Clinic of Obstetrics and Gynecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
Acta Obstet Gynecol Scand. 2021 Dec;100(12):2209-2215. doi: 10.1111/aogs.14228. Epub 2021 Jul 26.
This study was conducted to evaluate soluble Toll-like receptor 2 (sTLR-2) and soluble Toll-like receptor 4 (sTLR-4) levels in vaginally obtained amniotic fluid and investigate their value in the prediction of histological chorioamnionitis (HCA).
This prospective case-control study included patients who had been diagnosed with preterm premature rupture of membranes before 34 weeks of gestation and were admitted to Vilnius University Hospital Santaros Klinikos. Free leaking amniotic fluid was obtained vaginally using a sterile speculum up to 48 h before delivery. Amniotic fluid levels of sTLR-2 and sTLR-4 were determined using an enzyme-linked immunosorbent assay. The diagnosis of chorioamnionitis was confirmed by histological examination of the placenta and membranes after delivery.
The study included 156 patients, 65 with (HCA Group) and 91 without (non-HCA Group) HCA. No statistically significant differences were noted in the concentrations of sTLR-2 and sTLR-4 in vaginally obtained amniotic fluid between patients with and without HCA: the median sTLR-2 level was 0.09 ng/mL in the HCA Group vs 0.1 ng/mL in non-HCA Group, and the median sTLR-4 level was 0.23 ng/mL in the HCA Group vs 0.28 ng/mL in non-HCA Group (p > 0.05). A positive correlation between sTLR-2 and sTLR-4 levels was identified (ρ = 0.57, p < 0.001), but no correlation was found between these markers and gestational age.
Concentrations of sTLR-2 and sTLR-4 in vaginally obtained amniotic fluid do not reflect the presence of HCA in pregnancies complicated by preterm premature rupture of membranes before 34 weeks of gestation.
本研究旨在评估阴道获得的羊水可溶性 Toll 样受体 2（sTLR-2）和可溶性 Toll 样受体 4（sTLR-4）水平，并探讨其在预测组织学绒毛膜羊膜炎（HCA）中的价值。
本前瞻性病例对照研究纳入了在妊娠 34 周前诊断为早产胎膜早破并入住维尔纽斯大学Santaros 临床医院的患者。在分娩前 48 小时内，使用无菌窥器经阴道获取自由渗漏的羊水。采用酶联免疫吸附试验测定 sTLR-2 和 sTLR-4 的羊水水平。分娩后通过胎盘和胎膜的组织学检查确诊绒毛膜羊膜炎。
本研究共纳入 156 例患者，其中 65 例（HCA 组）和 91 例（非 HCA 组）发生 HCA。HCA 组和非 HCA 组患者阴道获得的羊水 sTLR-2 和 sTLR-4 浓度无统计学差异：HCA 组 sTLR-2 中位数为 0.09ng/mL，非 HCA 组为 0.1ng/mL；HCA 组 sTLR-4 中位数为 0.23ng/mL，非 HCA 组为 0.28ng/mL（p>0.05）。sTLR-2 和 sTLR-4 水平呈正相关（ρ=0.57，p<0.001），但与胎龄无相关性。
妊娠 34 周前早产胎膜早破患者阴道获得的羊水 sTLR-2 和 sTLR-4 浓度不能反映 HCA 的存在。
