Second Department of Obstetrics and Gynaecology, University of Athens Medical School, Aretaieio Hospital, 124B Vasilisis Sofias Ave., 11526, Athens, Greece.
In Vivo. 2012 Sep-Oct;26(5):799-812.
Preterm birth continues to be one of the most important issues in current obstetric medicine, being the single largest cause of perinatal morbidity and mortality. The signals that initiate preterm and term labour remain a mystery. Intrauterine inflammation with the secretion of cytokines is one of the accepted explanations for the mechanism of initiation of preterm labour. This review discusses the current understanding of the molecular mechanisms for the initiation of preterm labour, focusing chiefly on the role of intra-amniotic fluid mediators, whether endogenous or infection-induced, in the regulation of inflammatory response pathways associated with spontaneous preterm labour. Prostaglandins (PGs) are considered to be one of the key mediators of preterm labour, with the concentration of biologically active PGs in the amniotic fluid, particularly PGE(2) and PGF(2α), being significantly higher in women with preterm labour. Cytokines, such as interleukins and tumour necrosis factor alpha, additionally play a dominant role in preterm labour, particularly in association with infection. Elevated amniotic fluid concentrations of extracellular matrix mediators, including metalloproteases, are also implicated in the process of foetal membrane rupture in preterm labour. Allelic variations in the main amniotic fluid mediators may be the key to understanding the disparity in the rates of preterm birth between different ethnic populations. We also discuss the role of other potential mediators such as cell-adhesion molecules, nitric oxide and novel biomarkers found in the amniotic fluid.
早产仍是当前产科医学中最重要的问题之一，是围产期发病率和死亡率的首要原因。引发早产和足月产的信号仍是个谜。子宫内炎症导致细胞因子分泌，这是引发早产的机制之一。本文综述了目前对早产启动的分子机制的理解，主要集中在羊水中内源性或感染诱导的介质在调节与自发性早产相关的炎症反应途径中的作用。前列腺素（PGs）被认为是早产的关键介质之一，羊水中具有生物活性的 PGs，尤其是 PGE（2）和 PGF（2α）的浓度，在早产妇女中明显更高。细胞因子，如白细胞介素和肿瘤坏死因子-α，在早产中也起主要作用，尤其是与感染有关。细胞外基质介质（包括基质金属蛋白酶）在早产时羊水中浓度升高，也与胎膜破裂过程有关。主要羊水中介质的等位基因变异可能是理解不同种族人群早产率差异的关键。我们还讨论了其他潜在介质的作用，如细胞黏附分子、一氧化氮和羊水中发现的新型生物标志物。
