Vrachnis Nikolaos, Malamitsi-Puchner Adriadne, Samoli Evi, Botsis Dimitrios, Iliodromiti Zoe, Baka Stavroula, Hassiakos Dimitrios, Creatsas George
Second Department of Obstetrics and Gynecology, Aretaeion Hospital, University of Athens, Greece.
J Soc Gynecol Investig. 2006 Apr;13(3):186-90. doi: 10.1016/j.jsgi.2006.01.003.
To determine during mid-trimester amniocentesis if elevated concentrations of ADAM-8 (A Disintegrin And Metalloprotease 8) and/or cortisol can recognize women at risk for spontaneous preterm delivery.
The study involved 312 women who underwent mid-trimester amniocentesis. Thirteen patients, who progressed to preterm delivery, were matched with 21 controls for age, parity, gestational age at amniocentesis, and year of amniocentesis. ADAM-8 and cortisol levels were measured by enzyme-linked immunosorbent assay and radioimmunoassay, respectively.
ADAM-8 mean amniotic fluid concentrations were significantly higher in women with preterm delivery than in women delivering at term (mean 1213.9 [SE 96.7] pg/mL [range, 780 to 1854 pg/mL] vs mean 937.2 [SE 50.3] pg/mL [range, 486 to 1508 pg/mL], P < .02). Amniotic fluid ADAM-8 concentrations higher than 1149 pg/mL had the highest specificity and odds ratio (OR) in the identification of the women with increased risk for preterm delivery (sensitivity 61.5%; specificity 81.7%; OR, 9.6 [95% confidence interval (CI), 1.8 to 50.3]). Women with preterm delivery had suggestively higher amniotic fluid concentrations of cortisol (mean 1.3 [SE 0.2] microg/dL [range, 0.4 to 2.2 microg/dL]) than women delivering at term (mean 1.0 [SE 0.09] microg/dL [range, 0.6 to 1.7 microg/dL], P < .07). Furthermore, cortisol levels were positively correlated with ADAM-8 levels (Spearman's r = .418, P < .014).
Elevated mid-trimester amniotic fluid ADAM-8 concentrations possibly are a risk factor for preterm delivery, particularly if ADAM-8 levels are greater than 1149 pg/mL. Potential intrauterine inflammation is also associated with suggestively increased amniotic fluid cortisol levels.
在孕中期羊膜腔穿刺术期间，确定ADAM-8（一种解整合素和金属蛋白酶8）和/或皮质醇浓度升高是否可识别有自发早产风险的女性。
该研究纳入了312例行孕中期羊膜腔穿刺术的女性。13例进展为早产的患者与21例对照在年龄、产次、羊膜腔穿刺时的孕周及羊膜腔穿刺年份方面进行匹配。分别采用酶联免疫吸附测定法和放射免疫测定法测量ADAM-8和皮质醇水平。
早产女性的羊水ADAM-8平均浓度显著高于足月分娩女性（平均1213.9 [标准误96.7] pg/mL [范围，780至1854 pg/mL] 对比平均937.2 [标准误50.3] pg/mL [范围，486至1508 pg/mL]，P <.02）。羊水ADAM-8浓度高于1149 pg/mL在识别早产风险增加的女性中具有最高的特异性和优势比（OR）（敏感性61.5%；特异性81.7%；OR，9.6 [95%置信区间（CI），1.8至50.3]）。早产女性的羊水皮质醇浓度（平均1.3 [标准误0.2] μg/dL [范围，0.4至2.2 μg/dL]）比足月分娩女性（平均1.0 [标准误0.09] μg/dL [范围，0.6至1.7 μg/dL]）略高（P <.07）。此外，皮质醇水平与ADAM-8水平呈正相关（斯皮尔曼相关系数r =.418，P <.014）。
孕中期羊水ADAM-8浓度升高可能是早产的一个危险因素，特别是当ADAM-8水平大于1149 pg/mL时。潜在的宫内炎症也与羊水皮质醇水平的提示性升高有关。
