胎膜早破患者血清白细胞计数、C反应蛋白、白介素22及其受体表达与绒毛膜羊膜炎的关系
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摘要
目的探讨胎膜早破患者血清中白介素22(IL-22)、白介素22受体1(IL-22R1)、C反应蛋白(CRP)、白细胞(WBC)表达与绒毛膜羊膜炎的关系。方法选择2016年10月~2017年9月沧州市妇幼保健院(以下简称"我院")收治的100例胎膜早破患者作为研究对象。根据有无绒毛膜羊膜炎及感染程度分为临床绒毛膜羊膜炎组(38例)、亚临床绒毛膜羊膜炎组(33例)和无绒毛膜羊膜炎组(29例),另随机选择我院同期收治的30例正常足月妊娠孕妇作为对照组。比较四组孕妇血清中IL-22、IL-22R1、CRP、WBC水平,并用ROC曲线分析各指标对绒毛膜羊膜炎的诊断价值。结果血清中WBC:临床绒毛膜羊膜炎组、亚临床绒毛膜羊膜炎组、无绒毛膜羊膜炎组均高于对照组,临床绒毛膜羊膜炎组高于亚临床绒毛膜羊膜炎组和无绒毛膜羊膜炎组,差异均有统计学意义(P<0.05),亚临床绒毛膜羊膜炎组高于无绒毛膜羊膜炎组,但差异无统计学意义(P>0.05);血清中CRP、IL-22和IL-22R1蛋白:临床绒毛膜羊膜炎组、亚临床绒毛膜羊膜炎组、无绒毛膜羊膜炎组均高于对照组,临床绒毛膜羊膜炎组高于亚临床绒毛膜羊膜炎组和无绒毛膜羊膜炎组,亚临床绒毛膜羊膜炎组高于无绒毛膜羊膜炎组,差异均有统计学意义(P<0.05)。四组患者血清中WBC、CRP、IL-22、IL-22R1的曲线下面积分别为0.717、0.778、0.909、0.916(P=0.049、0.028、0.000、0.000)。结论 IL-22、IL-22R1、CRP、WBC等指标在预测胎膜早破并发绒毛膜羊膜炎方面均有一定临床意义,且IL-22和IL-22R1预测价值最高,尤其是在预测亚临床绒毛膜羊膜炎患者方面。
Objective To investigate the relationship between expression of IL-22, IL-22 R1, CRP and WBC in serum of patients with premature rupture of membranes and chorioamnionitis. Methods A total of 100 patients with premature rupture of membranes who were treated in Cangzhou Maternal and Child Health Care Hospital( "our hospital" for short)from October 20 to September 2017 were selected as subjects, and they were divided into clinical chorioamnionitis group(38 cases), subclinical chorioamnionitis group(33 cases) and no chorionic amnioticitis group(29 cases) according to whether infected with chorioamnionitis and infection degree. Another 30 cases of normal full-term pregnant women in our hospital were randomly selected as a control group. The serum levels of IL-22, IL-22 R1, CRP and WBC of pregnant women in four groups were tested. The diagnostic value of each index by ROC curve were analyzed. Results Serum WBC: clinical chorioamniositis group, subclinical chorioamnitis group, chorionic amniotic inflammation group were higher than the control group. Clinical chorioamniositis group was higher than subclinical chorioamniositis group(P <0.05), while without significant difference between the subclinical chorioamnionitis group and the chorionic amniotic group(P > 0.05). Serum CRP, IL-22 and IL-22 R1: the levels of them in the clinical chorioamniositis group, subclinical chorioamnionitis group and no chorionic amniotic inflammation group were higher than those in the control group. The levels in the clinical chorioamnitis group was higher than subclinical chorioamnionitis group and no chorionic amniotic inflammation group(P < 0.05). There was also a re-markable difference between the subclinica chorioamniositis group and no chorionic amniotic inflammation group(P <0.05). The area under the curve(AUC) of WBC, CRP, IL-22 and IL-22 R1 in the serum of the four groups was 0.717,0.778, 0.909 and 0.916(P = 0.049, 0.028, 0.000 and 0.000). Conclusion There is a definite clinical significance of IL-22, IL-22 R1, CRP, WBC in the prediction of premature rupture of membranes with chorioamniositis, of which IL-22 and IL-22 R1 has the highest predict value, especially in the prediction of patients with subclinical chorioamnionitis.
Objective To investigate the relationship between expression of IL-22, IL-22 R1, CRP and WBC in serum of patients with premature rupture of membranes and chorioamnionitis. Methods A total of 100 patients with premature rupture of membranes who were treated in Cangzhou Maternal and Child Health Care Hospital( "our hospital" for short)from October 20 to September 2017 were selected as subjects, and they were divided into clinical chorioamnionitis group(38 cases), subclinical chorioamnionitis group(33 cases) and no chorionic amnioticitis group(29 cases) according to whether infected with chorioamnionitis and infection degree. Another 30 cases of normal full-term pregnant women in our hospital were randomly selected as a control group. The serum levels of IL-22, IL-22 R1, CRP and WBC of pregnant women in four groups were tested. The diagnostic value of each index by ROC curve were analyzed. Results Serum WBC: clinical chorioamniositis group, subclinical chorioamnitis group, chorionic amniotic inflammation group were higher than the control group. Clinical chorioamniositis group was higher than subclinical chorioamniositis group(P <0.05), while without significant difference between the subclinical chorioamnionitis group and the chorionic amniotic group(P > 0.05). Serum CRP, IL-22 and IL-22 R1: the levels of them in the clinical chorioamniositis group, subclinical chorioamnionitis group and no chorionic amniotic inflammation group were higher than those in the control group. The levels in the clinical chorioamnitis group was higher than subclinical chorioamnionitis group and no chorionic amniotic inflammation group(P < 0.05). There was also a re-markable difference between the subclinica chorioamniositis group and no chorionic amniotic inflammation group(P <0.05). The area under the curve(AUC) of WBC, CRP, IL-22 and IL-22 R1 in the serum of the four groups was 0.717,0.778, 0.909 and 0.916(P = 0.049, 0.028, 0.000 and 0.000). Conclusion There is a definite clinical significance of IL-22, IL-22 R1, CRP, WBC in the prediction of premature rupture of membranes with chorioamniositis, of which IL-22 and IL-22 R1 has the highest predict value, especially in the prediction of patients with subclinical chorioamnionitis.
引文
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[5]Gomez-Lopez N,Romero R,Xu Y,et al.A Role for the Inflammasome in Spontaneous Labor at Term with Acute Histologic Chorioamnionitis[J].Reprod Sci,2017,24(6):934-953.
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[7]Jones BC,Logsdon NJ,Walter MR.Structure of IL-22bound to its high-affinity IL-22R1 chain[J].Structure,2008,16(9):1333-1344.
[8]马文革,蔡银素,杨翠丽,等.C反应蛋白和白细胞介素-6与胎膜早破绒毛膜羊膜炎的关系[J].河北医药,2011,33(4):542-543.
[9]周仲元,陶贝贝.胎膜早破患者发生组织学绒毛膜羊膜炎的影响因素及新生儿结局[J].现代妇产科进展,2014,23(3):192-194.
[10]赵昊云,张秦,吴元赭.胎膜早破合并绒毛膜羊膜炎的预测指标新进展[J].东南国防医药,2014,(4):397-400.
[11]Cekmez Y,Cekmez F,Ozkaya E,et al.u PAR,IL-33,and ST2 values as a predictor of subclinical chorioamnionitis in preterm premature rupture of membranes[J].J Interferon Cytokine Res,2013,33(12):778-782.
[12]Meirowitz NB,Ananth CV,Smulian JC,et al.Effect of labor on infant morbidity and mortality with preterm premature rupture of membranes:United States populationbased study[J].Obstet Gynecol,2001,97(4):494-498.
[13]Romero R,Chaemsaithong P,Docheva N,et al.Clinical chorioamnionitis at term VI:acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity[J].J Perinat Med,2016,44(1):33-51.
[14]Dulay AT,Buhimschi IA,Zhao G,et al.Compartmentalization of acute phase reactants Interleukin-6,C-Reactive Protein and Procalcitonin as biomarkers of intra-amniotic infection and chorioamnionitis[J].Cytokine,2015,76(2):236-243.
[15]Kacerovsky M,Musilova I,Jacobsson B,et al.Vaginal fluid IL-6 and IL-8 levels in pregnancies complicated by preterm prelabor membrane ruptures[J].J Matern Fetal Neonatal Med,2015,28(4):392-398.
[16]Oner C,Schatz F,Kizilay G,et al.Progestin-inflammatory cytokine interactions affect matrix metalloproteinase-1and-3 expression in term decidual cells:implications for treatment of chorioamnionitis-induced preterm delivery[J].J Clin Endocrinol Metab,2008,93(1):252-259.
[17]Perriard G,Mathias A,Enz L,et al.Interleukin-22 is increased in multiple sclerosis patients and targets astrocytes[J].J Neuroinflammation,2015,12:119.
[18]Duhen T,Geiger R,Jarrossay D,et al.Production of interleukin 22 but not interleukin 17 by a subset of human skin-homing memory T cells[J].Nat Immunol,2009,10(8):857-863.
[19]Wang Y,Xu B,Li MQ,et al.IL-22 secreted by decidual stromal cells and NK cells promotes the survival of human trophoblasts[J].Int J Clin Exp Pathol,2013,6(9):1781-1790.
[20]Andoh A,Zhang Z,Inatomi O,et al.Interleukin-22,a member of the IL-10 subfamily,induces inflammatory responses in colonic subepithelial myofibroblasts[J].Gastroenterology,2005,129(3):969-984.
[2]Liu J,Wu J,Yang N,et al.Intra-amniotic administration of exogenous pulmonary surfactant for improving in lung maturity of fetal rabbits with intrauterine infection caused by premature rupture of membranes[J].Bosn J Basic Med Sci,2011,11(2):103-107.
[3]Menon R,Fortunato SJ.Infection and the role of inflammation in preterm premature rupture of the membranes[J].Best Pract Res Clin Obstet Gynaecol,2007,21(3):467-478.
[4]Montelongo EM,Blue NR,Lee RH.Placenta Accreta in a Woman with Escherichia coli Chorioamnionitis with Intact Membranes[J].Case Rep Obstet Gynecol,2015,2015:121864.
[5]Gomez-Lopez N,Romero R,Xu Y,et al.A Role for the Inflammasome in Spontaneous Labor at Term with Acute Histologic Chorioamnionitis[J].Reprod Sci,2017,24(6):934-953.
[6]Bry KJ,Jacobsson B,Nilsson S,et al.Gastric fluid cytokines are associated with chorioamnionitis and white blood cell counts in preterm infants[J].Acta Paediatr,2015,104(6):575-580.
[7]Jones BC,Logsdon NJ,Walter MR.Structure of IL-22bound to its high-affinity IL-22R1 chain[J].Structure,2008,16(9):1333-1344.
[8]马文革,蔡银素,杨翠丽,等.C反应蛋白和白细胞介素-6与胎膜早破绒毛膜羊膜炎的关系[J].河北医药,2011,33(4):542-543.
[9]周仲元,陶贝贝.胎膜早破患者发生组织学绒毛膜羊膜炎的影响因素及新生儿结局[J].现代妇产科进展,2014,23(3):192-194.
[10]赵昊云,张秦,吴元赭.胎膜早破合并绒毛膜羊膜炎的预测指标新进展[J].东南国防医药,2014,(4):397-400.
[11]Cekmez Y,Cekmez F,Ozkaya E,et al.u PAR,IL-33,and ST2 values as a predictor of subclinical chorioamnionitis in preterm premature rupture of membranes[J].J Interferon Cytokine Res,2013,33(12):778-782.
[12]Meirowitz NB,Ananth CV,Smulian JC,et al.Effect of labor on infant morbidity and mortality with preterm premature rupture of membranes:United States populationbased study[J].Obstet Gynecol,2001,97(4):494-498.
[13]Romero R,Chaemsaithong P,Docheva N,et al.Clinical chorioamnionitis at term VI:acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity[J].J Perinat Med,2016,44(1):33-51.
[14]Dulay AT,Buhimschi IA,Zhao G,et al.Compartmentalization of acute phase reactants Interleukin-6,C-Reactive Protein and Procalcitonin as biomarkers of intra-amniotic infection and chorioamnionitis[J].Cytokine,2015,76(2):236-243.
[15]Kacerovsky M,Musilova I,Jacobsson B,et al.Vaginal fluid IL-6 and IL-8 levels in pregnancies complicated by preterm prelabor membrane ruptures[J].J Matern Fetal Neonatal Med,2015,28(4):392-398.
[16]Oner C,Schatz F,Kizilay G,et al.Progestin-inflammatory cytokine interactions affect matrix metalloproteinase-1and-3 expression in term decidual cells:implications for treatment of chorioamnionitis-induced preterm delivery[J].J Clin Endocrinol Metab,2008,93(1):252-259.
[17]Perriard G,Mathias A,Enz L,et al.Interleukin-22 is increased in multiple sclerosis patients and targets astrocytes[J].J Neuroinflammation,2015,12:119.
[18]Duhen T,Geiger R,Jarrossay D,et al.Production of interleukin 22 but not interleukin 17 by a subset of human skin-homing memory T cells[J].Nat Immunol,2009,10(8):857-863.
[19]Wang Y,Xu B,Li MQ,et al.IL-22 secreted by decidual stromal cells and NK cells promotes the survival of human trophoblasts[J].Int J Clin Exp Pathol,2013,6(9):1781-1790.
[20]Andoh A,Zhang Z,Inatomi O,et al.Interleukin-22,a member of the IL-10 subfamily,induces inflammatory responses in colonic subepithelial myofibroblasts[J].Gastroenterology,2005,129(3):969-984.