임산부 및 제대 혈중 그렐린 농도와 신생아 출생 체중과의 연관성
Relationship between Ghrelin levels of maternal serum, umbilical vein and birth weight
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목적: 임신 분기별 혈중 그렐린 농도의 변화 추이를 관찰하고, 저체중아를 분만한 임산부 20명을 연구군, 정상 체중아를 분만한 20명을 대조군으로 하여 임산부 및 제대 정맥 혈중 그렐린 농도를 측정하여 태아 출생 체중과의 관련성을 조사하였다. 연구 방법: 임신 분기별 임산부 혈중 그렐린 농도는 제1삼분기에는 산전진찰을 위한 최초 방문(임신 6∼8주)시 측정하였고, 이후 제2삼분기 (임신 18∼20주), 제3삼분기 (임신 36∼38주) 및 산욕기 (분만 다음 날)에 측정하였다. 신생아 출생체중과의 연관성을 조사하기 위한 임산부 혈중 그렐린 농도는 제3삼분기에 분만을 위한 입원 당일에 측정하였고, 제대 혈중 그렐린 농도는 분만 직후 제대 정맥을 통해 측정하였다. 결과: 임신 중 임산부 (N=41) 혈중 그렐린 농도는 제1삼분기에는 평균 26.0±6.3 pg/mL, 제2삼분기는 35.7±12.7 pg/mL, 제3삼분기는 26.5±10.3 pg/mL로 제2삼분기에 가장 높았고, 제3삼분기에는 감소하였으며, 분만 후에는 39.9±23.4 pg/mL로 다시 증가하는 양상을 보였다. 임산부의 혈중 그렐린 농도는 저체중아를 분만한 경우 (N=20)는 평균 37.3±8.7 pg/mL, 정상 체중아를 분만한 경우 (N=20)는 28.8±16.1 pg/mL로 양 군에서 유의한 차이가 없었으며 (P>0.05), 신생아의 출생 체중과 통계적으로 유의한 상관관계를 보이지 않았다 (r=-0.102, P>0.05). 임산부의 제대 혈중 그렐린 농도는 저체중아를 분만한 경우 (N=20)는 평균 89.3±38.7 pg/mL로 정상 체중아를 분만한 경우 (N=20)의 39.9±26.1 pg/mL에비해 유의하게 높았으며 (P<0.05), 신생아 출생체중과 통계적으로 유의한 음의 상관관계를 보였다 (r=-0.411, P<0.05). 결론: 본 연구에서 임산부 제대 혈중 그렐린 농도는 신생아의 출생 체중과 통계적으로 유의한 음의 상관관계를 보여 태아에서 영양공급의 급, 만성 변화를 반영한다.
Abstract
Objective: Ghrelin is a newly isolated peptide from the stomach. Subsequent studies revealed that ghrelin is expressed in human placenta. Circulating ghrelin levels reflect acute and chronic energy balance in humans. However, it is not proven whether ghrelin plays a role during pregnancy. The purpose of this study was to compare relationship between ghrelin levels of maternal serum, umbilical vein and birth weight. Methods: We measured maternal ghrelin levels (N=41) in each trimester and postpartum whose fetus were appropriate-for-gestational age. Also we checked cord blood ghrelin levels at delivery in appropriate-for-gestational age group (N=20) and small-for-gestational age group (N=20). Results: Ghrelin was detected in all samples from maternal and cord blood. Maternal serum ghrelin levels showed a peak in the 2nd trimester (35.7±12.7 pg/mL) and decreased in the late 3rd trimester (26.5±10.3 pg/mL). An increase was observed again in postpartum, which was measured at one day after delivery. There was no significant correlation between maternal serum ghrelin level and birth weight (P>0.05), but there was statistically significant correlation between cord blood ghrelin level and birth weight (r=-0.411, P<0.05). Conclusion: Maternal serum ghrelin levels showed a peak around mid-gestation during pregnancy and then, decreased in the 3rd trimester, the time of increased maternal body weight. There was no association between maternal serum ghrelin level and birth weight. But small-for-gestational age neonates present with higher umbilical cord ghrelin level than that of appropriate-for-gestational age neonates. It is conceivable that ghrelin may play a physiologic role in fetal adaptation to intrauterine malnutritional state.
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