瑞典早产女性人群宫颈液中的白细胞介素-6和白细胞介素-8：与羊水微生物入侵、羊膜腔内炎症及早产的关系

Interleukin-6 and interleukin-8 in cervical fluid in a population of Swedish women in preterm labor: relationship to microbial invasion of the amniotic fluid, intra-amniotic inflammation, and preterm delivery.

作者信息

Holst Rose-Marie, Mattsby-Baltzer Inger, Wennerholm Ulla-Britt, Hagberg Henrik, Jacobsson Bo

机构信息

Perinatal Center, Department of Obstetrics and Gynecology, Institute for the Health of Women and Children, Sahlgrenska University Hospital, Göteborg, Sweden.

出版信息

Acta Obstet Gynecol Scand. 2005 Jun;84(6):551-7. doi: 10.1111/j.0001-6349.2005.00708.x.

DOI:10.1111/j.0001-6349.2005.00708.x

PMID:15901266

Abstract

BACKGROUND

Intrauterine infection and inflammation in women with preterm labor are related to adverse perinatal outcome. Due to its subclinical nature, a correct diagnosis depends on retrieval of amniotic fluid. Amniocentesis is, however, not performed as a clinical routine because of its invasiveness. Hypothetically, cytokines in the cervical fluid may represent an alternative diagnostic approach. The aim was to examine cervical interleukin (IL)-6 and IL-8 in relation to microbial invasion of the amniotic fluid, intra-amniotic inflammation, and preterm birth in women in preterm labor.

METHODS

Women with singleton pregnancies in preterm labor (<34 weeks of gestation) and intact membranes were included. Cervical (n = 91) and amniotic fluids (n = 56) were collected. Polymerase chain reaction for Ureaplasma urealyticum and Mycoplasma hominis and culture for aerobic and anaerobic bacteria were performed. IL-6 and IL-8 were analyzed with enzyme-linked immunosorbent assay.

RESULTS

Non-lactobacillus-dominated biota was detected in cervical secretion in 25% (22/89) and the presence of micro-organisms in the amniotic fluid in 16% (9/56) of the patients. The presence of U. urealyticum in the cervical fluid (21/46) was associated with significantly higher levels of IL-6 in the secretion. IL-6 and IL-8 were significantly higher in cervical fluid of women with intra-amniotic infection and inflammation and in women who delivered < or =7 days and/or before 34 weeks of gestation. Cervical IL-6 > or = 1.7 ng/ml was related to intra-amniotic inflammation (relative risk: 2.67; range: 1.50-4.74) and had a sensitivity, specificity, positive predictive value, and negative predictive value of 58, 83, 75, and 69%, respectively, in the identification of intra-amniotic inflammation. Similar data were obtained for IL-8 > or = 6.7 ng/ml.

CONCLUSIONS

High levels of cervical IL-6 and IL-8 are moderately predictive of intrauterine infection/inflammation and preterm delivery.

摘要

背景

早产女性的宫内感染和炎症与不良围产期结局相关。由于其亚临床性质，正确诊断依赖于羊水的获取。然而，羊膜腔穿刺术因其侵入性未作为临床常规操作。理论上，宫颈液中的细胞因子可能代表一种替代诊断方法。目的是研究早产女性宫颈白细胞介素（IL）-6和IL-8与羊水微生物入侵、羊膜腔内炎症及早产的关系。

方法

纳入单胎妊娠且胎膜完整的早产（妊娠<34周）女性。收集宫颈液（n = 91）和羊水（n = 56）。进行解脲脲原体和人型支原体的聚合酶链反应以及需氧菌和厌氧菌培养。采用酶联免疫吸附测定法分析IL-6和IL-8。

结果

25%（22/89）的患者宫颈分泌物中检测到非乳酸杆菌为主的生物群，16%（9/56）的患者羊水中存在微生物。宫颈液中解脲脲原体的存在（21/46）与分泌物中IL-6水平显著升高相关。羊膜腔内感染和炎症的女性以及在妊娠<或=7天和/或34周前分娩的女性宫颈液中IL-6和IL-8显著更高。宫颈IL-6≥1.7 ng/ml与羊膜腔内炎症相关（相对危险度：2.67；范围：1.50 - 4.74），在识别羊膜腔内炎症时，其敏感性、特异性、阳性预测值和阴性预测值分别为58%、83%、75%和69%。IL-8≥6.7 ng/ml时获得类似数据。