Chi Benjamin H, Mudenda Victor, Levy Jens, Sinkala Moses, Goldenberg Robert L, Stringer Jeffrey S A
School of Medicine, University of Alabama, Birmingham, AL 35294-0024, USA.
Am J Obstet Gynecol. 2006 Jan;194(1):174-81. doi: 10.1016/j.ajog.2005.06.081.
This study was undertaken to examine the prevalence of acute and chronic chorioamnionitis among women infected with human immunodeficiency virus-1 (HIV-1) and to determine the relative contribution of each to perinatal HIV-1 transmission.
In 227 HIV-infected women receiving intrapartum/neonatal nevirapine prophylaxis, we examined associations between fetal membrane histology, cord blood interleukin-6 (IL-6), and perinatal HIV-1 transmission.
Acute chorioamnionitis was present in 122 of 227 specimens; chronic chorioamnionitis in 64 of 227. There was a positive correlation between acute chorioamnionitis and labor length (r = 0.208; P = .002), time of ruptured membrane (r = 0.177; P = .008), and cord IL-6 (r = 0.390; P < .001). Chronic chorioamnionitis was associated with high viral load (P = .05) and low cord IL-6 (P < .001). Severe chronic chorioamnionitis was associated with intrauterine HIV-1 transmission (odds ratio [OR] = 7.61; 95% CI = 1.04-85.5), but no correlation was demonstrated between acute chorioamnionitis and vertical transmission.
In a setting of high perinatal nevirapine use, acute chorioamnionitis was not associated with vertical HIV-1 transmission. Risk for intrauterine transmission increased significantly when chronic chorioamnionitis was present.
本研究旨在调查感染人类免疫缺陷病毒1型（HIV-1）的女性中急性和慢性绒毛膜羊膜炎的患病率，并确定每种炎症对围产期HIV-1传播的相对影响。
在227名接受产时/新生儿奈韦拉平预防的HIV感染女性中，我们研究了胎膜组织学、脐带血白细胞介素-6（IL-6）与围产期HIV-1传播之间的关联。
227份标本中，122份存在急性绒毛膜羊膜炎；227份中有64份存在慢性绒毛膜羊膜炎。急性绒毛膜羊膜炎与产程（r = 0.208；P = 0.002）、破膜时间（r = 0.177；P = 0.008）和脐带IL-6（r = 0.390；P < 0.001）呈正相关。慢性绒毛膜羊膜炎与高病毒载量（P = 0.05）和低脐带IL-6（P < 0.001）有关。严重慢性绒毛膜羊膜炎与宫内HIV-1传播相关（比值比[OR] = 7.61；95%可信区间 = 1.04 - 85.5），但急性绒毛膜羊膜炎与垂直传播之间未显示相关性。
在围产期大量使用奈韦拉平的情况下，急性绒毛膜羊膜炎与HIV-1垂直传播无关。存在慢性绒毛膜羊膜炎时，宫内传播风险显著增加。
