Gulbis B, Jauniaux E, Jurkovic D, Gervy C, Ooms H A
Department of Clinical Chemistry, Hôpital Erasme, Université Libre de Bruxelles, Belgium.
Pediatr Res. 1996 Apr;39(4 Pt 1):731-5. doi: 10.1203/00006450-199604000-00027.
The objective of this study was to evaluate the biochemical indices of normal fetal kidney maturation in early pregnancy. Urea, creatinine, gamma-glutamyltransferase, and beta 2-microglobulin levels were measured on paired samples of amniotic and coelomic fluids and maternal serum collected at the time of pregnancy termination in a group of woman with pregnancies between 8 and 11 wk, or on paired samples of amniotic fluid and maternal serum collected from woman undergoing early transabdominal amniocentesis between 11 and 16 wk. Before 11 wk of gestation (n = 12), significantly lower concentrations of creatinine and beta 2-microglobulin, and higher concentration of gamma-glutamyltransferase were found in amniotic fluid compared with both maternal serum and coelomic fluid. Significant positive correlations were found between gestational age (8-16 wk) and amniotic fluid (n = 47) levels of urea (r = 0.45; p < 0.01), creatinine (r = 0.68; p < 0.001), gamma-glutamyltransferase (r = 0.71; p < 0.001), and beta 2-microglobulin (r = 0.69; p < 0.001). The maternal serum levels of the corresponding variables did not varied significantly. The abrupt increase in creatinine, gamma-glutamyltransferase, and beta 2-microglobulin amniotic fluid concentrations after 10 wk of gestation provides biochemical evidence for the maturation of the fetal renal glomerular function at a time when the reabsorption capacity of the proximal tubular cells is not established. We suggest that this important variation in the amniotic fluid composition, unrelated to any comparable changes in the maternal serum, reflects the fetal kidney development from the mesonephros to the metanephros.
本研究的目的是评估妊娠早期正常胎儿肾脏成熟的生化指标。在一组妊娠8至11周的妇女终止妊娠时，对羊水、体腔液和母血的配对样本进行尿素、肌酐、γ-谷氨酰转移酶和β2-微球蛋白水平的测定，或对11至16周接受早期经腹羊膜腔穿刺术的妇女的羊水和母血配对样本进行测定。妊娠11周前（n = 12），与母血和体腔液相比，羊水中肌酐和β2-微球蛋白浓度显著降低，γ-谷氨酰转移酶浓度较高。在胎龄（8至16周）与羊水（n = 47）尿素水平（r = 0.45；p < 0.01）、肌酐水平（r = 0.68；p < 0.001）、γ-谷氨酰转移酶水平（r = 0.71；p < 0.001）和β2-微球蛋白水平（r = 0.69；p < 0.001）之间发现显著正相关。相应变量的母血水平无显著变化。妊娠10周后羊水肌酐、γ-谷氨酰转移酶和β2-微球蛋白浓度的突然增加为胎儿肾小球功能成熟提供了生化证据，此时近端肾小管细胞的重吸收能力尚未建立。我们认为，羊水中这种重要的成分变化与母血中任何类似变化无关，反映了胎儿肾脏从中肾到后肾的发育过程。
