Revello Rocio, Alcaide María José, Abehsera Daniel, Martin-Camean María, Sousa E Faro Gomes Mafalda, Alonso-Luque Bárbara, Bartha Jose L
a Division of Maternal and Foetal Medicine , University Hospital La Paz , Madrid , Spain.
b Department of Clinical Chemistry , University Hospital La Paz , Madrid , Spain.
J Matern Fetal Neonatal Med. 2018 Jul;31(14):1839-1844. doi: 10.1080/14767058.2017.1330407. Epub 2017 Jun 2.
First, to determinate the frequency of chorioamnionitis and funisitis in cases of intramniotic detection of Ureaplasma urealyticum. Second, to assess the predictive capability of some biological markers in the amniotic fluid of these women to predict histological inflammation.
We prospectively studied 20 cases of women with premature rupture of membranes or preterm labour (PROM) or preterm labour and intraamniotic detection of Ureaplasma urealyticum. Gestational age at admission was 26.74 ± 2.53 weeks. Amniotic fluid concentrations of IL18, IL 2, IL4, IL6, IL10, IL12, TNF-alpha, IFN-g, and MMP-8 were measured by the Multiplex method. Amniotic fluid glucose and leukocyte count were also measured by standard methods. Placental detailed histological studies were performed. Student's t-test, forward stepwise conditional binary logistic regression analysis and ROC curves were used.
Histological chorioamnionitis was present in 45% of cases (9/20) and funisitis just in 15% (3/20). Interleukins 6, 8, 12, MMP-8, and leukocyte count were significantly elevated in cases of histological inflammation, defined as choriamnionitis or chorioamniotis + funisitis (p = .007, .03, .01, .03, .03, respectively) while glucose was decreased (p = .04). Binary logistic regression for the prediction of inflammation showed a high predictive value (R = .66, p = .002) including in the equation only the IL6 value.
A significant percentage of cases with intraamniotic detection of Ureaplasma urealyticum shows no pathological signs of histological inflammation. Concentration of Interleukin 6 in amniotic fluid can be useful for the diagnosis of subclinical chorioamnionitis in these cases.
第一，确定羊膜腔内检测到解脲脲原体的病例中绒毛膜羊膜炎和脐带炎的发生率。第二，评估这些女性羊水中某些生物标志物预测组织学炎症的能力。
我们前瞻性地研究了20例胎膜早破或早产（PROM）或早产且羊膜腔内检测到解脲脲原体的女性病例。入院时的孕周为26.74±2.53周。采用多重检测法测定羊水白细胞介素18（IL18）、白细胞介素2（IL2）、白细胞介素4（IL4）、白细胞介素6（IL6）、白细胞介素10（IL10）、白细胞介素12（IL12）、肿瘤坏死因子-α（TNF-α）、干扰素-γ（IFN-γ）和基质金属蛋白酶-8（MMP-8）的浓度。同时采用标准方法测定羊水葡萄糖和白细胞计数。进行胎盘详细的组织学研究。采用学生t检验、向前逐步条件二元逻辑回归分析和ROC曲线。
45%的病例（9/20）存在组织学绒毛膜羊膜炎，仅15%（3/20）存在脐带炎。在定义为绒毛膜羊膜炎或绒毛膜羊膜炎+脐带炎的组织学炎症病例中，白细胞介素6、8、12、MMP-8和白细胞计数显著升高（p分别为0.007、0.03、0.01、0.03、0.03），而葡萄糖降低（p=0.04）。用于预测炎症的二元逻辑回归显示具有较高的预测价值（R=0.66，p=0.002），方程中仅包括IL6值。
相当比例的羊膜腔内检测到解脲脲原体的病例未显示组织学炎症的病理迹象。羊水白细胞介素6浓度可用于诊断这些病例中的亚临床绒毛膜羊膜炎。
