Park Chan-Wook, Yoon Bo Hyun, Kim Sun Min, Park Joong Shin, Jun Jong Kwan
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
Obstet Gynecol Sci. 2013 Jul;56(4):227-33. doi: 10.5468/ogs.2013.56.4.227. Epub 2013 Jul 15.
There is no data on which is more important for the intensity of intra-amniotic inflammation (IAI) between total grade or involved anatomical region in acute histologic chorioamnionitis (acute-HCA) of preterm-gestations. The objective of current study is to examine this issue.
The intensity of IAI was measured by amniotic fluid (AF) white blood cell (WBC) count and matrix metalloproteinase-8 (MMP-8) concentration in 225 singleton preterm-gestations (<36 weeks) who had acute-HCA including chorio-decidua involvement and delivered within 5 days of amniocentesis. Acute-HCA was defined in the presence of acute inflammatory changes in each anatomical region (i.e., chorio-decidua, amnion or chorionic plate). Patients were divided into 6 groups according to total grade (i.e., 1-6) and the presence or absence of chorio-decidua restriction (i.e., chorio-decidua restriction vs. extension beyond chorio-decidua) of acute-HCA.
There was no significant difference in a median AF WBC and MMP-8 between the two groups (group-1, cases with total grade 1 vs. group-2, cases with total grade 2) among cases with chorio-decidua restriction (each for P>0.05) and between the four groups (group-3, cases with total grade 2 vs. group-4, cases with total grade 3 vs. group-5, cases with total grade 4 vs. group-6, cases with total grade 5-6) among cases with extension beyond chorio-decidua (each for P>0.05). However, group-3 (cases with extension beyond chorio-decidua) had a significantly higher median AF WBC and MMP-8 than group-2 (cases with chorio-decidua restriction) among cases with total grade 2 (each for P<0.05).
Involved anatomical region is more important than total grade for the intensity of IAI in acute-HCA of preterm-gestations.
在早产急性组织学绒毛膜羊膜炎（急性-HCA）中，对于羊膜腔内炎症（IAI）的强度而言，尚无数据表明总体分级或受累解剖区域哪个更为重要。本研究的目的是探讨这一问题。
对225例单胎早产（<36周）且患有急性-HCA（包括绒毛膜蜕膜受累）并在羊膜腔穿刺后5天内分娩的孕妇，通过羊水（AF）白细胞（WBC）计数和基质金属蛋白酶-8（MMP-8）浓度来测量IAI的强度。急性-HCA的定义为每个解剖区域（即绒毛膜蜕膜、羊膜或绒毛板）存在急性炎症变化。根据急性-HCA的总体分级（即1-6级）以及绒毛膜蜕膜受限情况（即绒毛膜蜕膜受限与超出绒毛膜蜕膜范围），将患者分为6组。
在绒毛膜蜕膜受限的病例中，两组（1组，总体分级为1级的病例与2组，总体分级为2级的病例）之间的AF WBC中位数和MMP-8无显著差异（每组P>0.05）；在超出绒毛膜蜕膜范围的病例中，四组（3组，总体分级为2级的病例与4组，总体分级为3级的病例与5组，总体分级为4级的病例与6组，总体分级为5-6级的病例）之间的AF WBC中位数和MMP-8也无显著差异（每组P>0.05）。然而，在总体分级为2级的病例中，3组（超出绒毛膜蜕膜范围的病例）的AF WBC中位数和MMP-8显著高于2组（绒毛膜蜕膜受限的病例）（每组P<0.05）。
在早产急性-HCA中，对于IAI的强度而言，受累解剖区域比总体分级更为重要。
