Roles of glucocorticoids in human parturition: A controversial fact?
Roles of glucocorticoids in human parturition: A controversial fact?
复制标题
糖皮质激素在人类分娩中的作用：一个有争议的事实？
DOI：
10.1016/j.placenta.2014.03.005
复制
发表时间：
2014-05-01
期刊：
影响因子：
3.8
通讯作者：
Sun, K.
中科院分区：
文献类型：
--
作者：
Li, X. Q.;Zhu, P.;Sun, K.
糖皮质激素在分娩启动中的关键作用在几种家养哺乳动物物种中已有很好的记录。然而，糖皮质激素在人类分娩中的作用仍然存在争议，主要是因为缺乏合成糖皮质激素的作用，以促进先兆早产孕妇的胎儿器官成熟，对妊娠期的长短。本文将综述糖皮质激素在人类分娩中的研究，并提供证据证明糖皮质激素在人类分娩中也起重要作用，但同时宫内组织中高浓度的雌激素可能是GCs启动分娩所必需的。合成的GCs地塞米松和betteramine完整地穿过胎盘，导致对胎儿HPA轴的强负反馈和减少DHEA的产生从胎儿肾上腺中提取用于胎盘合成雌激素。这可能会否定全身给药GC对引产的影响，特别是在子宫肌层尚未完全被雌激素激活的情况下。内源性糖皮质激素被胎盘11 β-HSD 2灭活，从而限制母体皮质醇对胎儿HPA轴的负反馈，并允许皮质醇和雌激素水平在妊娠结束时同时升高。因此，内源性糖皮质激素，特别是在子宫内组织中局部产生的糖皮质激素可能通过增强胎膜中前列腺素的产生和刺激胎盘中雌激素和CRH的产生而在人类分娩中发挥重要作用。(C)2014爱思唯尔有限公司版权所有。
The pivotal role of glucocorticoids in the initiation of parturition has been very well documented in several domestic mammalian animal species. However the role of glucocorticoids in human parturition remains controversial mainly because of the absence of effect of synthetic glucocorticoids, given to promote fetal organ maturation in pregnant women with threatened preterm delivery, on the length of gestation. This article will review studies of glucocorticoids in human parturition and provide evidence for an important role of glucocorticoids in human parturition as well but a simultaneous high concentration of estrogen within the intrauterine tissues may be necessary for GCs to initiate parturition.The synthetic GCs dexamethasone and betamethasone pass through the placenta intact resulting in potent negative feedback on the fetal HPA axis and diminished production of DHEA from fetal adrenal glands for estrogen synthesis by the placenta. This may negate the effect of systemic administration of GCs on the induction of labor, especially in cases where the myometrium is not yet fully primed by estrogen. Endogenous glucocorticoids are inactivated by the placental 11 beta-HSD2 thus limiting the negative feedback of maternal cortisol on the fetal HPA axis and allowing the simultaneous rise of cortisol and estrogen levels towards the end of gestation. Therefore, endogenous glucocorticoids, particularly glucocorticoids produced locally in the intrauterine tissues may play an important role in parturition in humans by enhancing prostaglandin production in the fetal membranes and stimulating estrogen and CRH production in the placenta. (C) 2014 Elsevier Ltd. All rights reserved.