目的 探讨sHLA-G在胎膜早破发生、发展过程中的作用以及相关性,并探讨其与组织学绒毛膜羊膜炎(histological chorioamnionitis,HCA)的相关性。方法 通过检测胎膜早破(promature rupture of memberes,PROM)及正常妊娠的孕妇血清及羊水中可溶性人白细胞抗原-G (soluble human leukocyte antigen-G,sHLA-G)的水平变化,采用酶联免疫吸附实验测定正常分娩的足月胎膜早破孕妇(term premature rupture of membrances,TPROM)、未足月胎膜早破孕妇(preterm pr-emature rupture of membranes,PPROM)各30例与正常妊娠对照组24例血清及羊水中sHLA-G的表达水平变化,以及观察其在HCA与非HCA组中两因子的水平变化。结果 (1)胎膜早破孕妇血清及羊水中sHLA-G水平与正常对照组相比均升高,并于产后胎膜组织病理检测出HCA组血清及羊水中sHLA-G的水平均高于非HCA组,差异均有统计学意义(P<0.05);(2)从破膜时间与胎膜HCA发生率的关系可知:<8 h发生率为7.14%,8～12 h发生率为33.3%,>12 h发生率为64.2%,3组比较,差异有统计学意义(P<0.05),可认为破膜时间越长感染发生率越高。结论 孕妇血清及羊水中sHLA-G水平升高可能参与了胎膜早破或合并有绒毛膜羊膜炎的发生,进而推测其可能作为胎膜早破或绒毛膜羊膜炎的临床诊断指标之一。
Abstract
Objective To study the roles of soluble human leukocyte antigen-G(sHLA-G)in the occurrence and development of premature rupture of membranes and their correlations by detecting premature rupture of memberes(PROM)and the levels of sHLA-G in maternal serum and amniotic fluid under normal pregnancy, and to evaluate the correlations of sHLA-G and IL-18 in predicting histological chorioamnionitis. Methods The levels of sHLA-G in maternal serum and amniiotic fluid under normal pregnancy were detected, which among 30 cases of pregnant women in the term premature rupture of membrances (TPROM) group, 30 cases in the preterm premature rupture of membranes (PPROM) group and 24 cases in the control group by enzyme linked immunosorbent assay. And its correlation with histological chorioamnionitis was discussed. The data were analyzed by using statistical software of SPSS13.0. Results (1)The levels of sHLA-G in maternal serum and amniotic fluid of PROM group were both higher than those in normal control group.The postpartum fetal membrane pathological examination in PROM group showed that the levels of sHLA-G in chorioamnionitis patients were higher than those in non-chorioamnionitis patients. and the differences were statistically significant(P<0.05).(2)For the relationship between the fetal membranes rupture time and the incidence of fetal membrane chorioamnionitis: the <8 h incidence rate was 7.14%,the 8-12 h incidence rate was 33.3%, the >12 h incidence rate was 64.2%; by comparing the incidences in three groups, the differences were statistically significant(P<0.05).It was considered that the incidence of infection increased with increasing rupture time. Conclusion The increase in the levels of sHLA-G in maternal serum andamniotic fluid might be involved in the incidence of premature rupture of membranes,or with chorioamnionitis. sHLA-G is speculated to be as one of the clinical diagnostic indexes of premature rupture of membranes and amniotic infection.
关键词
胎膜早破 /
组织学绒毛膜羊膜炎 /
可溶性人白细胞抗原-G
Key words
promature rupture of members /
histological chorioamnionitis /
soluble human leukocyte antigen-G
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 谢 幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:1.
[2] Fujiwara A, Fukushima K, Inoue H,et al.Perinatal management of preterm premature ruptured membranes affects neonatal prognosis preterm Premature Ruptureof the membranes [J].J Perinat Med,2014,11:1-7.
[3] Gezer A, Parafit-Yalciner E, Guralp O, et al.Neonatalmorbidity mortality outcomes in pre-term premature rupture of membranes[J]. J Obstet Gynaecol,2013,33(1) :38-42.
[4] Blanchon L, Accoceberry M, Belville C, et al. Rupture of membranes: pathophysiology, diagnosis, consequences and management[J].J Gynecol Obstet Biol Re- prod (Paris),2013, 42(2):105-106.
[5] Aguin E, Van De Ven C, Cordoba M,et al. Cerclage retention versus removal following preterm premature rupture of membranes and association with amniotic fluid markers[J].Int J Gynaecol Obstet,2014,2(13):7286-7292.
[6] Saglam A, Ozgur C, Derwig I, et al. The role of apoptosis in preterm premature rupture of the human fetal rupture of the human fetal membranes[J].Arch Gynecol Obstet,2013,288(3):501-507.
[7] Magee B, Smith G. Histological chorioamnionitis associated with preterm prelabour rup-ture of membranes at kingston general hospital: a practice audit[J].J Obstet Gynaecol,2013, 5(12):1083-1089.
[8] ShuChi Mu,Cheng Huilin,YILing Chen .ImPact on Neonatal Outcome and Anthropeometric Growth inVery Low Birthweight Infants with Histological Chorioamnionitis[J].J Formos Med Assoc,2008,107(4):304-310.
[9] 罗雪梅,周昌菊.孕妇血清可溶性细胞间粘附分子-1与亚临床绒毛膜羊膜炎的关系[J].中国实用妇科与产科杂志,2006,2(22):112-114.
[10] Al Riyami N1, Al Ruheili I, Al Shezaw F,et al.Extreme Preterm Premature Rupture of Membranes : Risk Factors and Feto Maternal Outcomes[J].Oman Medical Journal, 2013,28(2):108-111.
[11] van der Ham D P, van Melick M J, Smits L, et al. Methods for the diagnosis of rupture of the fetal membranes in equivocal cases: a systematic review[J].Eur J Obstet Gynecol Reprod Biol,2011,157(2):123-127.
[12] 赵明瑜,张 璐,徐志敏,等.血清可溶性人白细胞抗原 G 测定在诊断亚临床绒毛膜炎中的意义[J].医药论坛杂志,2013,34(1):7-9.
[13] 吕发辉. 胎膜早破并发绒毛膜羊膜炎的诊断进展[J].医学综述,2013,19(2):294-297.
[14] Geraghty D E,Koller B H,Orr H T.A human major histocompatibility complex classⅠgene that encodes a protein with a shortened cytoplasmic segment[J].Proc Natl Acad Sci USA,1987,84(24):9145-9149.
[15] Kamishikiryo J,Maenaka K.HLA -G molecule[J].Curr PharmDes,2009,15(28):3318-3324.
[16] Aruna M, Sudheer P S,Andal S, et al. HLA-G polymorphism patterns show lack of detectable association with recurrent spontaneous abortion[J].Tissue Antigens,2010,76(3):216-222.
[17] Fabio Morandi, Elisa Ferretti, Paola Bocca,et al.A Novel Mechanism of Soluble HLA-G Mediated Immune Modulation: Downregulation of T Cell Chemokine Receptor Expression and Impairment of ChemotaxisThe prevalence of endometriosis in women with chronic pelvic pain[J].Gynecol Obstet Invest,2010,5 (7):1-9.
[18] 赵明瑜,张 璐.可溶性人白细胞抗原G与妊娠合并绒毛膜羊膜炎的临床相关性研究[J].中华实验和临床感染病杂志,2011,5(4): 437-442.
[19] 汪丛敏,石清蒲,李 力. TPROM时间、血清C反应蛋白与绒毛膜羊膜炎的相关性[J].中国妇幼保健,2012, 27(36):5888-5889.
[20] Kusanovic J P,Romero R,Jodicke C,et al.Amniotic fluid soluble human leukocyte antigen-G in term and preterm parturition,and intra-amniotic infection / inflammation[J]. Matern Fetal Neonatal Mel,2009,22( 12) : 1151-1166.
PDF(891 KB)
