Effect of single and multiple courses of prenatal corticosteroids on 17-hydroxyprogesterone levels: Implication for neonatal screening of congenital adrenal hyperplasia
Effect of single and multiple courses of prenatal corticosteroids on 17-hydroxyprogesterone levels: Implication for neonatal screening of congenital adrenal hyperplasia
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DOI：
10.1203/01.pdr.0000142733.50918.6e
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发表时间：
2004-11-01
影响因子：
3.6
通讯作者：
Coutant, R
中科院分区：
文献类型：
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作者：
Gatelais, F;Berthelot, J;Coutant, R
从滤纸血中检测17-羟孕酮（17-OHP）被广泛用于筛查先天性肾上腺皮质增生（CAH）。然而，在预期早产的妊娠中，产前用类固醇治疗以诱导肺成熟可能会抑制胎儿肾上腺并干扰这种筛查。在160名出生于妊娠25至35周之间的婴儿中，我们在72-96 h时测量滤纸血中的17-OHP，并比较了未接受产前类固醇（n = 50）和接受产前类固醇（n = 110）的婴儿之间的值。单疗程类固醇是在24小时内注射两次12 mg倍他米松：30名婴儿接受半个疗程，45名接受完整的单疗程，35名接受多个疗程。结果表示为中位数（第25百分位数;第75百分位数）。血液17-OHP组间差异显著：23.7（14.2; 30.7）nmol/L，26.1（15.0; 50.1）nmol/L，20.1（13.8; 29.1）nmol/L和14.9（9.5; 26.2）nmol/L（分别为无类固醇、半个单疗程、完整的单疗程和多个疗程; p < 0.05，Kruskal-Wallis检验多重比较）。然而，只有产前接受多疗程类固醇治疗的婴儿血液17-OHP低于未接受治疗的婴儿（Mann-Whitney U检验p < 0.05）。在多元回归分析中，类固醇治疗和胎儿宫内发育迟缓是血17-OHP的显著负预测因子，而呼吸窘迫综合征是显著正预测因子（多重R = 0.50，p < 0.001）。对早产儿进行多次类固醇治疗可使滤纸血中17-OHP值降低约30%，从而增加CAH筛查程序中假阴性结果的风险。
Measurement of 17-hydroxyprogesterone (17-OHP) from filter-paper blood is widely used to screen for congenital adrenal hyperplasia (CAH). However, in pregnancies with an expected preterm delivery, prenatal treatment with steroids to induce pulmonary maturation could suppress the fetal adrenals and interfere with this screening. In 160 infants who were born between 25 and 35 wk of gestation, we measured 17-OHP in filter-paper blood at 72-96 h and compared the values between those who had not received antenatal steroids (n = 50) and those who had (n = 110). A single course of steroids was two 12-mg injections of betamethasone given within a 24-h interval: 30 infants received a half single course, 45 received a full single course, and 35 received multiple courses. Results are expressed as medians (25th percentile; 75th percentile). Blood 17-OHP differed significantly among groups: 23.7 (14.2; 30.7) nmol/L, 26.1 (15.0; 50.1) nmol/L, 20.1 (13.8; 29.1) nmol/L, and 14.9 (9.5; 26.2) nmol/L (for, respectively, no steroid, half a single course, a full single course, and multiple courses; p < 0.05, multiple comparisons with the Kruskal-Wallis test). However, only infants who were treated with multiple antenatal courses of steroids had lower blood 17-OHP than those who were untreated (p < 0.05 with the Mann-Whitney U test). In multiple regression analysis, steroid treatment and intrauterine growth retardation were significant negative predictors of blood 17-OHP, whereas respiratory distress syndrome was a significant positive predictor (multiple R = 0.50, p < 0.001). Multiple courses of steroids in preterm infants decrease 17-OHP values by similar to30% in filter-paper blood, thus raising the risk of false-negative results in screening programs for CAH.