Toll样受体-2、4及单核细胞趋化蛋白-1与胎膜早破和绒毛膜羊膜炎的相关性研究

目的探讨Toll样受体(toll-like receptor,TLR)-2、TLR-4及单核细胞趋化蛋白-1(monocyte chemotactic protein-1,MCP-1)在胎膜早破(premature rupture of membrane,PROM)、绒毛膜羊膜炎中的临床意义。方法选择2017年9月至2018年1月在延边大学附属医院产科分娩的足月PROM患者52例(足月PROM组),未足月PROM患者46例(未足月PROM组),足月胎膜完整者40例(对照组)。显微镜下在绒毛膜及羊膜组织上有≥5个中性粒细胞浸润诊断为绒毛膜羊膜炎。产后取胎盘及胎膜组织行免疫组织化学染色,根据半定量积分法进行染色结果判定。未足月PROM组新生儿娩出断脐后,采集脐血检测MCP-1含量。采用秩和检验和χ^2检验进行统计分析。结果未足月PROM组和足月PROM组的胎盘组织中TLR-2阳性率[分别为80.43%(37/46)和78.85%(41/52)]、TLR-4阳性率[分别为86.96%(40/46)和82.69%(43/52)]均高于对照组[TLR-2阳性率:57.50%(23/40),TLR-4阳性率:62.50%(25/40)],差异有统计学意义(P<0.05);但未足月组与足月组比较差异无统计学意义(P>0.05)。46例未足月PROM患者中,根据胎盘胎膜病理检查发现绒毛膜羊膜炎11例,非绒毛膜羊膜炎35例。虽然绒毛膜羊膜炎组胎盘组织中的TLR-2阳性率[100.00%(11/11)]和TLR-4阳性率[90.91%(10/11)]均高于非绒毛膜羊膜炎组[分别为74.29%(26/35)和85.71%(30/35)],但差异均无统计学意义(P>0.05)。绒毛膜羊膜炎组新生儿脐血中的MCP-1含量[109.12(74.72~222.12)ng/L]高于非绒毛膜羊膜炎组[60.52(48.52~135.12)ng/L],差异有统计学意义(P<0.05)。结论胎盘组织中TLR-2、4的表达增高可能与PROM的发生发展有关。新生儿脐血中MCP-1含量升高可提示绒毛膜羊膜炎的发生。

Correlation of TRL-2, 4 and MCP-1 with premature rupture of membrane and chorioamnionitis

Objective To explore clinical significance of TLR-2, TLR-4 and MCP-1 in the premature rupture of membrane and chorioamnionitis. Methods From September 2017 to January 2018, 52 patients with term premature rupture of membrane(TPROM group), 46 patients with preterm premature rupture of membranes(PPROM group), and 40 term-birth women with intact fetal membrane(control group)were selected in the Department of Obstetrics, the Affiliated Hospital of Yanbian University. There were more than 5 neutrophil infiltrations on the chorionic and amniotic tissues under the microscope, which was diagnosed as chorioamnionitis. The placenta and fetal membrane tissue were taken for immunohistochemical staining after birth, and the dyeing result was determined according to the semi-quantitative integration method. The umbilical cord blood of newborns(PPROM group) was taken to detect the MCP-1 content. Statistical analysis was performed by the rank sum test and the χ^2 test. Results The positive rate of TLR-2 in the placental tissue [80.43%(37/46) vs 78.85%(41/52), respectively], and the positive rate of TLR-4 [86.96%(40/46) vs 82.69%(43/52)] in the PPROM group and the TPROM group were higher than those in the control group [positive rate of TLR-2 : 57.50%(23/40), positive rate of TLR-4: 62.50%(25/40)], which was statistical significance(P<0.05);however, there was no statistical significance between the PPROM group and the TPROM group(P>0.05). Among of 46 patients of PPROM group, 11 cases of chorioamnionitis and 35 cases of non-chorioamnionitis were found according to the pathological examination of placental membrane. Although the positive rate of TLR-2 [100.00%(11/11)] and positive rate of TLR-4 [90.91%(10/11)] in the placental tissue of the chorioamnion group were higher than those in the non-chorioamnion group [74.29%(26/35) vs 85.71%(30/35) respectively], but there were no statistical significance(P>0.05). The content of MCP-1 in umbilical cord blood of newborns in chorioamnion group [109.12(74.72-222.12) ng/L] was higher than that in non-chorioamnionitis group [60.52(48.52-135.12) ng/L], which was statistical significance(P<0.05). Conclusions The increased expression of TLR-2, 4 in placenta tissue may be related to the occurrence and development of PROM. The increase level of MCP-1 in neonatal umbilical cord blood can indicate the occurrence of chorioamnionitis.