胎膜早破孕妇不同时段血清和羊水中MIF、MMP-3及IL-8的对比研究

目的探讨血清和羊水中MIF、MMP-3及IL-8的检测在胎膜早破的意义及与绒毛膜羊膜炎之间的关系。方法采用ELISA法分别检测75例PROM分娩组和70例非PROM分娩组的血清及羊水中MIF,MMP-3及IL-8的水平分布和表达,采用HE染色的方法确诊绒毛膜羊膜炎。结果 PROM组MIF、MMP-3、IL-8水平均明显高于对照组,PROM绒毛膜羊膜炎组MIF、MMP-3、IL-8水平均明显高于PROM非绒毛膜羊膜炎组。在PROM组中,随着破膜时间的延长,血清和羊水中MIF、MMP-3、IL-8水平逐渐增加。经统计学分析,各组间两两比较有显著性差异（P〈0.05）。结论 MIF、MMP-3、IL-8在胎膜早破的发病机制中起着重要的作用,MIF、MMP-3、IL-8与绒毛膜羊膜炎有密切关系。     

基质金属蛋白酶-9、白介素-1β与未足月胎膜早破的关系

目的探讨基质金属蛋白酶-9（MMP-9）、白细胞介素-1β（IL-1β）与未足月胎膜早破（PPROM）及绒毛膜羊膜炎的关系。方法采用双抗体夹心酶联免疫吸附法检测未足月胎膜早破组56例、足月胎膜早破组38例、正常妊娠组30例孕妇的血清、羊水、脐血中MMP-9、IL-1β的水平,并进行胎膜的病理检查。结果胎膜早破孕妇的血清、羊水、脐血中MMP-9、IL-1β水平明显高于对照组,而且未足月胎膜早破孕妇的MMP-9、IL-1β水平亦高于足月胎膜早破者（P〈0.01）;未足月胎膜早破组的绒毛膜羊膜炎的发生率明显高于足月胎膜早破组（P〈0.01）;发生绒毛膜羊膜炎的胎膜早破孕妇的血清、羊水、脐血中MMP-9、IL-1β水平明显高于非绒毛膜羊膜炎的胎膜早破孕妇（P〈0.01）。结论检测孕妇血清的MMP-9、IL-1β水平可作为未足月胎膜早破良好的预测指标,测定孕妇血清、羊水的MMP-9、IL-1β水平还有助于胎膜早破并绒毛膜羊膜炎的早期诊断。     

胎膜早破孕妇母血、脐血中IL-6、IL-18的变化及临床意义

目的通过检测胎膜早破孕妇母血及脐血中IL-6、IL-18的水平，探讨其与亚临床绒毛膜羊膜炎的关系，预测亚临床绒毛膜羊膜炎的可行性。方法ELISA方法测定足月前胎膜早破组（PPROM）、足月胎膜早破组（PROM）及正常对照组孕妇母血、脐血中IL-6、IL-18的水平，胎膜病理检查确定有无组织学绒毛膜羊膜炎。结果（1）胎膜早破孕妇血清及脐血中IL-6、IL-18明显高于对正常照组；（2）有组织学绒毛膜羊膜炎者，其母血、脐血中IL-6、IL-18的水平高于无绒毛膜羊膜炎者。母血中IL-18是反应绒毛膜羊膜炎严重程度的独立因素；（3）母体血清IL-18浓度为23.09ng/ml时，IL-6浓度为24.58ng/ml时，可作为预测绒毛膜羊膜炎的阈值。结论IL-18可作为早期预测胎膜早破时绒毛膜羊膜炎的指标。     

基质金属蛋白酶8,C-反应蛋白,IL-6与胎膜早破患者绒毛膜羊膜炎的关系研究

目的 探讨胎膜早破孕妇血清中及羊水中基质金属蛋白酶8(MMP-8)和白细胞介素6(IL-6)及血清中C-反应蛋白(CRP)与绒毛膜羊膜炎的关系.方法 选择40例胎膜早破患者为研究组,同期正常40例孕妇为对照组,采用酶联免疫吸附法和放射免疫法检测MMP-8和IL-6水平,CRP水平测定采用数率散射比浊法,同时行产后胎膜病理检查.结果 胎膜早破孕妇羊水中MMP-8和IL-6水平明显高于对照组,差异显著(P＜0.05);羊水中MMP-8和IL-6及血清中IL-6和C-反应蛋白在绒毛膜羊膜炎组差异显著(P＜0.05).结论 胎膜早破孕妇羊水中IL-6、MMP-8和血清IL-6、血C-反应蛋白(CRP)水平对诊断绒毛膜羊膜炎有临床应用价值.     

IL-6、MMP-9、TNF-α在胎膜早破早产孕妇血清、羊水中的表达及意义

目的研究IL-6、MMP-9、TNF-α在未足月胎膜早破早产孕妇的血清、羊水中的含量及表达,探讨其与胎膜早破早产的关系。方法采用酶联免疫吸附法检测30例胎膜早破早产孕妇（PPROM组）与20例正常孕妇（对照组）血清和羊水中的IL-6、MMP-9、TNF-α的含量,同时进行胎膜的病理检查。结果 PPROM组母血清及羊水中IL-6、MMP-9的含量均高于对照（P〈0.05）,羊水中TNF-α的含量较对照组高（P〈0.05）。PPROM组绒毛膜羊膜炎者血清、羊水中IL-6、TNF-α（P〈0.05）、MMP-9（P〈0.01）水平均高于非绒毛膜羊膜炎者。结论孕妇血清、羊水中IL-6、MMP-9、TNF-α水平与PPROM感染引起的早产有关,检测其水平可作为PPROM良好的预测指标。     

IL-6和CRP在预测未足月胎膜早破亚临床感染中的作用

目的探讨IL-6及CRP在预测未足月胎膜早破亚临床中的作用。方法通过对166例未足月胎膜早破孕妇的血清IL-6及CRP的测定及胎盘病检,将诊断为亚临床绒毛膜羊膜炎的36例及无绒毛膜羊膜炎84例作为研究对象,分析两组病例的IL-6及CRP。结果亚临床绒毛膜羊膜炎组的IL-6及CRP明显高于无绒毛膜羊膜炎组,对比有显著性差异（P〈0.05）。结论 IL-6及CRP可用于预测未足月胎膜早破绒毛膜羊膜炎,两者联合诊断绒毛膜羊膜炎的敏感性及特异性〉90%     

不同途径IL-8测定预测不良妊娠结局的比较研究

目的探讨白细胞介素8（interleukin-8，IL-8）对不良妊娠结局预测价值。方法采用酶联免疫吸附（ELISA）法，检测102例异常妊娠孕妇（观察组）及63例同期正常孕妇（对照组）阴道分泌物及血清IL-8含量，同时两组孕妇均取胎膜行病理检查。结果异常妊娠组IL-8含量、绒毛膜羊膜炎发生率明显高于对照组，差异有显著意义（P〈0．01、P〈0．05）。绒毛膜羊膜炎孕妇IL-8均高于非绒毛膜羊膜炎，差异有显著意义（P〈0．01、P〈0．05），结论孕妇IL-8变化与不良妊娠结局的关系密切，IL-8可能参与了不良妊娠结局的发生发展，它可作为预测不良妊娠结局和判断绒毛膜羊膜炎的参考指标，并且血清IL-8的有较高敏感性和特异性。     

血清IL-6水平与胎膜早破合并宫内感染的关系

目的探讨血清IL-6水平与胎膜早破合并宫内感染的关系.方法选取胎膜早破孕妇46例(其中早产早破组22例,足月早破组24例),和产科门诊定期产检的正常孕妇50例为对照组(其中未足月对照组22例,足月对照组28例),用酶联免疫法测定血清IL-6含量,分娩时取部分胎盘胎膜组织送病检.结果胎膜早破孕妇组织学绒毛膜羊膜炎的发生率为52.4%(24/46).早产早破组与足月早破组血清IL-6水平相比无差异(P>0.05),但均高于对照组(P<0.05=),无论是早产早破组还是足月早破组,有组织学绒毛膜羊膜炎者血清IL-6水平均高于无组织学绒毛膜羊膜炎者及对照组(P<0.05=).结论血清IL-6水平升高可作为早期诊断胎膜早破合并宫内感染的指标.     

母血、羊水、脐血中MMP-9及其组织抑制物TIMP-1水平变化与胎膜早破关系的临床研究

目的探讨母血、羊水、脐血中基质金属蛋白酶9(MMP-9)及其组织抑制物1(TIMP-1)的水平变化与胎膜早破发生的相关性,分析其作为一种新型的生物学标志物对绒毛膜羊膜炎和新生儿预后判断的临床价值.方法采用双抗体夹心酶联免疫吸附法检测58例胎膜早破母血、羊水、脐血中MMP-9/TIMP-1水平的水平变化,同时进行胎膜的病理检查.结果胎膜早破组母血、羊水、脐血中MMP-9的含量均高于对照组,尤以羊水中MMP-9水平升高更明显,而TIMP-1水平变化则明显低于对照组(P＜0.05,P＜0.01).MMP-9的含量随破膜时间的延长而增高,尤其破膜时间超过24h增高更为明显.而TIMP-1则随破膜时间的延长而下降,尤其破膜时间超过24h降低更为明显.并发绒毛膜羊膜炎者其MMP-9水平明显高于非绒毛膜羊膜炎患者,而TIMP-1水平则明显低于非绒毛膜羊膜炎患者(P＜0.05,P＜0.01).胎膜早破组产妇所生新生儿Apgar评分≤7分者,其MMP-9的含量显著高于Apgar≥8分的新生儿,而TIMP-1的含量则显著低于Apgar≥8分的新生儿(P＜0.05,P＜0.01).结论MMP-9的异常升高及其抑制物TIMP-1的显著下降是胎膜早破发生的重要发病机制.MMP-9/TIMP-1含量变化可以成为一种新的生物学标志物用于胎膜早破并绒毛膜羊膜炎特别是尚处于亚临床感染状态的孕妇进行早期诊断,并有助于评估新生儿预后.     

PCT、IL-6和CRP水平预测未足月胎膜早破患者并发绒毛膜羊膜炎及新生儿早发性败血症的价值研究

目的 观察联合检测PCT、IL-6和CRP水平预测未足月胎膜早破患者并发绒毛膜羊膜炎及新生儿早发性败血症的临床价值。方法 将2017年1月~2018年6月在我院治疗的70例未足月胎膜早破（PPROM）患者设为观察组,选取同期在我院产检孕周正常的70例孕妇设为对照组,根据病理检查将观察组分为绒毛膜羊膜炎组与无绒毛膜羊膜炎组,同时依据新生儿感染情况分为败血症组和非感染组。对比观察组和对照组外周血、脐血PCT、IL-6、CRP水平表达情况,并对观察组孕妇分娩后胎盘胎膜进行病理学检查以及追踪新生儿感染情况。结果 观察组孕妇外周血中PCT、IL-6、CRP水平均高于对照组,差异有统计学意义（P＜0.05）;无绒毛膜羊膜炎组PCT、IL-6、CRP水平低于绒毛膜羊膜炎组,差异有统计学意义（P＜0.05）;联合检测PCT、IL-6及CRP诊断绒毛膜羊膜炎的敏感性为68.75%、特异性为93.75%、阳性预测值为97.05%;脐血PCT、IL－6、CRP水平在败血症组新生儿中显著升高,与非感染组新生儿及对照组新生儿比较,差异有统计学意义（P＜0.05）。结论 PPROM孕妇外周血PCT、IL-6、CRP水平较高,三项指标联合检测对绒毛膜羊膜炎预测价值高,脐血PCT、IL－6、CRP水平检测有利于早期诊断新生儿早发性败血症。     

Upregulated amniotic fluid cytokines and chemokines in emergency cerclage with protruding membranes

PROBLEM To identify the prognostic factors for pregnancy outcome in women who received emergency cerclage for dilated cervix with protruding membranes. METHOD OF STUDY A prospective cohort study was performed, and a total of 14 women who received emergency cerclage were included. Clinical features and laboratory findings including amniotic fluid cytokines and chemokines were compared between women who had successful pregnancy (survival group, n = 6) and those who had perinatal death (non-survival group, n = 8). Five healthy pregnant women served for normal controls for amniotic fluid study. RESULTS The overall neonatal survival was 42.9% in women with emergency cerclage. Serum C-reactive protein levels on postoperative day 3 and 7 were significantly higher in non-survival group when compared with those in survival group (P = 0.002, P = 0.01). Amniotic fluid levels of interleukin (IL)-1α, IL-1β, IL-6, IL-8, IL-10, tumor necrosis factor-α, and monocyte chemoattractant protein-1 levels of the patients were significantly higher than those of normal controls. Amniotic fluid levels of IL-1α, IL-1β, and IL-8 were significantly increased in the non-survival group when compared with those of the survival group. CONCLUSION Systemic and local inflammatory markers including proinflammatory cytokines and chemokines may predict pregnancy outcome in women with emergency cerclage for dilated cervix with protruding membranes.     

胎膜早破羊水与新生儿咽拭子细菌培养分析

目的评估胎膜早破与分娩间隔时间相关的新生儿和母亲感染结局。方法对住院胎膜早破孕妇33例按破膜距临产的时间分为4组：〈12h、12～24h、25～48h、〉48h,与未破膜组孕妇30例均进行羊水和新生儿咽拭子细菌培养。采用非参数检验进行统计学处理。结果胎膜早破超过48h羊水与新生儿咽拭子细菌培养阳性率为60%、40%,胎膜早破24～48h阳性率为20%、0,小于24h均为阴性。对照组羊水与新生儿咽拭子菌培养均为阴性。结论随破膜时间延长,母婴感染率增加。破膜后48h内分娩,能获得最好母婴结局。     

Amniochorion: A Source of Interleukin-8

PROBLEM : Preterm labor and premature rupture of the membranes are major complications of pregnancy. We have reported the possible role of amniochorionic membrane in the production of inflammatory cytokines and the early onset of labor. This study was conducted to detect the expression of IL-8 mRNA and peptide production in cultured fetal membranes. METHOD : Amniochorionic membranes were collected from women undergoing elective cesarean section at term. Membranes were cultured in an organ explant system and the expression of IL-8 was studied over a 10-day period by RT-PCR and in situ hybridization. IL-8 peptide localization was accomplished using immunocytochemistry. RESULTS : Constitutive expression of IL-8 mRNA in cultured fetal membranes was demonstrated in both amniotic and chorionic leave cells. mRNA and peptide for IL-8 was homogeneously distributed throughout the amniotic and chorionic cells. CONCLUSION : Human amniochorionic membrane is a source of IL-8 mRNA and peptide.     

两种方法检测分娩期孕妇解脲支原体、沙眼衣原体宫内感染的分析

目的了解分娩期孕妇解脲支原体(Uu)、沙眼衣原体(CT)感染的发病率及其对不良妊娠结局的影响.方法采用PCR方法检测宫颈分泌物、羊水配对标本Uu、CT-DNA,及蛋白芯片方法检测孕妇空腹血清、脐动脉血血清配对标本Uu、CT-IgG抗体.结果 116例分娩期孕妇宫颈分泌物Uu、CT的阳性率分别是37.93%,5.17%,而羊水中Uu、CT的检出率为0%.孕妇血清Uu、CT感染率分别是38.14%,14.66%,脐动脉血血清Uu、CT阳性率19.83%,6.90%,血行性宫内感染垂直传播率约为50%.Uu或CT阳性组孕妇胎膜早破、胎儿宫内窘迫、相对性脐带过短发生率显著高于Uu和CT阴性组孕妇(P＜0.05).结论分娩期孕妇Uu和CT感染与胎膜早破、胎儿宫内窘迫、脐带缠绕有关.Uu、CT蛋白芯片方法是一种检测Uu、CT感染的新方法,值得临床推广应用.     

Evaluation of amniotic fluid for aerobic and anaerobic bacteria.

Studies of 117 pregnant women, 83 at term, were instituted to determine the bacteriologic state of amniotic fluid, utilizing both standard aerobic and anaerobic technics. A high association of postpartum infection was found in women who had long periods of premature reptured membranes and many vaginal examinations. Significant organisms including anaerobes, were isolated in many of these instances. Based on the findings of these studies, it is recommended that amniocentesis for aerobic and anaerobic cultures be done when membranes have been ruptured for 8 hours or more, and when the patient has had seven or more vaginal examinations during the course of labor.     

Cytokine levels in midtrimester amniotic fluid in normal pregnancy and in the prediction of pre-eclampsia

Midtrimester amniotic fluid cytokines may reflect the function of the maternal immune system in the maternal-fetal interface and thus be predictive of pre-eclampsia. We determined the concentrations of interleukin (IL)-6, IL-8, IL-10, IL-11, IL-12, IL-15, tumour necrosis factor (TNF)-alpha and transforming growth factor (TGF)-beta in amniotic fluid at 14-16 weeks of gestation from women with normal pregnancies and from those who subsequently developed severe pre-eclampsia. The concentrations of the cytokines in amniotic fluid did not significantly differ between patients and normal controls. The median concentration of IL-6 was 950 pg/ml in normal pregnant women and 578 pg/ml in the patient group. The median concentration of IL-8 was 606 pg/ml in normal controls and 294 pg/ml in the patient group. The levels of IL-6, IL-8 and TGF-beta correlated positively with each other. TNF-alpha concentrations were low and similar in both groups. IL-10 and IL-12 were detected at very low levels in 37 and 7% of the samples, respectively. No difference was found in IL-15 concentrations between the groups. IL-11 was found only at low levels in both groups. Although none of the cytokines measured was predictive of pre-eclampsia, this study provides information of cytokines in amniotic fluid during the period when the spiral arteries are remodelled.     

检测孕妇感染解脲脲原体的意义

目的前瞻性研究孕妇感染解脲脲原体（ＵＵ）后对胎儿的影响。方法通过培养法对在青岛市计划生育科研所和第八人民医院就诊和住院的９４５名孕妇进行了宫颈粘液检查，并对其中３５５例ＵＵ阳性者的羊水进行了培养检查，前瞻性观察其对胎儿的危害。结果早孕妇女ＵＵ感染阳性率为２７．８３％，显著低于晚孕妇女的３８．９２％。宫腔感染ＵＵ后，胎儿自然流产率、死胎率、出生缺陷率和羊膜早破率都显著高于未感染组，但新生儿出生体重二组差异无显著性。结论随着孕期的增加，孕妇感染ＵＵ的风险也增加。孕妇感染ＵＵ后对胎儿形成严重危害     

Interleukin-1 alpha and interleukin-1 beta in preterm and term human parturition.

Interleukin-1 (IL-1) has been implicated in the mechanism of human parturition in the setting of infection. The purpose of this study was to determine the effect of labor (term and preterm) and microbial invasion of the amniotic cavity on amniotic fluid (AF) concentrations IL-1 alpha and IL-1 beta. AF was retrieved by transabdominal amniocentesis from the following groups of women: midtrimester genetic amniocentesis (16 to 18 wk) (N = 15), preterm labor with intact membranes (21 to 36 wk) with or without infection (N = 72), preterm premature rupture of membranes (PROM) (N = 88), and term not in labor or in active labor with or without infection (N = 58). AF was cultured for aerobic and anaerobic bacteria as well as Mycoplasmas. IL-1 was measured with a commercially available immunoassay validated for AF (sensitivity: IL-1 alpha, 157 pg/ml; IL-1 beta, 50 pg/ml). All women at midtrimester had undetectable AF IL-1 alpha and IL-1 beta. Among women in preterm labor with positive AF cultures, IL-1 alpha and IL-1 beta were detectable in the AF in 86.6% (13/15) and 100% (15/15), respectively. In contrast, all women with negative AF cultures without labor (N = 36) had undetectable AF IL-1 alpha concentrations and 52.7% (19/36) had undetectable AF IL-1 beta concentrations. Histopathological chorioamnionitis was present in 92.8% (13/14) of patients who had positive AF cultures and detectable IL-1 in the AF. IL-1 was significantly higher in patients with preterm PROM, labor, and positive AF cultures than in the other subgroups of patients with preterm PROM.(ABSTRACT TRUNCATED AT 250 WORDS)     

欣普贝生和缩宫素对足月胎膜早破引产效果比较

目的 比较欣普贝生和缩宫素对足月胎膜早破的临床效果。方法 选择我院2017年12月~2018年5月收治的胎膜早破孕妇200例,其中92例孕妇放置欣普贝生引产的作为欣普贝生组,缩宫素引产的108例孕妇作为缩宫素组,比较两组孕妇用药后引产结局,包括宫颈评分、破膜至用药时间、用药至临产时间、总产程、引产成功率、剖宫产率、产后出血及新生儿结局。结果 两组产后2 h出血量比较,差异无统计学意义（P＞0.05）;欣普贝生组引产前宫颈评分低于缩宫素组,用药至临产时间及总产程少于缩宫素组,差异有统计学意义（P＜0.05）;欣普贝生组、缩宫素组引产成功率分别为81.52%和83.33%,绒毛膜羊膜炎率分别3.26%、3.70%,差异均无统计学意义（P＞0.05）;两组新生儿窒息、羊水粪染及胎儿窘迫发生率比较,差异无统计学意义（P＞0.05）。结论 针对足月胎膜早破,宫颈不成熟的孕妇,欣普贝生诱发宫缩快,宫缩强而协调,是安全有效的引产方式,其剖宫产率、新生儿不良结局、产后出血与使用缩宫素基本一致,不增加风险。