Perinatology Research Branch, Wayne State University/Hutzel Women ’ s Hospital, MI 48201, USA.
J Perinat Med. 2013 Sep 1;41(5):581-94. doi: 10.1515/jpm-2013-0084.
The objective of this study was to determine whether maternal plasma concentrations of soluble α-klotho are different between women with microbial invasion of the intra-amniotic cavity (MIAC) and those without MIAC among preterm labor and intact membranes (PTL) or preterm prelabor rupture of membranes (pPROM).
A cross-sectional study was conducted to include women in the following groups: i) PTL with MIAC (n=14); ii) PTL without MIAC (n=79); iii) pPROM with MIAC (n=30); and iv) pPROM without MIAC (n=33). MIAC was defined as a positive amniotic fluid culture for microorganisms (aerobic/anaerobic bacteria or genital mycoplasmas). Amniotic fluid samples were obtained within 48 h of maternal blood collection. Plasma concentration of soluble α-klotho was determined by ELISA.
i) The median plasma concentration (pg/mL) of soluble α-klotho was significantly lower in patients with MIAC than in those without MIAC (787.0 vs. 1117.8; P<0.001). ii) Among patients with PTL, those with MIAC had a lower median plasma concentration (pg/mL) of soluble α-klotho than those without MIAC (787.0 vs. 1138.9; P=0.007). iii) Among patients with pPROM, those with MIAC had a lower median plasma concentration (pg/mL) of soluble α-klotho than those without MIAC (766.4 vs. 1001.6; P=0.045). iv) There was no significant difference in the median plasma concentration of soluble α-klotho between PPROM without MIAC and PTL without MIAC (1001.6 pg/mL vs. 1138.9 pg/mL, respectively; P=0.5). v) After adjustment for potential confounders (maternal age, tobacco use, gestational age at venipuncture), soluble α-klotho remained significantly associated with MIAC (P=0.02); and vi) Among patients without MIAC, smoking was significantly associated with a lower median plasma concentration soluble α-klotho than in non-smokers (794.2 pg/mL vs. 1382.0 pg/mL, respectively; P<0.001); however, this difference was not observed in patients with MIAC.
Intra-amniotic infection occurring at preterm gestations (regardless of membrane status) was associated with a decrease in maternal plasma concentrations of soluble α-klotho. Moreover, among patients without infection, the plasma concentration of α-klotho was lower in smokers.
本研究旨在确定在早产（胎膜完整或胎膜早破）并伴有或不伴有羊膜腔内微生物入侵（MIAC）的孕妇中，母体外周血中可溶性α-klotho 的浓度是否存在差异。
采用横断面研究的方法，纳入以下组别：i）MIAC 合并早产（PTL）（n=14）；ii）无 MIAC 的 PTL（n=79）；iii）MIAC 合并胎膜早破（pPROM）（n=30）；iv）无 MIAC 的 pPROM（n=33）。MIAC 的定义为羊水培养出需氧/厌氧细菌或生殖道支原体阳性。在采集母亲血液的 48 小时内获取羊水样本。通过 ELISA 测定可溶性 α-klotho 的血浆浓度。
i）MIAC 患者的可溶性 α-klotho 中位数（pg/mL）明显低于无 MIAC 患者（787.0 vs. 1117.8；P<0.001）。ii）在 PTL 患者中，MIAC 患者的可溶性 α-klotho 中位数（pg/mL）明显低于无 MIAC 患者（787.0 vs. 1138.9；P=0.007）。iii）在 pPROM 患者中，MIAC 患者的可溶性 α-klotho 中位数（pg/mL）明显低于无 MIAC 患者（766.4 vs. 1001.6；P=0.045）。iv）无 MIAC 的 pPROM 与无 MIAC 的 PTL 患者可溶性 α-klotho 中位数（1001.6 pg/mL vs. 1138.9 pg/mL）无显著差异（P=0.5）。v）在调整了潜在混杂因素（母亲年龄、吸烟、静脉穿刺时的孕周）后，可溶性 α-klotho 仍与 MIAC 显著相关（P=0.02）；vi）在无 MIAC 的患者中，与不吸烟者相比，吸烟者的可溶性 α-klotho 中位数明显较低（794.2 pg/mL vs. 1382.0 pg/mL，P<0.001）；然而，在 MIAC 患者中未观察到这种差异。
发生在早产（无论胎膜状况如何）的羊膜腔内感染与母体外周血可溶性 α-klotho 浓度降低有关。此外，在无感染的患者中，吸烟者的 α-klotho 血浆浓度较低。
