Capponi A, Rizzo G, De Angelis C, Arduini D, Romanini C
Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Italy.
Obstet Gynecol. 1997 Feb;89(2):242-7. doi: 10.1016/S0029-7844(96)00432-2.
To determine whether blood levels of atrial natriuretic peptide in small for gestational age (SGA) fetuses are related to Doppler indices measured in arterial and venous vessels.
Atrial natriuretic peptide was assayed in fetal blood obtained at funipuncture in 42 third-trimester fetuses, of whom 11 were appropriate for gestational age (AGA) and 31 were SGA. Small for gestational age fetuses were divided into three groups according to Doppler findings in the umbilical artery and inferior vena cava: 1) normal in both vessels (n = 10); 2) abnormal in the umbilical artery but normal in the inferior vena cava (n = 10); and 3) abnormal in both vessels (n = 11). Atrial natriuretic peptide levels were related to Doppler indices and acid-base status of the fetal blood.
Small for gestational age fetuses with abnormal waveforms in both vessels had higher atrial natriuretic peptide blood levels (median 544.8 pg/mL, range 404.2-1112.3) compared with AGA fetuses (median 316.8 pg/mL, range 159.3-470.1; P < or = .001), SGA fetuses with normal waveforms only in both vessels (median 299.8 pg/mL, range 242.6-480.5; P < or = .001), and SGA fetuses with abnormal waveforms only in the umbilical artery (median 367.6 pg/mL, range 192.7-748.9; P = .002). Blood levels of atrial natriuretic peptide were significantly related to the preload index in the inferior vena cava (p = 0.554, P < or = .001). This relation remained significant when the analysis was restricted to the SGA fetuses with abnormal waveforms in the umbilical artery and the inferior vena cava (p = 0.673, P = .03).
Small for gestational age fetuses with abnormal velocity waveforms in the inferior vena cava have significantly higher concentrations of atrial natriuretic peptide. This may represent a compensatory mechanism in the SGA fetus for regulation of an abnormal hemodynamic condition.
确定小于胎龄（SGA）胎儿的心房利钠肽血水平是否与动脉和静脉血管中测得的多普勒指数相关。
对42例孕晚期胎儿经脐穿刺获取的胎儿血进行心房利钠肽检测，其中11例为适于胎龄（AGA）胎儿，31例为SGA胎儿。根据脐动脉和下腔静脉的多普勒检查结果，将SGA胎儿分为三组：1）两条血管均正常（n = 10）；2）脐动脉异常但下腔静脉正常（n = 10）；3）两条血管均异常（n = 11）。心房利钠肽水平与胎儿血的多普勒指数及酸碱状态相关。
两条血管波形均异常的SGA胎儿，其心房利钠肽血水平（中位数544.8 pg/mL，范围404.2 - 1112.3）高于AGA胎儿（中位数316.8 pg/mL，范围159.3 - 470.1；P≤0.001）、两条血管波形均正常的SGA胎儿（中位数299.8 pg/mL，范围242.6 - 480.5；P≤0.001）以及仅脐动脉波形异常的SGA胎儿（中位数367.6 pg/mL，范围192.7 - 748.9；P = 0.002）。心房利钠肽血水平与下腔静脉的前负荷指数显著相关（p = 0.554，P≤0.001）。当分析仅限于脐动脉和下腔静脉波形异常的SGA胎儿时，这种关系仍然显著（p = 0.673，P = 0.03））。
下腔静脉速度波形异常的小于胎龄胎儿，其心房利钠肽浓度显著升高。这可能代表SGA胎儿调节异常血流动力学状态的一种代偿机制。
