先兆早产孕妇血清TNF-α、IL-6及IL-8和阴道分泌物MMP-8、IL-6检测的意义

本文通过将先兆早产孕妇的血清TNF-α、IL-6及IL-8值和阴道分泌物MMP-8和IL-6进行分析,旨在探讨和先兆早产发生之间的关系.     

先兆早产孕妇血清TNF—α、IL-及IL-8和阴道分泌物MMP-8、IL-6检测的意义

本文通过将先兆早产孕妇的血清TNF—α、IL-6及IL-8值和阴道分泌物MMP-8和IL-6进行分析，旨在探讨和先兆早产发生之间的关系。     

阴道分泌物白细胞介素8与孕妇宫内感染关系探讨

目的探索一种早期诊断宫内感染简便、易行的方法,对绒膜羊膜炎患者早期诊断、早期治疗,以减少围产期并发症及不良妊娠结局的发生。方法对375例不同孕周的孕妇检测其阴道分泌物沙眼衣原体(CT),解脲支原体(Uu),人型支原体(Mh),细菌性阴道病(BV)等病原微生物进行白细胞介素8(IL-8)定量检测及妊娠结局的随访观察,观察IL-8浓度与孕妇阴道感染及发生流产、早产、胎膜早破、胎儿宫内生长受限(FGR)等宫内感染的关系。结果发现有阴道微生物感染的孕妇(255例),阴道分泌物IL-8浓度明显高于无阴道感染的对照组(120例),发生宫内感染、流产、早产、胎膜早破、胎儿宫内生长受限(FGR)等的几率明显高于对照组。结论阴道分泌物IL-8浓度的监测可以作为早期诊断宫内感染的有效预测指标。     

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。     

先兆早产孕妇血清IL-6和宫颈分泌物fFN测定的临床分析

目的：探讨血清白细胞介素-6（IL-6）、宫颈分泌物胎儿纤维连接蛋白（fFN）检测对预测早产的临床价值。方法：随机选择先兆早产孕妇38例作为先兆早产组,予以保胎治疗,根据保胎成功与否,又分为保胎成功组（26例）与保胎未成功组（12例）。检测保胎成功组、保胎未成功组治疗前后血清IL-6、宫颈分泌物fFN含量情况,并与正常妊娠组（36例）比较。结果：治疗前,先兆早产组（保胎未成功组、保胎成功组）血清IL-6、宫颈分泌物fFN明显高于正常妊娠体检组（均P〈0.01）。治疗后,保胎成功组血清IL-6、宫颈分泌物fFN明显低于保胎未成功组（均P〈0.01）;保胎成功组血清IL-6、宫颈分泌物fFN,与治疗前比较有明显降低（均P〈0.01）。结论：临床可以通过检测孕妇血清IL-6、宫颈分泌物fFN的含量来预测早产;同时,可以将上述指标的好转作为临床保胎治疗有效的指标。     

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.     

TORCH-IgM阳性孕妇复查结果与妊娠结局的研究

目的探讨TORCH血清筛查IgM阳性孕妇复查结果与不良妊娠结局的关系.方法用酶免疫捕获法检测TORCH-IgM抗体、对阳性孕妇作2～3次TORCH-IgM复查和IgG检测,并对IgM复查阳性孕妇的阴道分泌物进行白细胞介素8(IL-8)检测、B超监测、新生儿脐血检查和妊娠结局观察.结果 TORCH-IgM第1次复检阳性率为33.33%(14/42), 第2次复检阳性率为19.05%(8/42),有4.76%(2/42)的孕妇IgG抗体阴转阳,同时伴阴道分泌物IL-8异常升高,在妊娠早期发生流产,其余TORCH-IgM抗体阳性的孕妇阴道分泌物白细胞介素8检测在正常范围内,妊娠结局正常.结论 TORCH-IgM血清学筛查阳性的孕妇应该多次复查、以便确认是否是活动期感染,进一步结合孕妇阴道分泌物IL-8检测、B超监测、新生儿脐血检查等多种综合检查方法,有助于提高TORCH宫内感染预测诊断的准确性.     

阴道分泌物IGFBP-1、fFN检测联合宫颈管长度对早产的预测价值

目的 探讨阴道分泌物胰岛素样生长因子结合蛋白1(IGFBP-1)、胎儿纤连蛋白（fFN）联合宫颈管长度对早产的预测价值。方法 选取沧州市人民医院226例确诊先兆早产的孕妇为研究对象,根据最终妊娠结局将其分为非早产组（162例）和早产组（64例）。采用酶联免疫吸附（ELISA）法检测阴道分泌物IGFBP-1、fFN水平,采用多普勒超声诊断仪检测宫颈管长度;采用Pearson法分析早产孕妇阴道分泌物IGFBP-1、fFN水平与宫颈管长度的相关性;采用受试者操作特征曲线（ROC曲线）分析阴道分泌物IGFBP-1、fFN水平及宫颈管长度对早产的预测价值;采用单因素及多因素Logistic回归分析影响孕妇早产的因素。结果 早产组阴道分泌物IGFBP-1、fFN水平高于非早产组,宫颈管长度低于非早产组,差异有统计学意义（P<0.05）。早产孕妇阴道分泌物IGFBP-1与fFN水平呈正相关（P<0.05）,且二者与宫颈管长度均呈负相关（P<0.05）。阴道分泌物IGFBP-1、fFN、宫颈管长度及联合预测早产的曲线下面积（AUC）分别为0.889、0.877、0.913、0.970...     

β-族溶血性链球菌感染与胎膜早破及母儿预后

目的探讨β-族溶血性链球茵（GBS）感染与胎膜早破的关系及母儿预后的影响。方法选择胎膜早破（PROM）292例和200例正常妊娠作对照,取宫颈-阴道分泌物进行GBS培养,对GBS阳性的胎膜早破孕妇的羊水作白介素-6测定,并随机选择20例GBS阴性的胎膜早破孕妇作比较,并比较母儿预后。结果胎膜早破孕妇宫颈-阴道分泌物GBS阳性率（14％）明显高于正常组（6．0％）（P〈0．05）,未足月胎膜早破孕妇122例GBS阳性率（17．2％）明显高于足月胎膜早破孕妇170例（11．8％）（P〈0．05）,GBS阳性的胎膜早破孕妇羊水白介素-6（IL-6）176．6±82．4ng／L明显高于GBS阴性的胎膜早破孕妇的122．7±59．3ng／L（P〈0．05）,GBS阳性胎膜早破孕妇的分娩距破膜时间〈24h、胎儿窘迫、低体重儿的发生率较阴性孕妇高（P〈0．05）,产褥感染、新生儿感染发生率较阴性孕妇高,但无统计学意义。结论GBS感染可引起胎膜早破的发生及影响母儿预后。     

MMP-9、IL-6在孕妇羊水中的水平与胎膜早破

目的探讨金属基质蛋白酶-9(MMP-9)、白细胞介素-6(IL-6)在胎膜早破(PROM)孕妇羊水中的改变.方法采用酶联免疫吸附法检测胎膜早破孕妇26例,平均孕期(37.83±0.65)w,平均年龄(27.86±2.30)岁;选取同期住院正常妊娠妇女15例为对照组,平均孕期(38.16±0.76)w,平均年龄(28.06±2.01)岁.结果膜早破孕妇羊水中MMP-9、IL-6水平明显高于对照组,差异显著(P＜0.01、P＜0.01);随着破膜时间的延长羊水中MMP-9、IL-6水平有增高趋势,尤其是破膜时间超过16h者明显增高,差异显著(P＜0.01、P＜0.01).羊水中MMP-9和IL-6水平,在胎膜早破合并绒毛膜羊膜炎与非绒毛膜羊膜炎患者,差异显著(P＜0.05和P＜0.01).结论MMP-9、IL-6可作为一个敏感的新指标,为预防胎膜早破的发生提供了临床依据.     

Decreased proinflammatory cytokines in cervicovaginal fluid, as measured in midgestation, are associated with preterm delivery

PROBLEM: The main aim of this study was to investigate the relationship between selected proinflammatory cytokines [interleukin IL-1 alpha (IL-1alpha), IL-1 beta (IL-1beta), IL-6 and IL-8] concentrations in cervicovaginal fluid, as measured in midgestation, and the risk of subsequent preterm delivery. METHOD OF STUDY: Cervicovaginal fluids were obtained from a cohort of 114 pregnant women at 22-34 weeks' gestation and analyzed for the concentrations of IL-1alpha, IL-1beta, IL-6 and IL-8 using enzyme-linked immunosorbent assay technique. Lower genital tract microbiology was diagnosed using Gram stain method and by culture. RESULTS: Mean gestational age at the time of sampling was 29.0 weeks. Mean time between sampling and delivery was 9.3 weeks (S.D. 4.7). Median cervicovaginal concentrations of IL-1alpha, IL-1beta, IL-6 and IL-8 did not differ between preterm and term delivery group. Women with lower genital tract pathological flora and IL-1alpha concentration below 25th percentile presented significant risk of subsequent preterm delivery as compared with women with no low cytokines (OR = 10.7; 95% CI, 2.0-58.1). Women with more than one cytokine' low concentration (below 25th percentile) presented an increased risk of preterm delivery--OR = 11.8 (95% CI, 1.8-78.0). CONCLUSIONS: The midgestation cytokines' measurement in cervicovaginal fluid of pregnant women could be useful for prediction of preterm delivery only among women with lower genital tract pathological flora.     

Different secretion patterns of matrix metalloproteinases and IL-8 and effect of corticotropin-releasing hormone in preterm and term cervical fibroblasts

The aims of the present study were to compare the levels of mRNA and protein expression of matrix metalloproteinase (MMP)-1, -3, -8 and -9 in human cervical tissue in preterm and term labor as well as not in labor and to determine if corticotropin-releasing hormone (CRH) has an effect on MMP-1, -3 and interleukin (IL)-8 secretion in both preterm and term cervical fibroblasts. Cervical biopsies were taken from 60 women: 18 at preterm labor, 7 at preterm not in labor, 18 at term labor and 17 at term not in labor. ELISA and Immulite were used for protein and real-time RT-PCR for mRNA analysis. Cervical fibroblast cultures were incubated for 18 h with different CRH concentrations (10(-13)-10(-6) M). The mRNA expression of MMP-1, -3 and -9 was higher in laboring groups compared with term not in labor. Protein levels of MMP-8 and -9 were higher in term in labor group compared with non-laboring groups. There were no significant differences in mRNA and protein expression between the preterm and respective term control groups. CRH significantly increased secretion of IL-8 in preterm and term cervical fibroblasts compared with controls. The secretion of IL-8 and MMP-1 was significantly higher and MMP-3 secretion lower in preterm cervical fibroblasts. In conclusion, cervical ripening at preterm seems to be a similar inflammatory process as at term with CRH involved. However, preterm and term cervical fibroblasts might have different phenotypes based on different secretion patterns of IL-8, MMP-1 and MMP-3.     

Fetal fibronectin as a marker for an imminent (preterm) delivery. A new technique using the glycoprotein lectin immunosorbent assay.

We have developed a new 'glycoprotein lectin immunosorbent assay' (GLIA) which permits the obstetrician to identify accurately pregnant women at risk for preterm delivery. This GLIA uses two lectins for the quantitative detection of glycosylation variants of fibronectins, namely, Maackia amurensis lectin (MAA) for the detection of fetal fibronectin (fFN), and Sambucus nigra lectin (Elderberry bark lectin; SNA). Fibronectin was quantitated in cervicovaginal secretions, amniotic fluid, and plasma of pregnant women. Detection of fFN in cervicovaginal secretions was considered to indicate a high risk of imminent delivery. The results were as follows: (1) The GLIA could differentiate between pregnant women after the onset of labour and/or with rupture of membranes and women without any signs of an imminent delivery (sensitivity 94%, specificity 96%, p < 0.001). (2) Differentiation was possible between asymptomatic pregnant women delivering within 10 days of sampling or after more than 10 days (sensitivity 93%, specificity 99%; p < 0.001). (3) If fFN was present in the cervicovaginal secretions, delivery occurred within 10 days of sampling irrespective of preterm delivery or delivery at term (p < 0.001). Thus, this GLIA is a useful assay for identifying those asymptomatic pregnant women who will deliver within 10 days of sampling.     

Optimization of the weck-Cel collection method for quantitation of cytokines in mucosal secretions

Measurement of immune components in mucosal secretions is important for the evaluation of local immunity at the mucosal surfaces. The Weck-Cel ophthalmic sponge provides a method for the collection of these secretions. The sponge absorbs a relatively large volume of material, therefore allowing for quantitation of multiple immune components. Additionally, it provides a method in which the same device may be used to collect specimens from different mucosal sites, such as the genital tract and oral cavity. This sampling technique has successfully been applied for collection and measurement of antibody in oral and genital tract secretions. The purpose of this work was to optimize the extraction of protein from the sponge matrix. Of particular interest was the recovery of cytokines from the sponge. Satisfactory recovery of the cytokines interleukin 1beta (IL-1beta), IL-2, IL-5, IL-12, IL-6, IL-8, IL-10, and granulocyte-macrophage colony-stimulating factor was obtained. However, IL-4 and gamma interferon recovery rates remained low. Using an alteration of the published extraction method, cytokine concentrations were measured in cervical secretions from women using oral contraceptives. The data revealed detectable concentrations of IL-6, IL-10, IL-8, and IL-12 on cycle days 9 and 20. The proposed technique provides an easy, practical, and consistent method for collection of nonconventional body fluids, such as cervicovaginal fluids and saliva, for the assay of immunoglobulins and several cytokines.     

Optimization of the Weck-Cel Collection Method for Quantitation of Cytokines in Mucosal Secretions

Measurement of immune components in mucosal secretions is important for the evaluation of local immunity at the mucosal surfaces. The Weck-Cel ophthalmic sponge provides a method for the collection of these secretions. The sponge absorbs a relatively large volume of material, therefore allowing for quantitation of multiple immune components. Additionally, it provides a method in which the same device may be used to collect specimens from different mucosal sites, such as the genital tract and oral cavity. This sampling technique has successfully been applied for collection and measurement of antibody in oral and genital tract secretions. The purpose of this work was to optimize the extraction of protein from the sponge matrix. Of particular interest was the recovery of cytokines from the sponge. Satisfactory recovery of the cytokines interleukin 1β (IL-1β), IL-2, IL-5, IL-12, IL-6, IL-8, IL-10, and granulocyte-macrophage colony-stimulating factor was obtained. However, IL-4 and gamma interferon recovery rates remained low. Using an alteration of the published extraction method, cytokine concentrations were measured in cervical secretions from women using oral contraceptives. The data revealed detectable concentrations of IL-6, IL-10, IL-8, and IL-12 on cycle days 9 and 20. The proposed technique provides an easy, practical, and consistent method for collection of nonconventional body fluids, such as cervicovaginal fluids and saliva, for the assay of immunoglobulins and several cytokines.     

妊高征患者血浆血管内皮活性因子及相关白细胞介素水平的变化

目的：探讨妊高征患者血浆ET、NO和血清IL-6、IL-8水平的变化与患者发病的关系。方法：35例非孕妇女、35例正常孕妇（对照组）及32例妊高征患者的血浆ET、血清IL-6及IL-8含量均采用放射免疫分析;血浆NO采用生化比色法。结果：35名正常孕妇血浆ET、NO均显著高于正常非孕妇女组（P〈0.01）;IL-6和IL-8水平则略有升高,但尚无统计学意义（P〉0.05）。32例妊高征患者治疗前血清ET、IL-6及IL-8三项指标水平较对照组升高极显著（P〈0.01）;NO水平则显著低于对照组（P〈0.01）。经治疗2周,ET、IL-6及IL-8三项指标较对照组下降均非常显著,与对照组比较已无显著差异（P〉0.05）;而NO水平则升高显著,与对照组比较亦无显著差异（P〉0.05）。相关分析结果表明,血浆ET水平与IL-6及IL-8水平呈显著正相关（r=0.6097、0.7213,P〈均0.01）。结论：妊高征患者血清4项指标的测定对于了解和认识其发病机理及预估病情有帮助。     

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。     

羊水中白细胞介素-8水平与绒毛膜羊膜炎的关系

目的探讨胎膜早破孕妇羊水中白细胞介素-8（IL-8）水平与绒毛膜羊膜炎的关系。方法用酶联免疫法（ELISA法）测定62例胎膜早破孕妇和46例正常足月妊娠未临产孕妇羊水中IL-8浓度;病理检查两组分娩后的胎膜组织,确定有无绒毛膜羊膜炎。结果胎膜早破组羊水中IL-8浓度高于对照组（P〈0.05）,破膜时间超过24h其羊水中IL-8水平明显高于破膜时间小于12h内的患者,绒毛膜羊膜炎组羊水中IL-8浓度高于对照组（P〈0.05）。结论胎膜早破及绒毛膜羊膜炎孕妇羊水中IL-8水平显著升高,可作为绒毛膜羊膜炎的早期诊断指标。