Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR, USA.
Am J Obstet Gynecol. 2012 Dec;207(6):475.e1-475.e14. doi: 10.1016/j.ajog.2012.10.871. Epub 2012 Oct 23.
We assessed the efficacy of a maternal multidose azithromycin (AZI) regimen, with and without antiinflammatory agents to delay preterm birth and to mitigate fetal lung injury associated with Ureaplasma parvum intraamniotic infection.
Long-term catheterized rhesus monkeys (n = 16) received intraamniotic inoculation of U parvum (10(7) colony-forming U/mL, serovar 1). After contraction onset, rhesus monkeys received no treatment (n = 6); AZI (12.5 mg/kg, every 12 h, intravenous for 10 days; n = 5); or AZI plus dexamethasone and indomethacin (n = 5). Outcomes included amniotic fluid proinflammatory mediators, U parvum cultures and polymerase chain reaction, AZI pharmacokinetics, and the extent of fetal lung inflammation.
Maternal AZI therapy eradicated U parvum intraamniotic infection from the amniotic fluid within 4 days. Placenta and fetal tissues were 90% culture negative at delivery. AZI therapy significantly delayed preterm delivery and prevented advanced fetal lung injury, although residual acute chorioamnionitis persisted.
Specific maternal antibiotic therapy can eradicate U parvum from the amniotic fluid and key fetal organs, with subsequent prolongation of pregnancy, which provides a therapeutic window of opportunity to effectively reduce the severity of fetal lung injury.
我们评估了一种母体多剂量阿奇霉素（AZI）方案的疗效，该方案联合或不联合抗炎药物，以延迟早产并减轻解脲脲原体羊膜内感染与胎儿肺损伤相关的问题。
长期置管恒河猴（n=16）接受解脲脲原体（10(7) 个菌落形成单位/mL，血清型 1）羊膜内接种。收缩开始后，恒河猴未接受治疗（n=6）；AZI（12.5mg/kg，每 12 小时静脉注射一次，共 10 天；n=5）；或 AZI 加地塞米松和吲哚美辛（n=5）。结果包括羊水中促炎介质、解脲脲原体培养和聚合酶链反应、AZI 药代动力学以及胎儿肺炎症的程度。
母体 AZI 治疗在 4 天内从羊水中根除解脲脲原体。分娩时胎盘和胎儿组织的培养阳性率为 90%。AZI 治疗显著延迟了早产并预防了晚期胎儿肺损伤，尽管仍存在急性绒毛膜羊膜炎。
特定的母体抗生素治疗可以从羊水中和胎儿的关键器官中根除解脲脲原体，随后延长妊娠时间，为有效减轻胎儿肺损伤的严重程度提供了治疗机会。
