Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Department of Immunology, State Research Institute Center of Innovative Medicine, Vilnius, Lithuania.
BMC Pregnancy Childbirth. 2024 Jan 10;24(1):54. doi: 10.1186/s12884-023-06221-0.
Improving noninvasive antenatal diagnosis of fetal inflammatory response syndrome (FIRS) can assist in the evaluation of prenatal risk and reduce perinatal outcomes. This study aimed to determine whether soluble urokinase-type plasminogen activator receptor (suPAR) in vaginally collected amniotic fluid is significant in identifying FIRS after preterm premature rupture of membranes before 34 weeks of gestation.
This was a prospective cohort study of 114 pregnant women and their newborns after preterm premature rupture of membranes at 22-34 weeks of gestation. SuPAR was evaluated using an enzyme-linked immunosorbent assay in vaginally collected amniotic fluid. Patients were classified according to the presence or absence of FIRS. FIRS was defined by umbilical cord blood interleukin-6 level > 11 pg/mL or histological funisitis. The data were analyzed using the R package (R-4.0.5).
SuPAR was detected in all amniotic fluid samples with a median of 26.23 ng/mL (interquartile range (IQR), 15.19-51.14). The median level of suPAR was higher in the FIRS group than in the non-FIRS group, 32.36 ng/mL (IQR, 17.27-84.16) vs. 20.46 ng/mL (IQR, 11.49-36.63) (P = 0.01), respectively. The presence of histological chorioamnionitis significantly increased the suPAR concentration in the FIRS group (P < 0.001). The areas under the curve for FIRS and FIRS with histological chorioamnionitis were 0.65 and 0.74, respectively, with an optimum cutoff value of 27.60 ng/mL. Controlling for gestational age, the cutoff of suPAR more than 27.60 ng/mL predicted threefold higher odds for FIRS and sixfold higher odds for FIRS with histologic chorioamnionitis.
Soluble urokinase-type plasminogen activator receptor in vaginally obtained amniotic fluid may assist in evaluating prenatal risk of FIRS in patients after preterm premature rupture of membranes before 34 weeks of gestation.
提高胎儿炎症反应综合征（FIRS）的非侵入性产前诊断能力有助于评估产前风险并改善围产结局。本研究旨在探讨 22-34 孕周胎膜早破孕妇阴道采集的羊水中可溶性尿激酶型纤溶酶原激活物受体（suPAR）是否可用于预测早产胎膜早破后发生的 FIRS。
这是一项前瞻性队列研究，共纳入 114 例孕 22-34 周早产胎膜早破孕妇及其新生儿。采用酶联免疫吸附试验检测阴道采集的羊水中 suPAR。根据是否发生 FIRS 将患者分为两组。FIRS 的定义为脐血白细胞介素-6 水平＞11pg/mL 或存在组织学绒毛膜羊膜炎。数据采用 R 软件包（R-4.0.5）进行分析。
所有羊水样本均检测到 suPAR，中位数为 26.23ng/mL（四分位距（IQR）：15.19-51.14）。FIRS 组的 suPAR 中位数高于非 FIRS 组，分别为 32.36ng/mL（IQR：17.27-84.16）和 20.46ng/mL（IQR：11.49-36.63）（P=0.01）。组织学绒毛膜羊膜炎的存在显著增加了 FIRS 组的 suPAR 浓度（P＜0.001）。FIRS 和伴有组织学绒毛膜羊膜炎的 FIRS 的曲线下面积分别为 0.65 和 0.74，最佳截断值为 27.60ng/mL。控制胎龄后，suPAR ＞27.60ng/mL 的截断值预测 FIRS 的发生风险增加 3 倍，伴有组织学绒毛膜羊膜炎的 FIRS 发生风险增加 6 倍。
阴道采集的羊水中可溶性尿激酶型纤溶酶原激活物受体可能有助于评估早产胎膜早破孕妇发生 FIRS 的产前风险。
