Lu Dan, Wang Zhi-xue, Wang Xiao-ling, Gu Xue-wen, Wang Yi-xiong, Fu Dan
Department of Obstetrics and Gynecology, Yangzhou University College of Medicine, Yangzhou 225001, China.
Zhonghua Fu Chan Ke Za Zhi. 2006 Jan;41(1):20-4.
To investigate the roles of matrix metalloproteinase (MMP)-9 and tissue inhibitors of matrix metalloproteinase (TIMP)-1 in maternal serum, amniotic fluid and umbilical cord serum in predicting premature rupture of the membranes (PROM) and chorioamnionitis.
The levels of MMP-9 and TIMP-1 were detected by enzyme linked immunosorbent assay in maternal serum, amniotic fluid, umbilical cord serum of 58 pregnant women with PROM and 38 women with normal pregnancies. Chorioamnionitis was histopathologically confirmed after delivery.
(1) The levels of MMP-9 in maternal serum, umbilical cord serum and amniotic fluid were (141.9 +/- 84.6) ng/L, (138.2 +/- 81.4) ng/L and (85.6 +/- 27.5) ng/L respectively, significantly higher in patients with PROM than those of the control group (P < 0.05, P < 0.05 and P < 0.01 respectively), while the levels of TIMP-1 in maternal serum, amniotic fluid and umbilical cord serum were (378.1 +/- 220.2) ng/L, (44.6 +/- 24.0) ng/L and (257.2 +/- 98.8) ng/L respectively, significantly lower in patients with PROM than those of the control group (P < 0.05, P < 0.05 and P < 0.01 respectively). (2) The longer the duration from rupture of membranes to delivery was, the more serious chorioamnionitis was, and the higher the levels of MMP-9 and the lower the TIMP-1 levels in maternal serum, amniotic fluid, and umbilical cord serum were. (3) The levels of MMP-9 in maternal serum, umbilical cord serum and amniotic fluid were (183.8 +/- 84.7) ng/L, (171.2 +/- 92.9) ng/L and (95.5 +/- 21.1) ng/L respectively, significantly higher in patients with chorioamnionitis than those of non-chorioamnionitis (P < 0.05, P < 0.05 and P < 0.01 respectively), while the levels of TIMP-1 in maternal serum, amniotic fluid and umbilical cord serum were (269.7 +/- 144.4) ng/L, (32.1 +/- 16.6) ng/L and (210.6 +/- 81.9) ng/L respectively, significantly lower in patients with chorioamnionitis than those of non-chorioamnionitis (P < 0.05, P < 0.05 and P < 0.01 respectively). (4) The levels of MMP-9 in maternal serum, umbilical cord serum and amniotic fluid were (234.4 +/- 79.4) ng/L, (222.1 +/- 120.1) ng/L and (108.5 +/- 42.2) ng/L respectively, significantly higher in neonates whose Apgar score < or = 7 than those of neonates whose Apgar score > or = 8 (P < 0.05, P < 0.05 and P < 0.01 respectively), while the levels of TIMP-1 in maternal serum, amniotic fluid and umbilical cord serum were (225.3 +/- 121.7) ng/L, (25.2 +/- 15.8) and (181.7 +/- 135.2) ng/L respectively, significantly lower in neonates whose Apgar score < or = 7 than those of neonates whose Apgar score > or = 8 (P < 0.05, P < 0.05 and P < 0.01 respectively).
It is suggested that preterm PROM is associated with increased MMP-9 and decreased TIMP-1 levels. MMP-9 and TIMP-1 are valuable clinical biological markers for identifying chorioamnionitis and predicting neonates prognosis.
探讨基质金属蛋白酶（MMP）-9和基质金属蛋白酶组织抑制剂（TIMP）-1在母血、羊水及脐血中预测胎膜早破（PROM）和绒毛膜羊膜炎的作用。
采用酶联免疫吸附测定法检测58例胎膜早破孕妇及38例正常孕妇的母血、羊水、脐血中MMP-9和TIMP-1水平。产后经组织病理学确诊绒毛膜羊膜炎。
（1）母血、脐血及羊水中MMP-9水平分别为（141.9±84.6）ng/L、（138.2±81.4）ng/L和（85.6±27.5）ng/L，胎膜早破患者显著高于对照组（分别为P<0.05、P<0.05和P<0.01）；而母血、羊水及脐血中TIMP-1水平分别为（378.1±220.2）ng/L、（44.6±24.0）ng/L和（257.2±98.8）ng/L，胎膜早破患者显著低于对照组（分别为P<0.05、P<0.05和P<头0.01）。（2）胎膜破裂至分娩时间越长，绒毛膜羊膜炎越严重，母血、羊水及脐血中MMP-9水平越高，TIMP-1水平越低。（3）绒毛膜羊膜炎患者母血、脐血及羊水中MMP-9水平分别为（183.8±84.7）ng/L、（171.2±92.9）ng/L和（95.5±21.1）ng/L，显著高于非绒毛膜羊膜炎患者（分别为P<0.05、P<0.05和P<0.01）；而绒毛膜羊膜炎患者母血、羊水及脐血中TIMP-1水平分别为（269.7±144.4）ng/L、（32.1±16.6）ng/L和（210.6±81.9）ng/L，显著低于非绒毛膜羊膜炎患者（分别为P<0.05、P<0.05和P<0.01）。（4）Apgar评分≤7分的新生儿母血、脐血及羊水中MMP-9水平分别为（234.4±79.4）ng/L、（222.1±120.1）ng/L和（108.5±42.2）ng/L，显著高于Apgar评分≥8分的新生儿（分别为P<0.05、P<0.05和P<0.01）；而Apgar评分≤7分的新生儿母血、羊水及脐血中TIMP-1水平分别为（225.3±121.7）ng/L、（25.2±15.8）和（181.7±135.2）ng/L，显著低于Apgar评分≥8分的新生儿（分别为P<0.05、P<0.05和P<0.01）。
提示早产胎膜早破与MMP-9水平升高及TIMP-1水平降低有关。MMP-9和TIMP-1是识别绒毛膜羊膜炎及预测新生儿预后有价值的临床生物学标志物。
