Kalinka Jarosław, Wasiela Małgorzata, Sobala Wojciech, Brzezińska-Błaszczyk Ewa
Klinika Perinatologii, I Katedry Ginekologii i Połoznictwa, UM w Lodzi.
Ginekol Pol. 2005 Sep;76(9):704-12.
Recent studies have suggested that proinflammatory cytokines might play a crucial role in the mechanism of preterm labour and delivery. The main aim of this prospective study was to evaluate the usefulness of selected proinflammatory cytokines' (IL-1 alpha, IL-1 beta, IL-6 and IL-8) levels in cervico-vaginal fluid of pregnant women as an early marker of preterm delivery.
Cervico-vaginal fluids were obtained from 107 pregnant women at 22 to 34 weeks' gestation, including 61 women with threatened preterm labour (TPL) and 46 women with physiological course of pregnancy (reference group). Those samples were analyzed for the concentrations of selected cytokines using standard enzyme-linked immunosorbent assay technique (ELISA). Lower genital tract microbiology was diagnosed using Gram stain method according to Spiegel's criteria and by culture.
Mean gestational age at the time of sampling was 28.6 weeks. Mean time between sampling and delivery was 8,24 weeks in TPL group and 10.2 weeks in reference group. BV was diagnosed in 25.2% of subjects under study. M. hominis and U. urealyticum were diagnosed more frequently among women from TPL group (25.9% vs 14.9% and 36.2% vs 17.0%, respectively). Out of 107 women 15 (14.0%) delivered before 37th week of gestation. The rate of preterem delivery was significantly higher in threatened preterm labour group--21.3% is comparison to reference group--4.3%. Median cervico-vaginal concentration of IL-1 alpha, IL-1 beta, IL-6 and IL-8 did not differ between preterm and term delivery group. Only women with lower genital tract infection and one cytokine's low concentration (below 25th percentile) presented a higher risk of preterm delivery--OR=2,91. If IL-1 alpha and IL-1 beta concentrations were below 25th percentile, the calculated risk of preterm delivery was OR = 4.65. The highest risk was noted for women with lower genital tract infection and low cervico-vaginal concentrations of IL-1 alpha and IL-8--OR = 8.0 (3.20-20.01).
The early gestation cytokines' levels in cervico-vaginal fluid of pregnant women could be useful for prediction of preterm delivery only among women with lower genital tract infection.
近期研究表明，促炎细胞因子可能在早产和分娩机制中起关键作用。这项前瞻性研究的主要目的是评估孕妇宫颈阴道液中所选促炎细胞因子（白细胞介素 -1α、白细胞介素 -1β、白细胞介素 -6 和白细胞介素 -8）水平作为早产早期标志物的有效性。
从 107 名妊娠 22 至 34 周的孕妇中获取宫颈阴道液，其中包括 61 名有早产风险的孕妇（早产风险组）和 46 名妊娠过程正常的孕妇（参照组）。使用标准酶联免疫吸附测定技术（ELISA）分析这些样本中所选细胞因子的浓度。根据 Spiegel 标准，采用革兰氏染色法并通过培养诊断下生殖道微生物学情况。
采样时的平均孕周为 28.6 周。早产风险组采样至分娩的平均时间为 8.24 周，参照组为 10.2 周。研究对象中 25.2%被诊断为细菌性阴道病。解脲脲原体和人型支原体在早产风险组女性中诊断更为频繁（分别为 25.9%对 14.9%和 36.2%对 17.0%）。107 名女性中有 15 名（14.0%）在妊娠 37 周前分娩。早产风险组的早产率显著高于参照组——分别为 21.3%和 4.3%。早产组和足月分娩组宫颈阴道液中白细胞介素 -1α、白细胞介素 -1β、白细胞介素 -6 和白细胞介素 -8 的中位数浓度无差异。仅下生殖道感染且一种细胞因子浓度低（低于第 25 百分位数）的女性早产风险更高——优势比 = 2.91。如果白细胞介素 -1α和白细胞介素 -1β浓度低于第 百分位数，计算得出的早产风险优势比为 4.风险最高的是下生殖道感染且宫颈阴道液中白细胞介素 -1α和白细胞介素 -8 浓度低的女性——优势比 = 8.0（3.20 - 20.01）。
孕妇宫颈阴道液中妊娠早期细胞因子水平仅对下生殖道感染的女性预测早产可能有用。
