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妊娠肝内胆汁淤积症对围生儿不良影响的可能机制研究
作者:杜雪寒1 蒋犁2 
单位:1.徐州市第一人民医院,妇产科,江苏,徐州,221002; 2.东南大学,临床医学院,江苏,南京,210009
关键词:妊娠肝内胆汁淤积症 围生儿 脐静脉 血管内皮细胞 血管内皮生长因子 
分类号:R714.255, R714.7
出版年·卷·期(页码):2007·26·第二期(136-139)
摘要:

目的:探讨妊娠肝内胆汁淤积症(ICP)对围生儿的不良影响及其可能机制.方法:临床收集ICP和正常妊娠孕妇各30例,采集孕妇外周静脉血,分离血清;比较新生儿体重、身长,胎盘重量,羊水粪染和Apgar评分情况.随机选取正常妊娠脐带,行脐静脉内皮细胞分离培养,用两种血清刺激培养的内皮细胞,MTT法检测内皮细胞活力,ELISA法检测内皮细胞分泌血管内皮生长因子的变化.结果:ICP患者娩出的新生儿体重、胎盘重量和Apgar 1min评分明显低于正常孕妇组,羊水粪染率明显高于正常孕妇组,有统计学差异.MTT法发现随着血清浓度的增加,内皮细胞的OD值逐渐降低,两两比较有统计学差异;ICP组各浓度点OD值均低于相应正常孕妇组,P<0.05.ELISA法发现:同正常孕妇组血清相比,ICP组血清HUVECs表达分泌型VEGF蛋白减少;随着血清浓度的升高,VEGF蛋白表达逐渐降低,有统计学差异.结论:ICP对围生儿产生不良影响.ICP围生儿预后不良可能与血管内皮细胞VEGF的分泌减少有关.

Objective To study the unfavourable effects of intrahepatic cholestasis in pregnancy(ICP) on perinatal infants and its mechanisms.Methods Thirty patients with ICP and thirty normal pregnant women were gathered.Their peripheral blood was collected before therapy.Sixty newborns’ weight,stature,Apgar score,placental weight and meconium staining of amniotic fluid were compared soonly after cesarean section in the 36-38 weeks.Endothelial cells were isolated from human umbilical veins in the 30 normal pregnancy women according to Jaffe’s method.In the fourth or fifth days of cells growth,human umbilical veins endothelial cells(HUVECs) were cocultured with serum of different concentration of ICP group and normal pregnancy group for 24h.The vitality of HUVECs was measured by MTT method.The expression value of vascular endothelial growth factor(VEGF) was detected by ELISA.Results Compared with normal pregnancy group,neonatal weight,placental weight and Apgar score were markedly lower,the incident rate of meconium staining of amniotic fluid was distinctly higher.With the serum concentration increased,the value of OD decreased.In the same serum concentration,the value of OD in ICP group serum was significantly lower than that in the normal pregnancy group serum,P<0.05.The level of VEGF in ICP group serum was lower than that in the nomal pregnancy group serum.With the serum concentration increased,the level of VEGF decreased in the ICP group.Conclusion ICP has unfavourable effects on the perinatal infants.It maybe have relations with the decrease of VEGF in the vascular endothelial cells.

参考文献:

[1] 曹泽毅. 中华妇产科学, 1999
[2] PALMER D G, EADS J. Intrahepatic cholistasis of pregnancy:a critical review, 2000
[3] HEINONEN S, KIRKINEN P. Pregnancy outcome with intrahepatic cholestasis. 1999(2). doi:10.1016/S0029-7844(99)00254-9
[4] CHEUNG C Y. Vascular endothelial growth factor:possible role in fetal development and placental function. 1997. doi:10.1016/S1071-5576(97)00025-7
[5] YAGEL S, GREENFIELD C, ARIEL I. Expression of angiopoietin-2 and the receptor tie-2 in human placenta. 1998. doi:10.1016/S1071-5576(97)86423-4
[6] CHEUNG C Y, BRACE R A. Developmental expression of vascular endothelial growth factor and its receptors in ovine placenta and fetal membranes. 1999. doi:10.1016/S1071-5576(99)00016-7
[7] NI Y J, MAY V, BRAS K. Pregnancy augments utero placental vascular endothelial growth factor gene expression and vasodilator effects, 1997

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