Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Obstetrics and Gynecology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea.
J Korean Med Sci. 2020 Feb 24;35(7):e26. doi: 10.3346/jkms.2020.35.e26.
We aimed to investigate whether various immune-related plasma proteins, alone or in combination with conventional clinical risk factors, can predict spontaneous preterm delivery (SPTD) and intra-amniotic infection in women with premature cervical dilation or a short cervix (≤ 25 mm).
This retrospective study included 80 asymptomatic women with premature cervical dilation (n = 50) or a short cervix (n = 30), who underwent amniocentesis at 17-29 weeks. Amniotic fluid (AF) was cultured, and maternal plasma was assayed for interleukin (IL)-6, matrix metalloproteinase (MMP)-9, tissue inhibitor of metalloproteinases (TIMP)-1, and complements C3a and C5a, using enzyme-linked immunosorbent assay (ELISA) kits. The primary outcome measures were SPTD at < 32 weeks and positive AF cultures.
The plasma levels of IL-6, C3a, and C5a, but not of MMP-9 and TIMP-1, were significantly higher in women with SPTD at < 32 weeks than in those who delivered at ≥ 32 weeks. The women who delivered at < 32 weeks had more advanced cervical dilatation, and higher rates of antibiotic and tocolytic administration and were less likely to be given vaginal progesterone than those who delivered at ≥ 32 weeks. Using a stepwise regression analysis, a combined prediction model was developed, which included the plasma IL-6 and C3a levels, and cervical dilatation (area under the curve [AUC], 0.901). The AUC for this model was significantly greater than that for any single variable included in the predictive model. In the univariate analysis, plasma IL-6 level was the only significant predictor of intra-amniotic infection.
In women with premature cervical dilation or a short cervix, maternal plasma IL-6, C3a, and C5a levels could be useful non-invasive predictors of SPTD at < 32 weeks. A combination of these biomarkers and conventional clinical factors may clearly improve the predictability for SPTD, as compared with the biomarkers alone. An increased plasma level of IL-6 predicted intra-amniotic infection.
我们旨在研究单独或联合常规临床危险因素的各种免疫相关血浆蛋白是否可预测伴有早产宫颈扩张或短宫颈（≤25mm）的孕妇自发性早产（SPTD）和羊膜腔内感染。
本回顾性研究纳入了 80 例在 17-29 周行羊膜穿刺术的无症状早产宫颈扩张（n=50）或短宫颈（n=30）孕妇。采用酶联免疫吸附试验（ELISA）试剂盒检测母血浆白细胞介素（IL）-6、基质金属蛋白酶（MMP）-9、金属蛋白酶组织抑制剂（TIMP）-1以及补体 C3a 和 C5a。主要结局指标为<32 周的 SPTD 和阳性羊水培养。
与≥32 周分娩的孕妇相比，<32 周分娩的孕妇的血浆 IL-6、C3a 和 C5a 水平显著更高，而 MMP-9 和 TIMP-1 水平则无显著差异。<32 周分娩的孕妇宫颈扩张程度更高，抗生素和宫缩抑制剂使用率更高，而阴道用黄体酮使用率更低。采用逐步回归分析，建立了一个包括血浆 IL-6 和 C3a 水平及宫颈扩张程度的综合预测模型（曲线下面积[AUC]为 0.901）。该模型的 AUC 显著大于预测模型中任何单一变量的 AUC。单因素分析中，血浆 IL-6 水平是羊膜腔内感染的唯一显著预测因子。
对于伴有早产宫颈扩张或短宫颈的孕妇，母血浆 IL-6、C3a 和 C5a 水平可能是<32 周 SPTD 的有用非侵入性预测因子。与单独使用生物标志物相比，这些生物标志物与常规临床因素的联合使用可明显提高 SPTD 的预测能力。血浆中 IL-6 水平的升高预测了羊膜腔内感染。
