L—精氨酸治疗胎儿宫内发育迟缓的效果及其机制探讨
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摘要
目的 探讨一氧化氮(NO)在胎儿宫内发育迟缓(IUGR)发生发展中的作用及L-精氨酸(L-Arg)治疗IUGR的效果和作用机制。
方法 选择符合入选条件的IUGR患者66例，其中L-Arg组30例，常规治疗组36例。另外，选择正常初产妇30例为正常妊娠对照组。监测胎儿生长发育参数、脐血流参数、孕母血液流变学参数、治疗前后孕妇血清NO水平及脐静脉血清NO水平，并比较新生儿出生体重和围产儿结局。
结果 治疗后，L-Arg组与常规治疗组比较：①L-Arg组双顶径(BPD)、股骨长(FL)及腹围(AC)的增长幅度较高(P均＜0.01)；②搏动指数(PI)、阻力指数(RI)较低(P＜0.01，P＜0.05)，快速血流比值(FBVR)较高(P＜0.01)；③全血粘度低切(LBV)值较低(P＜0.05)；④孕妇血清及脐静脉血清NO水平较高(P均＜0.01)；⑤小于胎龄儿(SGA)的发生率较低(P＜0.05)；⑥新生儿平均出生体重较高(P＜0.05)；⑦L-Arg组的治愈率为80.0％，显著高于常规治疗组(55.6％)(P＜0.05)。
结论 L-Arg通过增加内源性NO的合成和释放，具有改善母血粘度，疏通胎儿胎盘循环，促进胎儿生长发育的作用。L-Arg结合常规治疗较单纯常规治疗具有更好的临床疗效，值得临床推广。
Objectivities To investigate the relationship between nitric oxide (NO) and intrauterine growth retardation (IUGR), and to assess the effects of L-arginine (L-Arg) in treating IUGR.
Methods 66 pregnant women with IUGR were recruited. Of them, 36 cases (routine therapy group) were given routine therapy, while other 30 cases (L-Arg group) were given L-Arg combined with routine therapy. 30 cases with normal pregnancy were served as normal pregnant control group. Parameters such as fetal growth, umbilical artery flow, maternal hemorheology, maternal serum and umbilical vein serum NO level, newborn average birth weight and neonatal outcomes were measured and compared among these three groups.
Results After treatment ① the biparietal diameter (BPD), femoral length (FL) and abdominal circumference(AC) of L-Arg group were significantly increased as compared with those of routine therapy
group(P <0. 01 respectively);②the values of pulse index (PI) and resistant index (RI) of L-Arg group were
significantly lower than those of routine therapy group respectively(P<0. 01, P<0. 05), while the fast blood velocity rate (FBVR) was significantly higher(P<0. 01); ③ The value of blood viscosity at the low shear rate (LBV) of L-Arg group was significantly lower than that of routine therapy group (P<0. 05); ④Maternal serum NO level and umbilical vein NO level of L-Arg group were significantly higher than those of routine therapy group respectively ( P< 0.01 respectively);⑤the incidence of newborns with small for gestational age (SGA) of L-Arg group was significantly lower than that of routine group(P<0. 05) ; ⑥ The newborn average birth weight of L-Arg group was significantly lower than that of control group (
P<0. 01), but was significntly higher than that of routine therapy group (P<0. 05); ⑦The curative rate of L-Arg was 80. 0% which was
significantly higher than that of routine therapy group which was only 55. 6% (P<0. 05).
Conclusions NO deficiency may play an important role in the development of IUGR. L-Arg can increase NO level in vivo, improve maternal hemorheology and umbilical artery flow, accelerate fetal growth and increase newborn average birth weight. The curative effect of L-Arg combined with routine therapy is higher than that of routine therapy only.
方法 选择符合入选条件的IUGR患者66例，其中L-Arg组30例，常规治疗组36例。另外，选择正常初产妇30例为正常妊娠对照组。监测胎儿生长发育参数、脐血流参数、孕母血液流变学参数、治疗前后孕妇血清NO水平及脐静脉血清NO水平，并比较新生儿出生体重和围产儿结局。
结果 治疗后，L-Arg组与常规治疗组比较：①L-Arg组双顶径(BPD)、股骨长(FL)及腹围(AC)的增长幅度较高(P均＜0.01)；②搏动指数(PI)、阻力指数(RI)较低(P＜0.01，P＜0.05)，快速血流比值(FBVR)较高(P＜0.01)；③全血粘度低切(LBV)值较低(P＜0.05)；④孕妇血清及脐静脉血清NO水平较高(P均＜0.01)；⑤小于胎龄儿(SGA)的发生率较低(P＜0.05)；⑥新生儿平均出生体重较高(P＜0.05)；⑦L-Arg组的治愈率为80.0％，显著高于常规治疗组(55.6％)(P＜0.05)。
结论 L-Arg通过增加内源性NO的合成和释放，具有改善母血粘度，疏通胎儿胎盘循环，促进胎儿生长发育的作用。L-Arg结合常规治疗较单纯常规治疗具有更好的临床疗效，值得临床推广。
Objectivities To investigate the relationship between nitric oxide (NO) and intrauterine growth retardation (IUGR), and to assess the effects of L-arginine (L-Arg) in treating IUGR.
Methods 66 pregnant women with IUGR were recruited. Of them, 36 cases (routine therapy group) were given routine therapy, while other 30 cases (L-Arg group) were given L-Arg combined with routine therapy. 30 cases with normal pregnancy were served as normal pregnant control group. Parameters such as fetal growth, umbilical artery flow, maternal hemorheology, maternal serum and umbilical vein serum NO level, newborn average birth weight and neonatal outcomes were measured and compared among these three groups.
Results After treatment ① the biparietal diameter (BPD), femoral length (FL) and abdominal circumference(AC) of L-Arg group were significantly increased as compared with those of routine therapy
group(P <0. 01 respectively);②the values of pulse index (PI) and resistant index (RI) of L-Arg group were
significantly lower than those of routine therapy group respectively(P<0. 01, P<0. 05), while the fast blood velocity rate (FBVR) was significantly higher(P<0. 01); ③ The value of blood viscosity at the low shear rate (LBV) of L-Arg group was significantly lower than that of routine therapy group (P<0. 05); ④Maternal serum NO level and umbilical vein NO level of L-Arg group were significantly higher than those of routine therapy group respectively ( P< 0.01 respectively);⑤the incidence of newborns with small for gestational age (SGA) of L-Arg group was significantly lower than that of routine group(P<0. 05) ; ⑥ The newborn average birth weight of L-Arg group was significantly lower than that of control group (
P<0. 01), but was significntly higher than that of routine therapy group (P<0. 05); ⑦The curative rate of L-Arg was 80. 0% which was
significantly higher than that of routine therapy group which was only 55. 6% (P<0. 05).
Conclusions NO deficiency may play an important role in the development of IUGR. L-Arg can increase NO level in vivo, improve maternal hemorheology and umbilical artery flow, accelerate fetal growth and increase newborn average birth weight. The curative effect of L-Arg combined with routine therapy is higher than that of routine therapy only.
引文
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