital, Kayseri, Turkey.
出版信息
BMC Pregnancy Childbirth. 2018 Dec 20;18(1):502. doi: 10.1186/s12884-018-2149-7.
BACKGROUND
Nausea and vomiting occur 50-90% during the first trimester of pregnancy. However, patients with hyperemesis gravidarum (HG) may be hospitalized at an incidence rate of 0.8-2% before the 20th week of gestational age. The symptoms generally start during the 5-6th gestational weeks, reaching the highest degree during the 9th week, and decline after the 16-20th weeks of gestation. Clinical findings are proportional to the severity of the disease and severe HG is characterized with dehydration, electrolyte imbalance, and nutritional deficiency as a result of vomiting.
METHODS
The study population consisted of two groups of pregnant volunteers at 5-12 weeks of gestation: a severe HG group and a control group. The HG severity was scored using the Pregnancy-Unique Quantification of Emesis (and nausea) (PUQE).The serum levels of the maternal Ca, parathyroid hormone (PTH), Na, K, blood urea nitrogen(BUN), creatinine, vitamin D(25OHD3), and the maternal urine NTx levels were compared between the groups.
RESULTS
In total, 40 volunteers were enrolled in this study: 20 healthy pregnant volunteers and 20 with severe HG. There were no statistically significant differences between the maternal characteristics. The first trimester weight loss of ≥5 kg was significantly higher in the severe HG group (p < 0.001), while the control group had a significantly higher sunlight exposure ratio than the severe HG group (p = 0.021). The urine NTx levels were significantly higher in the severe HG group (39.22 ± 11.68NTx/Cre) than in the control group(32.89 ± 8.33NTx/Cre) (p = 0.028).The serum Ca, PTH, Na, K, BUN, and creatinine levels were similar between the groups (p = 0.738, p = 0.886, p = 0.841, p = 0.957, p = 0.892, and p = 0.824, respectively). In the severe HG group, the serum 25OHD levels were significantly lower than in the control group (p < 0.001).
CONCLUSIONS
The data from this study indicated that severe HG is associated with increased urine NTx levels. However, large-scale studies are required to understand the clinical significance of this finding, as well as the long-term consequences of elevated urine NTx levels and the underlying mechanisms.
TRIAL REGISTRATION
NCT02862496 Date of registration: 21/07/2016.
背景
恶心和呕吐在妊娠早期发生率为 50-90%。然而，妊娠剧吐（HG）患者在妊娠 20 周前的发病率为 0.8-2%。症状通常在第 5-6 周开始，第 9 周达到高峰，第 16-20 周后下降。临床发现与疾病的严重程度成正比，严重 HG 的特点是由于呕吐导致脱水、电解质失衡和营养缺乏。
方法
研究人群由妊娠 5-12 周的两组志愿者组成：严重 HG 组和对照组。采用妊娠专用呕吐（和恶心）评分（PUQE）对 HG 严重程度进行评分。比较两组孕妇血清 Ca、甲状旁腺激素（PTH）、Na、K、血尿素氮（BUN）、肌酐、维生素 D（25OHD3）和尿 NTx 水平。
结果
共有 40 名志愿者参与了这项研究：20 名健康孕妇志愿者和 20 名严重 HG 孕妇志愿者。两组孕妇的一般特征无统计学差异。严重 HG 组的孕早期体重减轻≥5kg 的比例显著高于对照组（p<0.001），而对照组的阳光暴露比例显著高于严重 HG 组（p=0.021）。尿 NTx 水平在严重 HG 组（39.22±11.68NTx/Cre）明显高于对照组（32.89±8.33NTx/Cre）（p=0.028）。两组孕妇血清 Ca、PTH、Na、K、BUN 和肌酐水平无统计学差异（p=0.738、p=0.886、p=0.841、p=0.957、p=0.892、p=0.824，分别）。在严重 HG 组，血清 25OHD 水平明显低于对照组（p<0.001）。
结论
本研究数据表明，严重 HG 与尿 NTx 水平升高有关。然而，需要进行大规模研究以了解这一发现的临床意义，以及尿 NTx 水平升高的长期后果及其潜在机制。
试验注册
NCT02862496 登记日期：2016 年 7 月 21 日。
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