Hillier S L, Witkin S S, Krohn M A, Watts D H, Kiviat N B, Eschenbach D A
Department of Obstetrics and Gynecology, University of Washington, Seattle.
Obstet Gynecol. 1993 Jun;81(6):941-8.
To assess the association between cytokines in the amniotic fluid (AF) and preterm delivery, the isolation of bacteria from the AF or chorioamnion, and histologic chorioamnionitis.
Fifty afebrile women with intact membranes in preterm labor at or before 34 weeks' gestation underwent amniocentesis. Cytokine levels were measured in AF, and cultures were performed. Placentas were cultured and examined histologically.
Thirty-two (64%) of the 50 patients delivered at or before 34 weeks' gestation. Delivery at or before 34 weeks, compared with delivery after 34 weeks, was related to increased levels of interleukin-6 (IL-6) (88 versus 12%; P < .001), interleukin-1 (IL-1) alpha (50 versus 6%; P = .004), IL-1 beta (42 versus 0%; P = .002), and prostaglandin (PG) E2 (66 versus 22%; P = .008). Bacteria were recovered from the AF of nine (18%) of the 50 patients. All of the cytokines with increased levels, plus tumor necrosis factor (TNF)-alpha, were related to bacteria in the AF. Increased IL-6, IL-1 alpha, IL-1 beta, TNF-alpha, and PGE2 were also associated with histologic chorioamnionitis among women who delivered within 1 week of amniocentesis. Elevated cytokine levels were not related to chorioamnion infection.
Elevated AF cytokines and PGE2 predicted delivery before 34 weeks' gestation and delivery within 7 days of the amniocentesis, as well as AF infection and histologic chorioamnionitis. These findings support the hypothesis that infection is one cause of preterm delivery, operating via a mechanism involving induction of cytokine production.
评估羊水（AF）中的细胞因子与早产、AF或绒毛膜羊膜炎细菌分离以及组织学绒毛膜羊膜炎之间的关联。
50例妊娠34周及以前胎膜完整且无发热的早产妇女接受了羊膜腔穿刺术。检测AF中的细胞因子水平并进行培养。对胎盘进行培养和组织学检查。
50例患者中有32例（64%）在妊娠34周及以前分娩。与34周后分娩相比，34周及以前分娩与白细胞介素-6（IL-6）水平升高（88%对12%；P <.001）、白细胞介素-1（IL-1）α（50%对6%；P =.004）、IL-1β（42%对0%；P =.002）以及前列腺素（PG）E2（66%对22%；P =.008）有关。50例患者中有9例（18%）的AF中培养出细菌。所有水平升高的细胞因子，加上肿瘤坏死因子（TNF）-α，都与AF中的细菌有关。在羊膜腔穿刺术1周内分娩的妇女中，IL-6、IL-1α、IL- lβ、TNF-α和PGE2升高也与组织学绒毛膜羊膜炎有关。细胞因子水平升高与绒毛膜羊膜炎感染无关。
AF细胞因子和PGE2升高可预测妊娠34周前分娩以及羊膜腔穿刺术7天内分娩，以及AF感染和组织学绒毛膜羊膜炎。这些发现支持了感染是早产的原因之一这一假说，其作用机制涉及诱导细胞因子产生。
