Andrys Ctirad, Kacerovsky Marian, Drahosova Marcela, Musilova Ivana, Pliskova Lenka, Hornychova Helena, Prochazka Martin, Jacobsson Bo
Department of Clinical Immunology and Allergy, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Czech Republic.
J Matern Fetal Neonatal Med. 2013 Mar;26(5):520-7. doi: 10.3109/14767058.2012.741634. Epub 2012 Nov 15.
To determine amniotic fluid soluble Toll-like receptor 2 (sTLR2) levels in PPROM according to the presence of microbial invasion of the amniotic cavity (MIAC), histological chorioamnionitis (HCA), and both these conditions. To test the cutoff level of 222.7 ng/mL, as proposed in our previous study, in order to distinguish women with both MIAC and HCA.
169 women with a gestational age between 24+0 and 36+6 weeks were included in a prospective cohort study. Amniocenteses were performed, and sTLR2 in the amniotic fluid were determined using ELISA.
Women with MIAC had higher sTLR2 levels (median 113.2 ng/mL) than those without MIAC (median 47.1 ng/mL; p < 0.0001). Women with HCA did not have a higher sTLR2 level (median 52.6 ng/mL) compared with women without HCA (median 47.1 ng/mL; p = 0.23). Women with both MIAC and HCA had higher sTLR2 levels (median: 311.3 ng/mL) than other women (17.5 ng/mL; p < 0.0001). The cutoff level 222.7 ng/mL had a sensitivity of 63%, a specificity of 98%, and a likelihood ratio of 40.3 for the prediction of both MIAC and HCA.
Amniotic fluid sTLR2 is a promising predictor of both MIAC and HCA with high specificity in PPROM.
根据羊膜腔微生物入侵（MIAC）、组织学绒毛膜羊膜炎（HCA）以及这两种情况的存在，确定未足月胎膜早破（PPROM）患者羊水可溶性Toll样受体2（sTLR2）水平。为检验我们之前研究中提出的222.7 ng/mL的临界值，以区分同时患有MIAC和HCA的女性。
169例孕龄在24⁺⁰至36⁺⁶周之间的女性被纳入一项前瞻性队列研究。进行羊膜腔穿刺，并采用酶联免疫吸附测定法（ELISA）测定羊水中的sTLR2。
患有MIAC的女性sTLR2水平（中位数为113.2 ng/mL）高于未患MIAC的女性（中位数为47.1 ng/mL；p < 0.0001）。与未患HCA的女性相比，患有HCA的女性sTLR2水平（中位数为52.6 ng/mL）并未升高（中位数为47.1 ng/mL；p = 0.23）。同时患有MIAC和HCA的女性sTLR2水平（中位数：311.3 ng/mL）高于其他女性（17.5 ng/mL；p < 0.0001）。222.7 ng/mL的临界值对预测MIAC和HCA的敏感性为63%，特异性为98%，似然比为40.3。
羊水sTLR2是PPROM中MIAC和HCA的一种有前景的预测指标，具有高特异性。
