母血细胞因子与绒毛膜羊膜炎关系的研究

目的探讨白细胞介素-6(IL-6),白细胞介素-8(IL-8),肿瘤坏死因子(TNF-α)与C-反应蛋白(CRP)对早产胎膜早破孕妇患绒毛膜羊膜炎的监测价值.方法对43例早产胎膜早破孕妇(29例有绒毛膜羊膜炎)血中IL-6,IL-8,TNF-α和CRP进行检测,并以正常孕妇20例作为对照组.结果29例绒毛膜羊膜炎患者血清IL-6,IL-8和CRP均明显高于非绒毛膜羊膜炎者和对照组,差异有显著性(P＜0.01);绒毛膜羊膜炎患者血清TNF-α水平也升高,但差异无显著性(P＞0.05);绒毛膜羊膜炎患者血IL-8,CRP,TNF-α水平与IL-6含量呈正相关.结论孕妇血中IL-6,IL-8和CRP的联合测定,可作为监测绒毛膜羊膜炎的重要指标,血TNF-α的测定也有一定的辅助作用.     

母血白细胞介素-6与早产亚临床绒毛膜羊膜炎及早产儿预后的关系

目的：探讨母血白细胞介素6（IL－6）与早产亚临床绒毛膜羊膜炎及早产儿预后的关系。方法：用酶联免疫吸附实验测定67例早产孕妇及32例相同孕周正常孕妇血IL－6，分娩时取部分胎盘胎膜送病检，记录1周内早产儿情况。结果：早产组血IL－6、WBC明显高于对照组（P＜0．05），组织学绒毛膜羊膜炎阳性组血清IL－6、C－反应蛋白（CRP）均明显高于组织学绒毛膜羊膜炎阴性组（P＜0．01）。母血IL－6≥10ng/L比IL－6＜10ng／L有较高的组织学绒毛膜羊膜炎和明显的新生儿发病率。结论：母血IL－6是预测早产亚临床绒毛膜羊膜炎及早产明显的新生儿发病率一项有用的指标。     

血清IL-6和IL-8对胎膜早破并发绒毛膜羊膜炎的监测

目的 探讨血清白细胞介素-6(IL-6)和白细胞介素-8(IL-8)作为胎膜早破合并宫内感染监测指标的可行性.方法 采用双抗体夹心ELISA法测定50例正常孕晚期妇女、25例胎膜早破未合并绒毛膜羊膜炎及49例胎膜早破合并绒毛膜羊膜炎孕妇血清IL-6和IL-8水平.结果 胎膜早破合并绒毛膜羊膜炎孕妇血清IL-6和IL-8为301.19±142.34 ng/L及312.32±149.56 ng/L,高于胎膜早破未合并绒毛膜羊膜炎者(分别为133.22±55.26 ng/L及125.35±61.30 ng/L)及正常孕晚期妇女(分别为126.59±57.12 ng/L及112.69±56.02 ng/L)(P＜0.001).IL-6和IL-8预测绒毛膜羊膜炎,灵敏度分别为0.857和0.898,特异性分别为0.96和0.92.结论 血清IL-6和IL-8可应用于胎膜早破感染的监测.     

绒毛膜羊膜炎诊断的研究进展

绒毛膜羊膜炎多继发于未足月胎膜早破,与早产关系密切.因为早产是3/4以上新生儿死亡的直接原因,故应高度警惕绒毛膜羊膜炎的发生,尤其是亚临床绒毛膜羊膜炎易被忽略.大量文献分别研究了传统生物指标包括红细胞沉降率、白细胞计数、C-反应蛋白,及近代分子生物指标包括基质金属蛋白酶、白细胞介素和肿瘤坏死因子等对绒毛膜羊膜炎的诊断价...     

未足月胎膜早破发生组织学绒毛膜羊膜炎风险评分系统构建

目的:建立未足月胎膜早破发生组织学绒毛膜羊膜炎(HCA)风险评分系统,为临床绒毛膜羊膜炎的早期诊断提供可靠的依据。方法:回顾分析2015年12月至2021年12月于安徽省立医院住院分娩的孕周为28～36⁺⁶周且符合本研究纳入排除标准的胎膜早破患者80例,其中未并发HCA者44例(对照组),并发HCA者36例(病例组)。综合孕妇年龄、孕周、孕产次、破膜时间、白细胞计数、中性粒细胞百分比、中性粒细胞及淋巴细胞计数、C-反应蛋白水平、NLR、PCT等指标,采用单因素和多因素逐步logistic回归分析,根据回归分析纳入变量的回归系数和OR值构建logistic评分系统和Additive评分系统,并采用受试者工作特征曲线检验其区分度、Hosmer-Lemeshow检验其校准度来评估预测模型。结果:未足月胎膜早破并发HCA预测模型：LogitP=30.992+0.516*WBC+0.305*NEU+0.675*NLR+0.626*CRP。定义简易logistic评分：WBC(>11.69)5分,NEU比例(>78.6)3分,NLR(>5.97)7分,CRP...     

绒毛膜羊膜炎与胎儿及新生儿疾病

绒毛膜羊膜炎是产科炎症反应,但与新生儿预后关系密切。母体的宫内炎症反应可以直接导致胎儿和婴儿患病率和死亡率增加,胎儿炎症反应综合征（FIRS）也不可忽视。早期识别和快速诊断有助于减少母儿的近期合并症,改善新生儿的远期预后。产科和儿科共同关注,整合信息,是早期发现、实施有效干预的临床重点之一。     

组织学绒毛膜羊膜炎发生的高危因素及其对母儿围产结局的研究

<正>绒毛膜羊膜炎(chorioamnionitis,CAM)是指病原体感染胎盘的绒毛膜羊膜和蜕膜而形成的炎症。CAM是早产、胎膜早破及母儿感染的重要原因。多项研究表明[1-2],CAM可导致母儿不良妊娠结局。CAM分为临床绒毛膜羊膜炎和组织学绒毛膜羊膜炎(histologic chorioamnionitis,HCA)。随着对胎盘病理重视程度的提高,HCA的诊断率显著升高。本研究通过回顾分析148例HCA患者及同期226例非HCA患者的病例资料,旨在探讨发生HCA的危险因素及HCA对妊娠结局的影响,以期得到临床对HCA的重视。     

血清一氧化氮测定在胎膜早破并绒毛膜羊膜炎诊断中的临床意义

胎膜早破(premature-rupture of membranes,PROM)发生率约占分娩总数的5％-15％,病因较复杂,与感染关系密切,互为因果,许多研究发现,细胞因子与胎膜早破并绒毛膜羊膜炎的发生相关。但20世纪80年代以来,一氧化氮(NO)却作为体内的一种重要信息传递物质日益受到重视。本研究应用放射免疫法测定并比较血清NO浓度在胎膜早破并绒毛膜羊膜炎孕妇中的变化,以探讨其在预测胎膜早破并绒毛膜羊膜炎的临床意义。     

绒毛膜羊膜炎发病机制及研究进展

病原体感染绒毛膜羊膜时,通过启动多种胞内信号转导系统,激活核转录因子,实现多种细胞因子的合成与释放,促进炎症反应的发生与扩大。炎症蔓延至胎儿血管时,还可造成胎儿感染,是早产、新生儿感染及死亡的重要原因。肿瘤坏死因子α(TNF-α)的释放与核因子κB(NFκB)的激活还与胎盘胎膜细胞凋亡的启动有关,这可能是胎膜早破的一个重要原因。蛋白质组学技术鉴定的一些与绒毛膜羊膜炎相关的生物标记物,可能是早产胎膜早破的重要因素之一。     

胎儿纤维连接蛋白与细菌性阴道病和绒毛膜羊膜炎关系的研究

目的 通过检测胎儿纤连蛋白（ＦＦＮ）研究细菌性阴道病和绒毛膜羊膜炎继产前早期诊断绒毛膜羊膜炎提供新方法。方法 采用酶联免疫吸附法（ＥＬＩＳＡ）对细菌性阴道病患者６０例（研究组）,健康孕妇４５例（对照组）进行宫阴道分泌物ＦＦＮ检测。以ＦＦＮ≥５０μｇ／Ｌ为判断阳性标准。     

血清IL-6检测与胎膜早破相关性研究

目的探讨孕妇血清IL6与胎膜早破及绒毛膜羊膜炎的关系。方法2004年1～10月中山大学附属第三医院对46例胎膜早破孕妇和50例正常孕妇,采用ELISA法测定血清IL6质量浓度,分娩时胎盘胎膜送病理检查。结果胎膜早破孕妇血清IL6质量浓度明显高于对照组,并随破膜时间的延长其含量升高(P<0.05),而且有绒毛膜羊膜炎者血清IL6高于无绒毛膜羊膜炎者及对照组(P<0.01);38例自然临产的胎膜早破孕妇中,血清IL6≥30ng/L者,其取样距临产时间短于血清<30ng/L者(P<0.05)。结论血清IL6含量升高对早期诊断胎膜早破合并绒毛膜羊膜炎及预测分娩具有重要意义。     

子宫内膜异位症患者腹腔液中瘦素及IL-8表达的临床意义

目的:探讨子宫内膜异位症(EMT)患者腹腔液中瘦素及白细胞介素-8(IL-8)表达及与其临床特征的相关性,探讨二者在EMT发病中的作用。方法:收集46例EMT患者(EMT组)及31例非EMT患者(对照组)的腹腔液,采用酶联免疫吸附试验(ELISA)法定量检测两组腹腔液中瘦素及IL-8的表达水平,分析瘦素、IL-8与EMT患者一般情况、分期及痛经或慢性盆腔痛评分的相关性。结果:腹腔液中瘦素、IL-8的表达水平与EMT患者年龄、体重、身高、体重指数及孕次均无相关性(r=-0.0900~0.1400,P均>0.05)。EMT组腹腔液中瘦素、IL-8表达水平(5.8±1.7ng/ml、75.0±23.3 pg/ml)分别高于对照组(2.2±0.9 ng/ml、18.6±9.4 pg/ml)(P<0.01)。瘦素在早期EMT组腹腔液中的表达水平(7.2±2.1 ng/ml)高于晚期EMT组(3.9±1.6 ng/ml)(P<0.01),而晚期EMT组的IL-8表达水平(138.0±31.4 pg/ml)高于早期EMT组(59.6±13.2 pg/ml)(P<0.05)。瘦素表达水平与rFAS分期呈负相关(r=-0.5615,P<0.05),IL-8表达水平与rFAS分期呈正相关(r=0.6320,P<0.01),晚期EMT患者IL-8表达水平与痛经或慢性盆腔痛评分呈正相关(r=0.6104,P<0.05)。盆腔EMT组的瘦素表达水平(9.7±2.0 ng/ml)高于卵巢巧克力囊肿组(4.3±1.6 ng/ml)(P<0.05)。结论:EMT患者腹腔液中瘦素及IL-8异常增高,升高的瘦素和IL-8可能起着促进、维持EMT病变的作用。瘦素可能与EMT的早期发病有关,而IL-8可能与EMT的进展有关。     

子宫内膜异位症患者腹腔液中IL-6、IL-8、IL-10含量升高及其临床意义

目的：检测子宫内膜异位症（endometriosis,EMS）患者腹腔液中IL-6、IL-8、IL-10含量及其临床意义。方法：剖腹探查手术中采集EMS组及对照组的腹腔液,用酶联免疫吸附法（ELISA）测细胞因子水平。EMS组中,13份测IL-6,16份测IL-8,22份测IL-10,共51份,对照组检测57份。结果：EMS组和对照组IL-6的含量分别为155．88±114．92ng／L和28．74±25．88ng／L（P＜0．01）。IL-8的含量分别为630．97±404．72ng／L和63．05±62．3ng／L（P＜0．01）。IL-10也明显高于对照组［（38．88±38．75ng／L比10．45±4．33ng／L（P＜0．01）〕。结论：EMS患者腹腔液中IL-6、IL-8及IL-10均升高,提示EMS患者的巨噬细胞活性增强,细胞因子含量增加,可干扰患者免疫调节功能。     

Amniotic fluid endothelin levels and the incidence of premature rupture of membranes.

Objective. The purpose of this prospective study was to record Endothelin 1 (ET1) concentrations in the second trimester amniotic fluid and in women who develop premature rupture of membranes (PROM), preterm premature rupture of the membranes (PPROM) and in women with uneventful pregnancies. Method. Amniotic fluid was retrieved by amniocentesis from 125 women in the second trimester of pregnancy. The levels of Endothelin were measured by a sensitive and specific radioimmunoassay. Results. From the 125 women included in the study 20 developed PROM and preterm PROM (13 PPROM and 7 PROM). The ET1 concentration was significantly higher (P<0.001) in PROM and PPROM than in normal pregnancy (96.4 vs. 43 pg/ml). The sub-analysis of the two rupture of membranes groups found that the concentration of ET1 was higher in the PPROM than in PROM (118 vs. 72 pg/ml). Conclusion. The amniotic fluid concentration of ET1 is elevated by the second trimester in women who later develop preterm PROM or term PROM.     

母血羊水中基质金属蛋白酶-9水平与胎膜早破关系的研究

目的　探讨基质金属蛋白酶 9(MMP 9)水平在胎膜早破孕妇血浆和羊水中的变化及与胎膜早破的关系。方法　 2 0 0 1年 2～ 12月采用酶联免疫吸附法对 2 6例胎膜早破孕妇和 2 0例正常妊娠孕妇血浆、羊水中MMP 9水平进行检测。结果　胎膜早破孕妇血浆与羊水中MMP 9水平分别为 4 2 2 2 7ng/L、187 2ng/L ,均明显高于对照组 ,差异有显著性意义 (P <0 0 1)。结论　MMP 9与胎膜早破有关 ,当MMP 9高于 35 0 0ng/L时 ,易发生胎膜早破 ,需及时采取预防措施。     

Maternal serum concentrations of s-Endoglin and IL-6 in pregnancy complicated by preterm premature membrane rupture

Objective: This study aimed to investigate maternal serum concentrations of s-Endoglin and compare s-Endoglin with other inflammatory markers in prediction of time to delivery, in pregnancies complicated by preterm premature rupture of membranes (PPROM).

Materials and methods: Fifty five patients complicated by PPROM whose gestational age were between 2433 weeks and 44 matched healthy pregnant women were included in present study. Maternal concentrations of s-Endoglin concentrations were measured by an enzyme-linked immunosorbent assay (ELISA) and compared with maternal inflammatory markers including interleukin-6 (IL-6), white blood cell (WBC) count and serum C-reactive protein (CRP). The best variable for prediction of preterm birth was computed.

Results: Mean s-Endoglin levels in PPROM were lower than control groups (0.24?±?0.12?pg/ml and 0.69?±?0.25?pg/ml, respectively, p?<?0.01). Besides IL-6 (p?<?0.01), WBC (p?=?0.016) and CRP (p?=?0.010) levels were higher in PPROM group. In PPROM group, ROC analysis results of s-Endoglin for prediction of preterm delivery <48 h, <7 days, <32 weeks were not different (p?>?0.05). For predicting preterm birth before 48 h and 7 days, only IL-6 at cut off value >0.70 (pg/ml) and >0.55 (pg/ml) had area under curve (AUC); 0.871 (0.7750.965), p?<?0.01, AUC; 0.925 (0.8560.993), p?<?0.001, respectively.

Conclusion: s-Endoglin as an anti-angiogenic marker seemed to have a role in pathogenesis but results of present study showed that, unlike IL-6, it was unsatisfactory for estimating time to delivery in PPROM.     

白细胞介素-8和白细胞介素-6对分娩发动的影响

目的 探讨白细胞介素－８（ＩＬ－８）、白细胞介素－６（ＩＬ－６）在分娩发动中的作用。方法 随机选择孕３８￣４１的５４例胎膜完整的单胎初产妇临产前后共６０份血清样本,进行ＩＬ－８、ＩＬ－６水平测定并分进行对比分析。结果 妊娠晚期,随着孕周的增加,血清ＩＬ－８水平逐渐增高,逐渐变软展平。ＩＬ－８水平与宫颈Ｂｉｓｈｏｐ评分呈直线正相关。临瓣一血清ＩＬ０－８水平明显低于临产水平,且在第一产程各阶段差异显著     

Midtrimester amniotic fluid matrix metalloproteinase-8 (MMP-8) levels above the 90th percentile are a marker for subsequent preterm premature rupture of membranes

OBJECTIVE: We sought to determine whether midtrimester amniotic fluid levels of matrix metalloproteinase-8 were associated with subsequent preterm premature rupture of membranes. STUDY DESIGN: We conducted a case-control study examining 57 asymptomatic women who underwent genetic amniocentesis from 14 to 21 weeks' gestation and subsequently had preterm premature rupture of membranes (<35 wk) and 58 women with subsequent term delivery. Measurement of total matrix metalloproteinase-8 level in amniotic fluid was conducted using a commercially available enzyme-linked immunosorbent assay and association with preterm birth due to preterm premature rupture of membranes was assessed. RESULTS: The overall distribution of matrix metalloproteinase-8 concentrations was similar in women who had preterm premature rupture of membranes and term controls (median 2.39 ng/mL, 25th to 75th percentile 1.1-10.1 vs 2.37 ng/mL, 25th to 75th percentile 1.5-4.7, P = .94). However, 26% of women who had preterm premature rupture of membranes had a matrix metalloproteinase-8 concentration above the 90th percentile (8.7 ng/mL), compared with only 10% of term controls (odds ratio 3.1, 95% CI 1.1-8.7; P = .03). Elevated matrix metalloproteinase-8 remained associated with preterm premature rupture of membranes after adjustment for maternal age, race, parity, gestational age, and year of amniocentesis (odds ratio 3.4, 95% CI 1.2-9.9; P = .03). CONCLUSIONS: The overall distribution of midtrimester amniotic fluid matrix metalloproteinase-8 levels did not differ between women who had preterm premature rupture of membranes and those delivered at term. However, marked elevations of midtrimester amniotic fluid matrix metalloproteinase-8 were highly associated with subsequent preterm premature rupture of membranes, suggesting that the pathophysiologic processes that contribute to preterm premature rupture of membranes may begin in early pregnancy.