Ballard R A, Ballard P L
University of Pennsylvania School of Medicine, Philadelphia, USA.
J Perinatol. 1996 Sep-Oct;16(5):390-6.
The value of antenatal therapy with glucocorticoids in improving the pulmonary outcome of preterm human infants was first demonstrated in 1972. Accelerated lung maturation occurs with physiologic stress levels of corticosteroid by receptor-mediated induction of specific developmentally regulated proteins. Since the first report by Liggins, multiple controlled trials have demonstrated a decreased number of cases of respiratory distress syndrome and mortality in treated infants. In addition, prenatal therapy leads to decreased intraventricular hemorrhage and hospital costs, and there is strong evidence for decreased incidence of both patent ductus arteriosus requiring therapy and necrotizing enterocolitis. The recommendations of the 1994 National Institutes of Health Consensus Conference include use of antenatal corticosteroids in virtually all women who are in labor when the fetus is between 24 to 34 weeks' gestation. The combination of antenatal corticosteroids with thyrotropin releasing hormone holds promise for further reducing the incidence and severity of respiratory distress syndrome and decreasing chronic lung disease in the preterm infant.
1972年首次证实了产前使用糖皮质激素对改善早产人类婴儿肺部结局的价值。生理应激水平的皮质类固醇通过受体介导诱导特定的发育调节蛋白，从而加速肺成熟。自利金斯首次报告以来，多项对照试验表明，接受治疗的婴儿中呼吸窘迫综合征和死亡率的病例数有所减少。此外，产前治疗可减少脑室内出血和住院费用，并且有强有力的证据表明需要治疗的动脉导管未闭和坏死性小肠结肠炎的发病率均降低。1994年美国国立卫生研究院共识会议的建议包括，对于妊娠24至34周之间即将分娩的几乎所有妇女，均使用产前皮质类固醇。产前皮质类固醇与促甲状腺激素释放激素联合使用有望进一步降低呼吸窘迫综合征的发病率和严重程度，并减少早产儿的慢性肺病。
