Yoon B H, Romero R, Park J S, Kim M, Oh S Y, Kim C J, Jun J K
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, and the Laboratory of Fetal Medicine Research, Clinical Research Institute, Seoul National University Hospital, Korea.
Am J Obstet Gynecol. 2000 Nov;183(5):1124-9. doi: 10.1067/mob.2000.109035.
The purpose of this study was to determine whether funisitis (inflammation of the umbilical cord detected by histologic examination of the placenta) is associated with changes in the umbilical cord plasma concentration of interleukin 6, microbial invasion of the amniotic cavity, and neonatal sepsis.
The relationship among the presence of funisitis, interleukin 6 concentrations in umbilical cord plasma at birth, the results of amniotic fluid culture performed within 3 days of birth, and the occurrence of congenital neonatal sepsis was examined in 315 consecutive singleton preterm births (20-35 weeks' gestation). Funisitis was diagnosed in the presence of neutrophil infiltration into the umbilical vessel walls or Wharton jelly. The interleukin 6 concentration was measured with a specific immunoassay. Amniocentesis was performed in 106 patients within 3 days of birth. Amniotic fluid was cultured for aerobic and anaerobic bacteria and for mycoplasmas.
(1) Funisitis was present in 25% of patients (78/315). (2) Patients with funisitis had a significantly higher median cord plasma interleukin 6 and a lower gestational age at birth than did those without funisitis (cord interleukin 6: median, 52.4 pg/mL; range, 0.9-19,230 pg/mL; vs median, 4.6 pg/mL; range, 0-18,108 pg/mL; gestational age: median, 31.1 weeks' gestation; range, 21.0-35.0 weeks' gestation; vs median, 32.9 weeks' gestation; range, 21.4-35.0 weeks' gestation; P<.001 for each comparison). (3) A cord plasma interleukin 6 of > or =17.5 pg/mL had a sensitivity of 70% and a specificity of 78% in the identification of funisitis. (4) Microbial invasion of the amniotic cavity and clinical chorioamnionitis were more common among patients with funisitis than among those without funisitis (positive amniotic fluid culture: 53% [20/38]; vs. 12% [8/68]; clinical chorioamnionitis: 18% [14/78]; vs. 4% [9/237]; P<.001 for each comparison). (5) Neonates with funisitis had a significantly higher rate of congenital sepsis than did those without this lesion (12% [8/66] vs. 1% [3/216]; P<.001); this difference remained significant after adjustment for gestational age at birth (odds ratio, 7.2; 95% confidence interval, 1.8-29.0).
(1) Umbilical cord plasma interleukin 6 concentrations were higher in neonates born with funisitis than in those without this lesion. (2) Funisitis is associated with amniotic fluid infection, congenital neonatal sepsis, and the fetal inflammatory response syndrome.
本研究旨在确定脐带炎（通过胎盘组织学检查检测到的脐带炎症）是否与脐带血浆中白细胞介素6浓度的变化、羊膜腔微生物入侵及新生儿败血症有关。
在315例连续的单胎早产（妊娠20 - 35周）中，研究了脐带炎的存在、出生时脐带血浆中白细胞介素6浓度、出生后3天内进行的羊水培养结果以及先天性新生儿败血症的发生之间的关系。当在脐带血管壁或华通胶中有中性粒细胞浸润时诊断为脐带炎。用特异性免疫测定法测量白细胞介素6浓度。106例患者在出生后3天内进行了羊膜腔穿刺。羊水培养需氧菌、厌氧菌和支原体。
（1）25%的患者（78/315）存在脐带炎。（2）有脐带炎的患者脐带血浆白细胞介素6中位数显著高于无脐带炎的患者，且出生时孕周更低（脐带白细胞介素6：中位数，52.4 pg/mL；范围，0.9 - 19,230 pg/mL；相比之下，中位数，4.6 pg/mL；范围，0 - 18,108 pg/mL；孕周：中位数，31.1周妊娠；范围，21.0 - 35.0周妊娠；相比之下，中位数，32.9周妊娠；范围，21.4 - 35.0周妊娠；每次比较P <.001）。（3）脐带血浆白细胞介素6≥17.5 pg/mL在识别脐带炎方面的敏感性为70%，特异性为78%。（4）有脐带炎的患者羊膜腔微生物入侵和临床绒毛膜羊膜炎比无脐带炎的患者更常见（羊水培养阳性：53% [20/38]；相比之下，12% [8/68]；临床绒毛膜羊膜炎：18% [14/78]；相比之下，4% [9/237]；每次比较P <.001）。（5）有脐带炎的新生儿先天性败血症发生率显著高于无此病变的新生儿（12% [8/66] 比 1% [3/216]；P <.001）；在对出生时孕周进行调整后，这种差异仍然显著（优势比，7.2；95%置信区间，1.8 - 29.0）。
（1）患有脐带炎的新生儿脐带血浆白细胞介素6浓度高于无此病变的新生儿。（2）脐带炎与羊水感染、先天性新生儿败血症及胎儿炎症反应综合征有关。
