Witczak Magdalena, Torbé Andrzej, Czajka Ryszard
Katedry i Kliniki Połoznictwa i Perinatologii Pomorskiej AM w Szczecinie.
Ginekol Pol. 2003 Oct;74(10):1343-7.
Cytokines may be implicated in the pathophysiologic mechanisms of preterm and term labor. Many studies indicate cytokines as predictors of preterm delivery and explain partially mechanism of preterm uterine contractions. Complicated relations between mediators in systemic fluids of a fetomaternal unit require further explorations. The right diagnosis and management require better understanding of these relationships.
The comparison of IL-1 alpha, IL-1 beta, IL-6 and IL-8 levels in maternal serum and amniotic fluid in term and preterm labor complicated by PROM.
In 44 patients in premature labor with PROM (group I) and 33 patients in labor at term with PROM (group II) cytokines levels were estimated one time in amniotic fluid: just after PROM, and two times in maternal serum: just after PROM and during labor.
Amniotic fluid cytokines levels were significantly higher in group I than in group II. Maternal serum cytokines concentrations of IL-1 alpha and IL-1 beta in group I were significantly higher than in group II. IL-6 level was significantly higher in group II than in group I. In both groups maternal serum IL-6 levels during labor significantly increased in comparison to IL-6 levels just after PROM. No correlations between amniotic fluid and maternal serum cytokine levels at PROM were observed.
Higher amniotic fluid cytokines levels in patients with preterm labor complicated by PROM than in labor at term with PROM indicate possible differences between PROM mechanisms in preterm and term labor. The increase of IL-6 level during labor can be related with the possible role of this cytokine in the immunological mechanism of the labor beginning. No relationships between amniotic fluid and maternal serum levels of investigated cytokines in PROM suggest the presence of the barrier stopped cytokines transfer by the placenta and the complete separation of these two compartments.
细胞因子可能与早产和足月分娩的病理生理机制有关。许多研究表明细胞因子可作为早产的预测指标,并部分解释了早产子宫收缩的机制。母胎单位全身液体中介质之间复杂的关系需要进一步探索。正确的诊断和管理需要更好地理解这些关系。
比较足月和早产胎膜早破患者母血和羊水中白细胞介素-1α(IL-1α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和白细胞介素-8(IL-8)的水平。
对44例早产胎膜早破患者(I组)和33例足月胎膜早破分娩患者(II组),在胎膜早破后即刻测定一次羊水细胞因子水平,在胎膜早破后即刻及分娩时测定两次母血细胞因子水平。
I组羊水细胞因子水平显著高于II组。I组母血中IL-1α和IL-1β的细胞因子浓度显著高于II组。II组IL-6水平显著高于I组。两组母血中分娩时IL-6水平较胎膜早破后即刻均显著升高。胎膜早破时羊水与母血细胞因子水平之间未观察到相关性。
早产胎膜早破患者羊水细胞因子水平高于足月胎膜早破分娩患者,提示早产和足月胎膜早破机制可能存在差异。分娩时IL-6水平升高可能与该细胞因子在分娩启动免疫机制中的可能作用有关。胎膜早破时羊水与母血中所研究细胞因子水平之间无相关性,提示存在胎盘阻止细胞因子转运的屏障,这两个腔室完全分离。