早产和足月分娩中的过敏毒素
Anaphylatoxins in preterm and term labor.
作者信息
Soto Eleazar, Romero Roberto, Richani Karina, Espinoza Jimmy, Nien Jyh Kae, Chaiworapongsa Tinnakorn, Santolaya-Forgas Joaquin, Edwin Samuel S, Mazor Moshe
机构信息
Perinatology Research Branch, NICHD, NIH, DHHS; Bethesda, MD, United States.
出版信息
J Perinat Med. 2005;33(4):306-13. doi: 10.1515/JPM.2005.051.
OBJECTIVE
The complement system plays a central role in the first line of defense against invading pathogens, and its activation involves the release of potent pro-inflammatory mediators such as anaphylatoxins C3a, C4a and C5a. The aim of this study was to determine whether differences existed in maternal plasma anaphylatoxin concentrations between patients with term and preterm parturition.
STUDY DESIGN
A cross-sectional study was designed to determine the plasma anaphylatoxin concentrations in 296 pregnant women in the following groups: 1) normal pregnancy between 20-36 6/7 weeks (n=64); 2) term not in labor (n=70); 3) term in labor (n=60); and 4) preterm labor with intact membranes (n=102). Women with preterm labor were classified into: a) term delivery (n=24); b) preterm delivery without intra-amniotic infection (IAI) (n=62); and c) preterm delivery with IAI (n=16). Concentrations of C3a, C4a and C5a were determined by ELISAs. Statistical analysis was conducted with non-parametric methods.
RESULTS
- The median plasma C5a concentration was lower in women at term in labor than in those not in labor (P<0.001). In contrast, there were no differences in plasma C3a and C4a concentrations between the two groups (P>0.05). 2) Among patients with preterm labor, those with IAI had a higher median plasma C5a concentration than those without IAI and those who delivered at term (post-hoc tests P<0.001 and P=0.01, respectively). When comparing the preterm labor subgroups with normal pregnancy, only women with preterm delivery and IAI had a median plasma C5a concentration higher than that of normal pregnant women (Kruskal-Wallis P<0.001, post hoc test P<0.001). There was no difference in the plasma C4a concentration among patients with preterm labor. The median plasma C3a concentration in patients with preterm labor with IAI was higher than in those without IAI (Kruskal-Wallis P=0.01, and post-hoc test P=0.005). There was no difference in the plasma C3a concentrations between women with preterm labor who delivered at term and those with preterm delivery, with or without IAI. In addition, no differences were observed in the median plasma C3a concentration between women with normal pregnancy and those in each of the preterm labor subgroups.
CONCLUSIONS
The maternal plasma concentration of anaphylatoxin C5a is increased in women with preterm labor and IAI, but not in spontaneous labor at term.
目的
补体系统在抵御入侵病原体的第一道防线中起核心作用，其激活涉及释放强效促炎介质，如过敏毒素C3a、C4a和C5a。本研究的目的是确定足月分娩和早产患者的母体血浆过敏毒素浓度是否存在差异。
研究设计
一项横断面研究旨在测定296名孕妇血浆中过敏毒素的浓度，这些孕妇分为以下几组：1）妊娠20 - 36 6/7周的正常妊娠（n = 64）；2）足月未临产（n = 70）；3）足月临产（n = 60）；4）胎膜完整的早产（n = 102）。早产女性又分为：a）足月分娩（n = 24）；b）无羊膜腔内感染（IAI）的早产（n = 62）；c）有IAI的早产（n = 16）。采用酶联免疫吸附测定法（ELISA）测定C3a、C4a和C5a的浓度。采用非参数方法进行统计分析。
结果
1）足月临产女性的血浆C5a浓度中位数低于未临产女性（P < 0.001）。相比之下，两组之间的血浆C3a和C4a浓度无差异（P > 0.05）。2）在早产患者中，有IAI的患者血浆C5a浓度中位数高于无IAI的患者和足月分娩者（事后检验P < 0.001和P = 0.01，分别）。将早产亚组与正常妊娠组进行比较时，只有早产且有IAI的女性血浆C5a浓度中位数高于正常妊娠女性（Kruskal - Wallis检验P < 0.001，事后检验P < 0.001）。早产患者中血浆C4a浓度无差异。有IAI的早产患者血浆C3a浓度中位数高于无IAI的患者（Kruskal - Wallis检验P = 0.01，事后检验P = 0.005）。足月分娩的早产女性与早产（无论有无IAI）女性之间的血浆C3a浓度无差异。此外，正常妊娠女性与各早产亚组女性的血浆C3a浓度中位数也无差异。
结论
早产且有IAI的女性母体血浆过敏毒素C5a浓度升高，但足月自然分娩的女性则不然。
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