Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Obstetrics and Gynecology, Chungnam National University Hospital, Daejeon, South Korea.
Am J Reprod Immunol. 2024 Jul;92(1):e13909. doi: 10.1111/aji.13909.
To explore the clinical utility of nine inflammatory immune-, adhesion-, and extracellular matrix-related mediators in the plasma for predicting intraamniotic inflammation and/or microbial invasion of the amniotic cavity (IAI/MIAC) and composite neonatal morbidity and/or mortality (CNMM) in women with preterm premature rupture of membranes (PPROM) when used alone or in combination with conventional blood-, ultrasound-, and clinical-based factors.
This retrospective cohort comprised 173 singleton pregnant women with PPROM (24 + 0 - 33 + 6 weeks), who underwent amniocentesis. Amniotic fluid was cultured for microorganisms and assayed for IL-6 levels. Plasma levels of AFP, CXCL14, E-selectin, Gal-3BP, kallistatin, progranulin, P-selectin, TGFBI, and VDBP were determined by ELISA. Ultrasonographic cervical length (CL) and neutrophil-to-lymphocyte ratio (NLR) were measured.
Multivariate logistic regression analyses revealed significant associations between (i) decreased plasma kallistatin levels and IAI/MIAC and (ii) decreased plasma progranulin levels and increased CNMM risk after adjusting for baseline variables (e.g., gestational age at sampling [or delivery] and parity). Using stepwise regression analysis, noninvasive prediction models for IAI/MIAC and CNMM risks were developed, which included plasma progranulin levels, NLR, CL, and gestational age at sampling, and provided a good prediction of the corresponding endpoints (area under the curve: 0.79 and 0.87, respectively).
Kallistatin and progranulin are potentially valuable plasma biomarkers for predicting IAI/MIAC and CNMM in women with PPROM. Particularly, the combination of these plasma biomarkers with conventional blood-, ultrasound-, and clinical-based factors can significantly support the diagnosis of IAI/MIAC and CNMM.
探讨九种炎症免疫、黏附和细胞外基质相关介质在血浆中的临床应用价值，以预测胎膜早破（PPROM）孕妇羊膜腔内炎症和/或微生物入侵（IAI/MIAC）以及复合新生儿发病率和/或死亡率（CNMM），单独或联合常规血液、超声和临床因素使用。
本回顾性队列研究纳入了 173 例单胎胎膜早破孕妇（24+0 至 33+6 周），进行了羊膜穿刺术。对羊水进行微生物培养和白细胞介素-6（IL-6）水平检测。采用酶联免疫吸附试验（ELISA）测定 AFP、CXCL14、E-选择素、Gal-3BP、激肽释放酶原、颗粒蛋白前体、P-选择素、TGFBI 和 VDBP 等血浆水平。测量超声宫颈长度（CL）和中性粒细胞与淋巴细胞比值（NLR）。
多变量逻辑回归分析显示，在调整基线变量（如采样[或分娩]时的胎龄和产次）后，血浆激肽释放酶原水平降低与 IAI/MIAC 显著相关，而血浆颗粒蛋白前体水平降低与 CNMM 风险增加显著相关。采用逐步回归分析，建立了用于预测 IAI/MIAC 和 CNMM 风险的非侵入性预测模型，该模型包括血浆颗粒蛋白前体水平、NLR、CL 和采样时的胎龄，对相应终点具有良好的预测能力（曲线下面积分别为 0.79 和 0.87）。
激肽释放酶原和颗粒蛋白前体是预测 PPROM 孕妇 IAI/MIAC 和 CNMM 的潜在有价值的血浆生物标志物。特别是，将这些血浆生物标志物与常规血液、超声和临床因素相结合，可以显著支持 IAI/MIAC 和 CNMM 的诊断。
