Menon Ramkumar, Thorsen Poul, Vogel Ida, Jacobsson Bo, Morgan Nicole, Jiang Lan, Li Chun, Williams Scott M, Fortunato Stephen J
Perinatal Research Center, Nashville, TN 37203, USA.
Am J Obstet Gynecol. 2008 May;198(5):533.e1-10. doi: 10.1016/j.ajog.2007.11.025. Epub 2008 Feb 14.
Preterm birth rate in the United States is higher in blacks than whites. It has been hypothesized that a differential inflammatory response may explain this disparity. The objective of this study is to examine the inflammatory cytokine, tumor necrosis factor (TNF)-alpha and soluble TNF receptor concentrations (sTNFR1 and sTNFR2) in the amniotic fluid of black and white women at delivery.
Amniotic fluid samples were collected during active labor from 158 cases (preterm births, gestational age 22(0/7) weeks to 36(0/7) weeks, 52 black and 106 white) and 175 controls (term births, gestational age 37(0/7) weeks to 42(0/7) weeks, 87 black and 88 white) at Centennial Women's Hospital, Nashville, TN. Amniotic fluid TNF-alpha, sTNFR1, and sTNFR2 concentrations and the molar ratios of TNF-alpha to its receptors were compared between cases and controls within each racial group.
Median TNF-alpha concentration was associated with preterm birth when whites and blacks were analyzed together, with cases having higher values (191.5 pg/mL) than controls (68.9 pg/mL; P < .001). There were no significant associations with sTNFR1 or sTNFR2 concentrations between cases (2409.4 and 2934.3 pg/mL, respectively) and controls (2759.9 and 3084.1 pg/mL, respectively) when the racial groups were analyzed together (P = .08, P = .4, respectively). Black cases associated with higher TNF-alpha concentrations (1287.0 pg/mL in cases and 67.3 pg/mL in controls; P < .001). In whites there was no association between TNF-alpha and preterm birth (P = .3). The molar ratio of TNF-alpha/total sTNFR (R1 plus R2) associated with higher TNF-alpha in black cases, compared with black controls (P < .001). There was no significant association between white cases and controls for ligand receptor ratios (P = .3).
The TNF-alpha/sTNFR profile in pregnancy differs between racial groups, suggesting a difference in bioavailability of TNF-alpha. The larger molar ratio of TNF-alpha/sTNFR in black cases may be indicative of a TNF-alpha mediated pathological process of preterm birth in blacks but not in whites.
美国黑人的早产率高于白人。据推测,不同的炎症反应可能解释了这种差异。本研究的目的是检测分娩时黑人和白人女性羊水中炎症细胞因子、肿瘤坏死因子(TNF)-α及可溶性TNF受体浓度(sTNFR1和sTNFR2)。
在田纳西州纳什维尔百年妇女医院,对158例(早产,孕周22(0/7)周至36(0/7)周,52例黑人、106例白人)和175例对照(足月产,孕周37(0/7)周至42(0/7)周,87例黑人、88例白人)在活跃期分娩时采集羊水样本。比较每个种族组中病例和对照之间羊水TNF-α、sTNFR1和sTNFR2浓度以及TNF-α与其受体的摩尔比。
将白人和黑人一起分析时,TNF-α浓度中位数与早产有关,病例组的值(191.5 pg/mL)高于对照组(68.9 pg/mL;P <.001)。将种族组一起分析时,病例组(分别为2409.4和2934.3 pg/mL)和对照组(分别为2759.9和3084.1 pg/mL)之间的sTNFR1或sTNFR2浓度无显著相关性(P分别为.08和.4)。黑人病例的TNF-α浓度较高(病例组为1287.0 pg/mL,对照组为67.3 pg/mL;P <.001)。在白人中,TNF-α与早产之间无相关性(P =.3)。与黑人对照组相比,黑人病例中TNF-α/总sTNFR(R1加R2)的摩尔比与较高的TNF-α相关(P <.001)。白人病例与对照组之间的配体受体比无显著相关性(P =.3)。
不同种族组孕期的TNF-α/sTNFR谱不同,提示TNF-α的生物利用度存在差异。黑人病例中较大的TNF-α/sTNFR摩尔比可能表明TNF-α介导了黑人而非白人的早产病理过程。