Di Naro Edoardo, Ghezzi Fabio, Raio Luigi, Romano Francesco, Mueller Michel D, McDougall Jane, Cicinelli Ettore
Departments of Obstetrics and Gynecology, University of Bari, Bari, Italy.
Acta Obstet Gynecol Scand. 2003 Dec;82(12):1072-9. doi: 10.1046/j.1600-0412.2003.00223.x.
To assess whether C-reactive protein (CRP) concentrations in cervical amniotic fluid reflect the condition of the intrauterine environment in patients with preterm premature rupture of membranes (PROM) before 35 weeks of gestation.
Amniotic fluid was obtained in 29 consecutive patients admitted with the diagnosis of preterm PROM earlier than 35 weeks of gestation either by amniocentesis or by collecting cervical fluid. CRP was measured in maternal blood, amniotic fluid, vaginal fluid and in cord blood obtained at delivery. Intraamniotic infection was defined as a positive amniotic fluid for aerobic or anaerobic bacteria, or Mycoplasma. The placentas and umbilical cords were examined for the presence of chorioamnionitis and funisitis.
A significant correlation was found between vaginal fluid CRP concentrations and both amniotic fluid (r = 0.95, p < 0.001) and umbilical cord levels (r = 0.47, p < 0.05). No correlation was found between maternal blood and vaginal fluid CRP concentrations. The proportion of patients with intraamniotic infection was 37.9% (11/29). The median (range) vaginal fluid CRP concentration was higher in patients with intraamniotic infection than in those with sterile amniotic fluid [901 (0-1354) vs. 507 (0-798) ng/mL, p < 0.001]. The median (range) vaginal fluid CRP concentration was higher in fetuses with (n = 12) than in those without funisitis (n = 17) [901 (598-1354) vs. 487 (0-1115) ng/mL, p < 0.01]. After adjustment for gestational age, vaginal fluid CRP concentration > 800 ng/mL remained a predictor of intraamniotic infection and funisitis.
Increased vaginal fluid CRP concentration is associated with intraamniotic infection and funisitis. As CRP is produced by hepatocytes and does not cross the placenta, its measurement in vaginal fluid might be an additional parameter for the assessment of fetal well-being in patients with premature PROM.
评估妊娠35周前胎膜早破（PROM）患者宫颈羊水C反应蛋白（CRP）浓度是否反映宫内环境状况。
连续纳入29例诊断为妊娠35周前早产PROM的患者，通过羊膜穿刺术或收集宫颈液获取羊水。检测母体血液、羊水、阴道液及分娩时获得的脐带血中的CRP。羊膜腔内感染定义为羊水需氧菌或厌氧菌或支原体检测阳性。检查胎盘和脐带是否存在绒毛膜羊膜炎和脐带炎。
发现阴道液CRP浓度与羊水（r = 0.95，p < 0.001）和脐带水平（r = 0.47，p < 0.05）均显著相关。母体血液和阴道液CRP浓度之间未发现相关性。羊膜腔内感染患者比例为37.9%（11/29）。羊膜腔内感染患者的阴道液CRP浓度中位数（范围）高于羊水无菌患者[901（0 - 1354）对507（0 - 798）ng/mL，p < 0.001]。有脐带炎（n = 12）的胎儿的阴道液CRP浓度中位数（范围）高于无脐带炎（n = 17）的胎儿[901（598 - 1354）对487（0 - 1115）ng/mL，p < 0.01]。校正孕周后，阴道液CRP浓度> 800 ng/mL仍是羊膜腔内感染和脐带炎的预测指标。
阴道液CRP浓度升高与羊膜腔内感染和脐带炎相关。由于CRP由肝细胞产生且不穿过胎盘，检测阴道液中的CRP可能是评估早产PROM患者胎儿健康状况的一个额外参数。
