趋化因子MCP-1与妊娠期下生殖道感染及感染性早产的相关性研究

目的研究趋化因子MCP-1在孕妇宫颈分泌物、母血清、脐血清中的表达及其与下生殖道感染及感染性早产的关系。同时，探索孕妇宫颈分泌物中MCP-1水平，对预测感染性早产的可行性。方法以2004年7月至2005年7月分别在四川大学华西第二医院及德阳市人民医院围生门诊行产前检查，并住院分娩的140例孕妇A组（早产组），n=72；B组（足月组），n=68]为研究对象。收集生殖道感染与未感染孕妇的宫颈分泌物，进行病原微生物学培养。分娩时，对胎盘、胎膜组织作绒毛膜羊膜炎的病理学诊断，采集孕妇宫颈分泌物、母血清、脐血清，用定量双抗体夹心酶联免疫吸附（ELIsA）法分别检测MCP-1水平。按上述测试结果，将A组分为早产宫颈分泌物病原微生物呈阳性组（A1组，n=36），早产宫颈分泌物培养呈阴性组（A2组，n=36）；将B组分为足月产宫颈分泌物病原微生物检测呈阳性组（B1组，n=30），足月产宫颈分泌物病原微生物检测呈阴性组（B2组，n=38）。（本研究遵循的程序符合四川大学华西第二医院及德阳市人民医院人体试验委员会所制定的伦理学标准，得到其批准，取得受试对象的知情同意，并与受试者签署临床研究知情同意书）。结果A组微生物阳性检出率（50．00％，36／72）高于B组（44．12％，30／68），两组比较，差异有显著意义（P〈0．01）；病理学诊断绒毛膜羊膜炎构成比显示，A组（36．11％，26／72）明显高于B组（8．82％，6／68），两组比较，差异有显著意义（P〈0．01）。A1组宫颈分泌物及血清MCP-1蛋白水平较其他三组（A2，B1，B2组）显著升高，差异有显著意义（P〈0．001）。结论有下生殖道感染早产孕妇的宫颈分泌物、母血清及脐血清中MCP-1蛋白的表达水平增强，与绒毛膜羊膜炎相关。宫颈分泌物中趋化因子MCP-1可作为预测感染性早产的指标。

Level of MCP-1 Rises in Cervicovaginal Infections and Infection Associated With Preterm Delivery

Objective To investigate the MCP-1 expression in cervicovaginal secretions, maternal plasma and cord blood and infection associated with preterm delivery, and proposed the feasibility to use MCP-1 protein level of cervicovaginal secretions to predict preterm delivery in the condition of infection. Methods From July 2004 to July 2005, 140 cases of pregnant women （72 cases for preterm delivered, group A; 68 cases for full-term delivery, group B） who had regular prenatal test and delivery at the Peoplels Hospital of Deyang, and West China Second University Hospital, Sichuan University were involved in this study. Cervicovaginal secretion samples were assayed by bacterial culture, and the subjects were classified into groups according to the germiculture results （group A1, preterm delivery with positive germiculture; group A2, preterm delivery with negative infection; group B1, full-term delivery with positive germiculture; group B2, full-term delivery with negative germiculture）. Placenta and embryolemma specimens after labor were send for pathological diagnosis of ehorioamnionitis; MCP-1 level in cervicovaginal secretions, maternal plasma from peripheral blood and cord blood collected during parturition, were measured by the method of ELISA. Informed consent was obtained from all participates. Results Positive incidence for the germicultures in group B was higher than that in group A with statistical significance （P〈0.01）. Based on the pathological diagnosis, the chorioamnionitis constituent ratio of group A was significantly higher than that of group B（P〈0. 001）. MCP-1 protein level in cervieovaginal secretions and plasma in group A1 rose significantly （P〈0. 001） in contrast to group A2, group B1 and group B2. Conclusion The elevation of MCP-1 expression level in cervicovaginal secretion samples and blood plasma from preterm delivery group with infection are related to chorioamnionitis. Therefore, MCP-1 protein in cervicovaginal secretion samples may be regarded as an indicator for infection-associated preterm delivery.