Helmo Fernanda Rodrigues, Alves Eduardo Arthur Rodovalho, Moreira Renata Alves de Andrade, Severino Viviane Oliveira, Rocha Laura Penna, Monteiro Maria Luíza Gonçalves Dos Reis, Reis Marlene Antônia Dos, Etchebehere Renata Margarida, Machado Juliana Reis, Corrêa Rosana Rosa Miranda
a Department of General Pathology , Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro , Minas Gerais , Brazil.
b Department of Immunology, Oncology Research Institute (IPON), Federal University of Triângulo Mineiro , Minas Gerais , Brazil.
J Matern Fetal Neonatal Med. 2018 May;31(9):1227-1233. doi: 10.1080/14767058.2017.1311318. Epub 2017 Apr 20.
Preterm birth accounts for nearly one million deaths among children under five years of age, and although its etiopathogenesis is not fully elucidated, ascending intrauterine infection and fetal inflammatory response seem to be the main triggers. The intense inflammatory response mediated by IL-1β, TNF-α, PAF, IFN-γ and IL-6, PGE and MMP-1 and MMP-9 causes fetal membrane damage and rupture, increased uterine contractions and biochemical and structural changes in the cervix. Furthermore, preterm neonates have deficient innate and adaptive immune responses characterized by reduced levels of IgG, opsonization and phagocytosis, as well as increased activation of Th1 cells in relation to Th2 cells. Therefore, this triad is favors the occurrence of neonatal complications, such as respiratory distress syndrome, necrotizing enterocolitis, retinopathy of prematurity and bronchopulmonary dysplasia. Due to serious maternal and child health complications of intrauterine infection, several studies have tried to identify biomarkers for the early diagnosis of this entity. This literature review aims to discuss the main scientific findings regarding the association between ascending intrauterine infection, immune system and preterm birth.
早产导致五岁以下儿童近百万死亡，尽管其发病机制尚未完全阐明，但上行性宫内感染和胎儿炎症反应似乎是主要诱因。由白细胞介素-1β、肿瘤坏死因子-α、血小板活化因子、干扰素-γ和白细胞介素-6、前列腺素E以及基质金属蛋白酶-1和基质金属蛋白酶-9介导的强烈炎症反应会导致胎膜损伤和破裂、子宫收缩增强以及宫颈的生化和结构变化。此外，早产新生儿的先天性和适应性免疫反应存在缺陷，其特征是免疫球蛋白G水平降低、调理作用和吞噬作用减弱，以及与辅助性T细胞2相比辅助性T细胞1的活化增加。因此，这三者共同促使新生儿并发症的发生，如呼吸窘迫综合征、坏死性小肠结肠炎、早产儿视网膜病变和支气管肺发育不良。由于宫内感染会引发严重的母婴健康并发症，多项研究试图寻找该病症早期诊断的生物标志物。这篇文献综述旨在探讨有关上行性宫内感染、免疫系统与早产之间关联的主要科学发现。
