Department of Obstetrics and Gynaecology, Children Health Research Institute, University of Western Ontario, London, Canada.
Early Hum Dev. 2010 Feb;86(2):113-7. doi: 10.1016/j.earlhumdev.2010.01.027. Epub 2010 Feb 18.
We have determined venous and arterial cord blood levels for IL-6 and TNFalpha at the time of delivery to assess gestational tissue versus fetal sources in labouring and non-labouring patients at term, and the relationship to labour events.
Fifty-five patients were studied (elective cesarean section n=24, and labouring n=31) with blood sampling from a clamped segment of cord after delivery of the fetus and from the cord at its insertion into the placenta after delivery of the placenta, with subsequent measurement of blood gases, pH, IL-6 and TNFalpha.
Umbilical cord levels for IL-6 were increased by 4 fold in low risk labouring patients, and a further 6 fold when showing histologic chorioamnionitis, but with no evident effect of nuchal cord with 'variable' fetal heart rate decelerations, fetal acidemia, nor of labour duration. IL-6 levels from the cord at its insertion into the placenta were generally higher than those from the respective umbilical levels indicating that placental release of IL-6 into cord blood must be occurring. However, a consistent venoarterial difference for IL-6 and thereby a net flux from the placenta could not be demonstrated. TNFalpha levels for both patient groups were uniformly low for all of the cord measurements with no significant differences noted.
Umbilical cord levels for IL-6 are increased in low risk labouring patients at term in the absence of evident infection which likely involves both gestational tissue and fetal contributions. Cord levels for IL-6 are further increased in low risk labouring patients showing histologic chorioamnionitis which might then contribute to newborn morbidity in these pregnancies.
我们测定分娩时脐静脉和脐动脉血中白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNFα）的水平，以评估临产和未临产足月产妇的妊娠组织和胎儿来源，并探讨其与分娩事件的关系。
我们对 55 例产妇（择期剖宫产 24 例，临产 31 例）进行研究，在胎儿娩出后从脐带夹闭段和胎盘娩出后脐带插入胎盘处采集血样，随后检测血气、pH 值、IL-6 和 TNFα。
低危临产产妇脐血 IL-6 水平增加 4 倍，出现组织学绒毛膜羊膜炎时增加 6 倍，但未见脐带绕颈伴“可变”胎儿心率减速、胎儿酸中毒，以及产程长短对 IL-6 水平有明显影响。胎盘插入脐带处的 IL-6 水平一般高于相应的脐血水平，提示 IL-6 必须从胎盘释放到脐血中。然而，未能证明 IL-6 存在静脉-动脉差异，因此也不能证明存在从胎盘的净通量。两组患者的 TNFα 水平在所有脐带测量中均较低，且无显著差异。
低危临产足月产妇脐血 IL-6 水平升高，无明显感染证据，可能涉及妊娠组织和胎儿的共同作用。低危临产且出现组织学绒毛膜羊膜炎的产妇，脐血 IL-6 水平进一步升高，这可能导致这些妊娠新生儿发病率增加。
