Galinsky Robert, Polglase Graeme R, Hooper Stuart B, Black M Jane, Moss Timothy J M
Ritchie Centre, Monash Institute of Medical Research, Monash University, P.O. Box 5418, Clayton, VIC 3168, Australia.
J Pregnancy. 2013;2013:412831. doi: 10.1155/2013/412831. Epub 2013 Mar 7.
Preterm birth is a major cause of perinatal mortality and long-term morbidity. Chorioamnionitis is a common cause of preterm birth. Clinical chorioamnionitis, characterised by maternal fever, leukocytosis, tachycardia, uterine tenderness, and preterm rupture of membranes, is less common than subclinical/histologic chorioamnionitis, which is asymptomatic and defined by inflammation of the chorion, amnion, and placenta. Chorioamnionitis is often associated with a fetal inflammatory response. The fetal inflammatory response syndrome (FIRS) is defined by increased systemic inflammatory cytokine concentrations, funisitis, and fetal vasculitis. Clinical and epidemiological studies have demonstrated that FIRS leads to poor cardiorespiratory, neurological, and renal outcomes. These observations are further supported by experimental studies that have improved our understanding of the mechanisms responsible for these outcomes. This paper outlines clinical and experimental studies that have improved our current understanding of the mechanisms responsible for chorioamnionitis-induced preterm birth and explores the cellular and physiological mechanisms underlying poor cardiorespiratory, neural, retinal, and renal outcomes observed in preterm infants exposed to chorioamnionitis.
早产是围产期死亡和长期发病的主要原因。绒毛膜羊膜炎是早产的常见原因。临床绒毛膜羊膜炎以母体发热、白细胞增多、心动过速、子宫压痛和胎膜早破为特征，不如亚临床/组织学绒毛膜羊膜炎常见，后者无症状，由绒毛膜、羊膜和胎盘的炎症定义。绒毛膜羊膜炎常与胎儿炎症反应相关。胎儿炎症反应综合征（FIRS）由全身炎症细胞因子浓度升高、脐带炎和胎儿血管炎定义。临床和流行病学研究表明，FIRS会导致不良的心肺、神经和肾脏结局。这些观察结果得到了实验研究的进一步支持，这些研究增进了我们对导致这些结局的机制的理解。本文概述了临床和实验研究，这些研究增进了我们目前对绒毛膜羊膜炎所致早产机制的理解，并探讨了在暴露于绒毛膜羊膜炎的早产儿中观察到的不良心肺、神经、视网膜和肾脏结局背后的细胞和生理机制。
