Division of Maternal-Fetal Medicine, Women & Infants' Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Am J Obstet Gynecol. 2013 Apr;208(4):321.e1-9. doi: 10.1016/j.ajog.2013.01.014. Epub 2013 Jan 10.
Both the state of pregnancy as well as disruption of vaginal flora and immune mediators may increase the risk of human immunodeficiency virus-1 acquisition. The objective of this study was to define immune changes in lower genital and systemic immunity associated with normal pregnancy.
This prospective cohort enrolled low-risk pregnant and nonpregnant women ages 18-35 years. Pregnant women at <14 weeks and nonpregnant women in follicular phase of the menstrual cycle were included. Cervical and vaginal fluid was collected. Concentrations of immune mediators were measured using enzyme-linked immunosorbent assay-based methods or multiplex immunoassay. Samples were inoculated onto various culture media allowing for growth of Lactobacillus species, Gardnerella vaginalis, Escherichia coli, Enterococcus species, anaerobic gram-negative rods, Candida, Staphylococcus aureus, Ureaplasma species, and Mycoplasma hominis. Concentrations of immune mediators and vaginal colonization frequencies were compared between the pregnant and nonpregnant groups.
Genital tract concentration of interleukin-1β was higher during pregnancy compared to nonpregnant participants. Serum C-reactive protein concentrations were higher in all trimesters of pregnancy. Concentrations of secretory leukocyte protease inhibitor did not differ between groups. Lactobacillus was more commonly isolated from vaginal cultures of nonpregnant participants (100% vs 70.2%, P = .02). Identification of Candida, G vaginalis, M hominis, and S aureus was common and not different between groups. Ureaplasma species was isolated from >60% pregnant participants.
The proinflammatory cytokine, interleukin-1β, as well as the systemic marker of inflammation, C-reactive protein, are increased during pregnancy. The impact of these proinflammatory changes during pregnancy deserves further study.
妊娠状态以及阴道菌群和免疫介质的破坏都可能增加人类免疫缺陷病毒-1（HIV-1）的感染风险。本研究旨在确定与正常妊娠相关的下生殖道和全身免疫的免疫变化。
本前瞻性队列纳入了年龄在 18-35 岁之间的低危妊娠和非妊娠女性。纳入了妊娠 <14 周和非妊娠女性的卵泡期。采集宫颈和阴道分泌物。使用酶联免疫吸附测定（ELISA）或多重免疫测定法测量免疫介质的浓度。将样本接种到各种培养基上，允许乳酸杆菌属、阴道加德纳菌、大肠杆菌、肠球菌属、厌氧革兰氏阴性杆菌、假丝酵母菌属、金黄色葡萄球菌、脲原体属和人型支原体生长。比较妊娠组和非妊娠组之间的生殖道免疫介质浓度和阴道定植频率。
与非妊娠参与者相比，妊娠期间生殖道中白细胞介素-1β的浓度更高。所有妊娠三期中血清 C 反应蛋白的浓度都较高。分泌型白细胞蛋白酶抑制剂的浓度在两组之间没有差异。非妊娠参与者的阴道培养中更常分离出乳酸杆菌（100%比 70.2%，P=0.02）。阴道加德纳菌、人型支原体和金黄色葡萄球菌的鉴定在两组之间是常见的，没有差异。超过 60%的妊娠参与者分离出脲原体属。
促炎细胞因子白细胞介素-1β以及炎症的系统标志物 C 反应蛋白在妊娠期间增加。这些妊娠期间的促炎变化的影响值得进一步研究。
