Placental clearance/synthesis of neurobiomarkers GFAP and UCH-L1 in healthy term neonates and those with moderate-severe neonatal encephalopathy.
Placental clearance/synthesis of neurobiomarkers GFAP and UCH-L1 in healthy term neonates and those with moderate-severe neonatal encephalopathy.
复制标题
健康足月新生儿和患有中重度新生儿脑病的神经生物标志物 GFAP 和 UCH-L1 的胎盘清除/合成。
DOI：
10.1038/s41390-019-0439-z
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发表时间：
2019
影响因子：
3.6
通讯作者：
Chalak,LinaF
中科院分区：
文献类型：
--
作者：
Mir,ImranN;StevenBrown,L;Rosenfeld,CharlesR;Chalak,LinaF
出生窒息合并新生儿脑病（NE）的新生儿脐动脉（UmA）血中GFAP和UCH-L1的胎儿浓度升高，但其来源和胎盘清除/合成的作用尚不清楚。方法对足月新生儿进行前瞻性队列研究，以(a)测定足月无并发症妊娠中GFAP和UCH-L1的UmA和静脉（UmV）血药浓度及其胎盘合成和/或清除；(b)比较无并发症妊娠与合并胎儿缺氧-窒息+NE的UmA浓度。研究三个足月组：无并发症剖宫产（组1，n= 15），无并发症阴道分娩（组2，n= 15），围产期缺氧-窒息+NE（组3，n= 8）。结果1组患者血清GFAP浓度低于2组（P= 0.02），胎盘清除率均为100%。相反，UmA和UmV UCH-L1浓度不受劳动的影响。3组UmA GFAP浓度分别比1组和2组高30倍和8倍，P= 0.02，而UmA UCH-L1浓度在所有组中相似。结论suma GFAP来源于胎儿，其循环水平受胎盘清除调节，在无并发症分娩时升高，在胎儿缺氧-窒息+NE存在时更明显，为缺氧-窒息+NE提供了比UCH-L1更好的生物标志物。
BackgroundFetal concentrations of GFAP and UCH-L1 are elevated in umbilical arterial (UmA) blood of neonates with birth asphyxia plus neonatal encephalopathy (NE), but their source and role of placental clearance/synthesis is unknown.MethodsProspective cohort study of term neonates to (a) determine UmA and venous (UmV) blood concentrations of GFAP and UCH-L1 in term uncomplicated pregnancies and their placental synthesis and/or clearance and (b) compare UmA concentrations in uncomplicated pregnancies with those complicated by fetal hypoxia–asphyxia+NE. Three term groups were studied: uncomplicated cesarean delivery without labor (Group 1,n= 15), uncomplicated vaginal delivery with labor (Group 2,n= 15), and perinatal hypoxia–asphyxia+NE (Group 3,n= 8).ResultsUmA GFAP concentrations were lower in Group 1 vs. 2 (P= 0.02) and both demonstrated 100% placental clearance. In contrast, UmA and UmV UCH-L1 concentrations were not unaffected by labor. Group 3 UmA GFAP concentrations were 30- and 8-fold higher than Groups 1 and 2, respectively,P= 0.02, whereas UmA UCH-L1 concentrations were similar in all groups.ConclusionsUmA GFAP is derived from the fetus, and circulating levels, which are modulated by placental clearance, increase during uncomplicated labor and more so in the presence of fetal hypoxia–asphyxia+NE, providing a better biomarker than UCH-L1 for hypoxia–asphyxia+NE.