羊水中性粒细胞弹性蛋白酶和乳酸脱氢酶：与组织学绒毛膜羊膜炎的关联。

Amniotic fluid neutrophil elastase and lactate dehydrogenase: association with histologic chorioamnionitis.

作者信息

Kidokoro Kumiko, Furuhashi Madoka, Kuno Naohiko, Ishikawa Kaoru

机构信息

Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.

出版信息

Acta Obstet Gynecol Scand. 2006;85(6):669-74. doi: 10.1080/01443610600604432.

DOI:10.1080/01443610600604432

PMID:16752257

Abstract

BACKGROUND

Chorioamnionitis (CAM) is considered to be one of the main causes of preterm labor and has been associated with an adverse perinatal outcome in preterm infants. The diagnosis of acute histologic CAM requires delivery and examination of the placenta. Although numbers of markers have been reported to predict histologic CAM before birth, it is unknown whether the levels of neutrophil elastase and lactate dehydrogenase (LDH) in amniotic fluid are associated with histologic CAM.

METHODS

Sixty women at gestational age of 16-35 weeks underwent transabdominal amniocentesis within 48 hr before delivery. Amniotic fluid was analyzed for white blood cell count, glucose level, LDH level, and neutrophil elastase level. The levels of neutrophil elastase were measured by latex immunoassay. Following delivery, tissue samples were obtained from umbilical cord, chorionic plate, and placental membranes. Histologic CAM was diagnosed based on Blanc's criteria.

RESULTS

Receiver-operator characteristic curve analysis showed that the amniotic fluid neutrophil elastase had the best screening efficiency in predicting histologic CAM. Using amniotic fluid cut-off levels of 0.15 microg/ml for neutrophil elastase and 250 IU/l for LDH, the sensitivity, specificity, and positive and negative predictive values for predicting histologic CAM were 88.9% versus 84.1%, 73.3% versus 66.7%, 90.9% versus 88.1%, and 68.8% versus 58.8%, respectively.

CONCLUSION

Amniotic neutrophil elastase and LDH are useful markers in predicting histologic CAM.

摘要

背景

绒毛膜羊膜炎（CAM）被认为是早产的主要原因之一，并且与早产婴儿不良围产期结局相关。急性组织学绒毛膜羊膜炎的诊断需要分娩并检查胎盘。尽管已有多种标志物被报道可在产前预测组织学绒毛膜羊膜炎，但羊水中中性粒细胞弹性蛋白酶和乳酸脱氢酶（LDH）水平是否与组织学绒毛膜羊膜炎相关尚不清楚。

方法

60名孕龄为16 - 35周的女性在分娩前48小时内接受了经腹羊膜穿刺术。对羊水进行白细胞计数、葡萄糖水平、LDH水平和中性粒细胞弹性蛋白酶水平分析。中性粒细胞弹性蛋白酶水平通过乳胶免疫测定法测量。分娩后，从脐带、绒毛板和胎盘膜获取组织样本。根据布兰克标准诊断组织学绒毛膜羊膜炎。

结果

受试者工作特征曲线分析表明，羊水中性粒细胞弹性蛋白酶在预测组织学绒毛膜羊膜炎方面具有最佳筛查效率。当中性粒细胞弹性蛋白酶羊水临界值为0.15微克/毫升、LDH为250国际单位/升时，预测组织学绒毛膜羊膜炎的敏感性、特异性、阳性预测值和阴性预测值分别为88.9%对84.1%、73.3%对66.7%、90.9%对88.1%、68.8%对58.8%。