Terrien Jérémy, Marque Catherine, Germain Guy
Génie Biologique--UMR CNRS 6600, U.T.C.--BP 20529, F-60205 Compiègne Cedex, France.
Eur J Obstet Gynecol Reprod Biol. 2004 Nov 15;117 Suppl 1:S10-4. doi: 10.1016/j.ejogrb.2004.07.009.
Use of the currently available tocolytics is controversial because it has not been associated with improved perinatal outcomes. New markers of preterm labour may come from gene-profiling studies, in as much as they may help in identifying novel genes regulating myometrial quiescence and in expanding our understanding of the pathologic process of uterine dysfunction. Study of certain transcripts in circulating white blood cells by RT-PCR could assist the obstetrician in evaluation of the risks. Uterine electromyography (EMG) also has the potential benefit of monitoring tocolytic treatment, although no standard method of clinical interpretation has yet been devised for the results yielded by this instrumentation. Recent functional genomic studies found that in the uterus at term there is a massive down-regulation of a large panel of developmental cell adhesion molecules and proliferation-related genes. Conversely, maintaining the developmental processes in an active state in patients at risk would help to prevent preterm delivery. It is too early to suggest any therapies with anticytokines in pregnant women. However, exploration of genetic polymorphisms, which may influence the balance of pro- and anti-inflammatory cytokines that are relevant to the course of preterm labour, seems to be a novel avenue that should be explored.
目前可用的宫缩抑制剂的使用存在争议，因为它与改善围产期结局并无关联。早产的新标志物可能来自基因谱研究，因为它们可能有助于识别调节子宫肌层静止的新基因，并拓展我们对子宫功能障碍病理过程的理解。通过逆转录聚合酶链反应（RT-PCR）研究循环白细胞中的某些转录本，可协助产科医生评估风险。子宫肌电图（EMG）在监测宫缩抑制剂治疗方面也可能有益，尽管尚未针对该仪器产生的结果设计出标准的临床解读方法。最近的功能基因组研究发现，足月时子宫中大量发育细胞黏附分子和增殖相关基因出现大幅下调。相反，使处于风险中的患者维持发育过程处于活跃状态将有助于预防早产。现在就建议对孕妇使用抗细胞因子疗法还为时过早。然而，探索可能影响与早产过程相关的促炎和抗炎细胞因子平衡的基因多态性，似乎是一条值得探索的新途径。
