Salafia C M, DeVore G R, Mainolfi E, Kelly J, Pezzullo J C, Rothlein R
Department of Laboratory Medicine, Danbury Hospital, CT 06810.
Am J Obstet Gynecol. 1993 Oct;169(4):830-4. doi: 10.1016/0002-9378(93)90012-8.
Our purpose was to determine if circulating intercellular adhesion molecule-1, a marker of chronic inflammation, is present in amniotic fluid in midtrimester, is increased in patients with elevated maternal serum alpha-fetoprotein level, and is associated with intrauterine growth retardation.
Amniotic fluid circulating intercellular adhesion molecule-1 levels were assayed by enzyme-linked immunoassay in 273 samples obtained by midtrimester amniocentesis in gestations involving a single, structurally normal fetus. The control group consisted of 108 patients with normal maternal serum alpha-fetoprotein levels and 165 patients with elevated levels. Intrauterine growth retardation was diagnosed if birth weight was < 10th percentile for the clinically estimated gestational age.
Circulating intercellular adhesion molecule-1 was detectable in amniotic fluid in 105 of 273 samples (38%). In the control group it was detectable in amniotic fluid in seven of 108 (6%). In patients with elevated maternal serum alpha-fetoprotein 97 of 164 (59%) had detectable levels (p < 0.001). Of the 273 cases 38 (14%) had intrauterine growth retardation. Of these 23 (59%) had detectable circulating intercellular adhesion molecule-1 levels (p < 0.001). Of the seven cases of intrauterine growth retardation with normal maternal serum alpha-fetoprotein levels, one (14%) had detectable circulating intercellular adhesion molecule-1. Of the 31 cases of intrauterine growth retardation with elevated maternal serum alpha-fetoprotein 22 (71%) had detectable circulating intercellular adhesion molecule-1. When circulating intercellular adhesion molecule-1 was detectable in amniotic fluid, increasing levels was significantly related to decreasing gestational age at delivery (p < 0.005).
Midtrimester amniotic fluid from normal pregnancies does not generally contain detectable circulating intercellular adhesion molecule-1. Detectable amniotic fluid levels are significantly related to a birth weight < 10th percentile at delivery and to elevated midtrimester maternal serum alpha-fetoprotein levels. Increasing circulating intercellular adhesion molecule-1 levels are related to shortened length of gestation. This test may contribute to risk assessment for intrauterine growth retardation and prematurity. Circulating intercellular adhesion molecule-1 is a known marker of inflammatory processes; its further study may also improve understanding of the pathophysiologic mechanisms of certain cases of intrauterine growth retardation and prematurity.
我们的目的是确定循环细胞间黏附分子-1（一种慢性炎症标志物）在孕中期羊水中是否存在，母体血清甲胎蛋白水平升高的患者其水平是否升高，以及它是否与宫内生长迟缓相关。
采用酶联免疫吸附测定法检测了273例孕中期羊膜腔穿刺获取的样本中的羊水循环细胞间黏附分子-1水平，这些妊娠均为单胎、结构正常胎儿。对照组包括108例母体血清甲胎蛋白水平正常的患者和165例水平升高的患者。如果出生体重低于临床估计孕周的第10百分位数，则诊断为宫内生长迟缓。
273例样本中有105例（38%）的羊水中可检测到循环细胞间黏附分子-1。对照组中，108例中有7例（6%）的羊水中可检测到该分子。母体血清甲胎蛋白水平升高的患者中，164例中有97例（59%）可检测到该分子（p<0.001）。273例病例中有38例（14%）发生宫内生长迟缓。其中23例（59%）可检测到循环细胞间黏附分子-1水平（p<0.001）。在母体血清甲胎蛋白水平正常的7例宫内生长迟缓病例中，1例（14%）可检测到循环细胞间黏附分子-1。在母体血清甲胎蛋白水平升高的31例宫内生长迟缓病例中，22例（71%）可检测到循环细胞间黏附分子-1。当羊水中可检测到循环细胞间黏附分子-1时，其水平升高与分娩时孕周减小显著相关（p<0.005）。
正常妊娠孕中期羊水一般不含可检测到的循环细胞间黏附分子-1。羊水中可检测到该分子与分娩时出生体重低于第10百分位数以及孕中期母体血清甲胎蛋白水平升高显著相关。循环细胞间黏附分子-1水平升高与妊娠时间缩短相关。该检测可能有助于宫内生长迟缓和早产的风险评估。循环细胞间黏附分子-1是炎症过程的已知标志物；对其进一步研究可能还会增进对某些宫内生长迟缓和早产病例病理生理机制的理解。
