Biggio Joseph R, Ramsey Patrick S, Cliver Suzanne P, Lyon Martha D, Goldenberg Robert L, Wenstrom Katharine D
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA.
Am J Obstet Gynecol. 2005 Jan;192(1):109-13. doi: 10.1016/j.ajog.2004.06.103.
We sought to determine whether midtrimester amniotic fluid levels of matrix metalloproteinase-8 were associated with subsequent preterm premature rupture of membranes.
We conducted a case-control study examining 57 asymptomatic women who underwent genetic amniocentesis from 14 to 21 weeks' gestation and subsequently had preterm premature rupture of membranes (<35 wk) and 58 women with subsequent term delivery. Measurement of total matrix metalloproteinase-8 level in amniotic fluid was conducted using a commercially available enzyme-linked immunosorbent assay and association with preterm birth due to preterm premature rupture of membranes was assessed.
The overall distribution of matrix metalloproteinase-8 concentrations was similar in women who had preterm premature rupture of membranes and term controls (median 2.39 ng/mL, 25th to 75th percentile 1.1-10.1 vs 2.37 ng/mL, 25th to 75th percentile 1.5-4.7, P = .94). However, 26% of women who had preterm premature rupture of membranes had a matrix metalloproteinase-8 concentration above the 90th percentile (8.7 ng/mL), compared with only 10% of term controls (odds ratio 3.1, 95% CI 1.1-8.7; P = .03). Elevated matrix metalloproteinase-8 remained associated with preterm premature rupture of membranes after adjustment for maternal age, race, parity, gestational age, and year of amniocentesis (odds ratio 3.4, 95% CI 1.2-9.9; P = .03).
The overall distribution of midtrimester amniotic fluid matrix metalloproteinase-8 levels did not differ between women who had preterm premature rupture of membranes and those delivered at term. However, marked elevations of midtrimester amniotic fluid matrix metalloproteinase-8 were highly associated with subsequent preterm premature rupture of membranes, suggesting that the pathophysiologic processes that contribute to preterm premature rupture of membranes may begin in early pregnancy.
我们试图确定孕中期羊水中基质金属蛋白酶-8水平是否与随后的胎膜早破相关。
我们进行了一项病例对照研究，研究对象为57名在妊娠14至21周时接受基因羊膜穿刺术且随后发生胎膜早破（<35周）的无症状女性，以及58名随后足月分娩的女性。使用市售的酶联免疫吸附测定法测量羊水中总基质金属蛋白酶-8水平，并评估其与胎膜早破所致早产的相关性。
胎膜早破女性和足月对照组女性中基质金属蛋白酶-8浓度的总体分布相似（中位数分别为2.39 ng/mL，第25至75百分位数为1.1 - 10.1 vs 2.37 ng/mL，第25至75百分位数为1.5 - 4.7，P = 0.94）。然而，26%的胎膜早破女性其基质金属蛋白酶-8浓度高于第90百分位数（8.7 ng/mL），而足月对照组中这一比例仅为10%（比值比3.1，95%可信区间1.1 - 8.7；P = 0.03）。在对产妇年龄、种族、产次、孕周和羊膜穿刺术年份进行校正后，基质金属蛋白酶-8升高仍与胎膜早破相关（比值比3.4，95%可信区间1.2 - 9.9；P = 0.03）。
胎膜早破女性和足月分娩女性在孕中期羊水基质金属蛋白酶-8水平的总体分布没有差异。然而，孕中期羊水基质金属蛋白酶-8的显著升高与随后的胎膜早破高度相关，这表明导致胎膜早破的病理生理过程可能在妊娠早期就已开始。
