孕妇牙周状况与胎膜早破关系研究
摘要
目的:本研究采用比较胎膜早破孕妇与正常孕妇牙周状况分析牙周状况与胎膜早破的关系,为临床针对病因预防胎膜早破的发生提供理论依据。
方法:选择早产胎膜早破(PPROM)孕妇18例、足月胎膜早破(PROM)孕妇20例作为实验组,足月正常孕妇(Non-PROM)28例作为对照组,检查牙周状况记录菌斑指数(PLI)、探诊深度(PD)和龈沟出血指数(SBI),采用免疫组织化学法检测各组宫颈部胎膜基质金属蛋白酶-9(MMP-9)的分布与表达。
结果:
1.胎膜早破受检者的菌斑指数高于正常对照组,早破组龈沟出血指数较对照组高,比对照组的牙龈炎症明显。各组间探诊深度无明显差别。
2.PPROM组、PROM组与Non-PROM组PLI及SBI的差异有统计学意义(P<0.05),PD差异无统计学意义,早破组比未胎膜早破组的牙周状况差。
3.MMP-9阳性信号定位于羊膜上皮细胞和绒毛膜细胞胞浆,在PPROM、足月PROM中可见不同程度的表达,非早破组胎膜中未见表达或见弱阳性表达。各组中羊膜和绒毛膜中MMP-9的表达差异均有显著性(P<0.05)。
4.绒毛膜中MMP-9表达与PD没有相关性,r=0.053,P=0.075;与SBI正相关,r=0.433,P<0.05;与PLI正相关,r=0.310,P<0.05.羊膜中MMP-9表达与PD没有相关性,r=0.077,P=0.597;与SBI正相关,r=0.430,P<0.05;与PLI正相关,r=0.324,P<0.05.
结论:
1.牙周炎症可能是导致胎膜早破的原因之一。
2.胎膜中MMP-9的表达PPROM组高于PROM组, PROM组高于Non-PROM组且差异有统计学意义,提示MMP-9参与了胎膜早破及牙周炎症的病理过程。
3.孕期及孕前应进行口腔保健,积极预防和治疗牙周疾病,预防不良妊娠结局的发生。
The concept of premature rupture of membranes is the rupture of membranes before labor.premature rupture of membranes seriously affect the safety of mother and child. There are many reasons for premature rupture of membranes, Such as mechanical injury and the twins, abnormal fetal position, the infection and so on.However, the exact pathogenesis has not yet entirely found. So to find the cause of PROM, to prevent the occurrence of PROM, thereby reducing the incidence of maternal and child is becoming the one of the hot issues in the current research field of obstetrics.
Infection is a major cause of PROM, and its subsequent infection of host inflammatory response can lead to an increase in vivo biological medium, the formation of immune micro-environment play an important role in the premature rupture of membranes.
The major components of membrane include theⅠ,Ⅲ,Ⅳ,Ⅴcollagen, proteoglycan and glycosaminoglycan, such as elastic fibers.
MMPs can degrade almost all extracellular matrix (ECM). In the infection, as a result of inflammatory cytokines IL-1β, IL-8, GM-CSF and metabolites of arachidonic acid to stimulate the cells to release matrix metalloproteinases, activation of MMPs can lead to degradation of collagen membrane rupture.
In our country, Periodontitis is one of common oral diseases in childbearing-age women. At present, periodontal disease is infectious disease that cause by plaque micro-organisms, the main source of infection is for the accumulation of the dental plaque in the neck and subgingival .first of all,it leads to gingival inflammation, when the inflammation extended to the deep periodontal organizations, caused by gingival and periodontal ligament collagen fibers dissolved destruction, and alveolar bone absorption, resulting in the formation of periodontal pocket. Periodontitis is a violation of gingival and periodontal supporting tissues destructive ,it is chronic inflammatory disease characterized by lesions of the support structure, including teeth - in the extracellular matrix of collagen fibers of periodontal destruction. Gingival inflammation, gingival crevicular fluid, saliva can check that the activity of MMP-9 increase.
Periodontitis in the mother may be the risk factors leading to premature rupture of membranes that has not been fully aware of and its mechanism may be due to periodontal disease caused by the original microbial activation and its elevated levelof MMP-9, through the degradation of fetal membrane cells extracellular matrix lead to the occurrence of premature rupture of membranes.
In this study, to analysis the periodontal status of normal pregnant women and pregnant women with premature rupture of membranes to find the relationship between them, To provide a theoretical basis for preventing the occurrence of premature rupture of membranes. Objective: To compare the periodontal status of premature rupture of membranes in pregnant women with normal pregnant women to analysis the relationship between the periodontal status and premature rupture of membranes. For the prevention of clinical cause for the occurrence of premature rupture of membranes and provide a theoretical basis.
Methods: Preterm Premature Rupture of Membranes (PPROM) in pregnant women in 18 cases, full-term premature rupture of membranes (PROM) as a study of 20 cases of pregnant women group, 28 cases of normal full-term pregnant women (Non-PROM) as a control group, check the record of plaque index (PLI), probing depth (PD) and gingival sulcus bleeding index (SBI), the use of immunohistochemical detection the distribution and expression of matrix metalloproteinase Department -9 (MMP-9) in cervical fetal membrane .
Results:
1. the plaque index and gingival sulcus bleeding index in premature rupture of membranes is higher than the normal control group, Among the three groups probing depth was no significant difference.
2.PPROM Group, PROM group and Non-PROM group PLI and SBI were statistically significant differences (P <0.05), PD was no significant difference. The PROM had the bad periodontal status.
3.MMP-9 positive signal located in the amniotic epithelial cells and chorionic cells in the PPROM, preterm PROM, we can see different levels of expression, non-membrane in the early break group has no expression or weakly positive expression. The study group and chorionic membrane in the expression of MMP-9 were significant differences (P <0.05).
4. The PD is not associated with expression of MMP-9 in chorionic, r = 0.053, P = 0.075; SBI is positive associated with expression of MMP-9 in chorionic, r = 0.433, P <0.05; PLI is positive associated with expression of MMP-9 in chorionic, r = 0.310, P <0.05. the PD is not associated with expression of MMP-9 in membrane, r = 0.077, P = 0.597; and BI are related, r = 0.430, P <0.05; with PLI positive correlation, r = 0.324, P <0.05.
Conclusion:
1. Premature rupture of membranes had worse periodontal status than the normal pregnant women, suggesting that periodontal disease may be one of the reasons that lead to premature rupture of membranes.
2. Membrane in the expression of MMP-9 higher than the PROM group PPROM group, PROM group than the Non-PROM group and the difference was statistically significant, suggesting that MMP-9 involved in the premature rupture of membranes and the pathogenesis of periodontal disease. Blood or urine testing of pregnant women in the level of MMP-9 can help to predict the occurrence of premature rupture of membranes for further study.
3. Oral health care and treatment of periodontal diseases should be carried out in pre-pregnancy to prevent the occurrence of adverse pregnancy outcomes.
方法:选择早产胎膜早破(PPROM)孕妇18例、足月胎膜早破(PROM)孕妇20例作为实验组,足月正常孕妇(Non-PROM)28例作为对照组,检查牙周状况记录菌斑指数(PLI)、探诊深度(PD)和龈沟出血指数(SBI),采用免疫组织化学法检测各组宫颈部胎膜基质金属蛋白酶-9(MMP-9)的分布与表达。
结果:
1.胎膜早破受检者的菌斑指数高于正常对照组,早破组龈沟出血指数较对照组高,比对照组的牙龈炎症明显。各组间探诊深度无明显差别。
2.PPROM组、PROM组与Non-PROM组PLI及SBI的差异有统计学意义(P<0.05),PD差异无统计学意义,早破组比未胎膜早破组的牙周状况差。
3.MMP-9阳性信号定位于羊膜上皮细胞和绒毛膜细胞胞浆,在PPROM、足月PROM中可见不同程度的表达,非早破组胎膜中未见表达或见弱阳性表达。各组中羊膜和绒毛膜中MMP-9的表达差异均有显著性(P<0.05)。
4.绒毛膜中MMP-9表达与PD没有相关性,r=0.053,P=0.075;与SBI正相关,r=0.433,P<0.05;与PLI正相关,r=0.310,P<0.05.羊膜中MMP-9表达与PD没有相关性,r=0.077,P=0.597;与SBI正相关,r=0.430,P<0.05;与PLI正相关,r=0.324,P<0.05.
结论:
1.牙周炎症可能是导致胎膜早破的原因之一。
2.胎膜中MMP-9的表达PPROM组高于PROM组, PROM组高于Non-PROM组且差异有统计学意义,提示MMP-9参与了胎膜早破及牙周炎症的病理过程。
3.孕期及孕前应进行口腔保健,积极预防和治疗牙周疾病,预防不良妊娠结局的发生。
The concept of premature rupture of membranes is the rupture of membranes before labor.premature rupture of membranes seriously affect the safety of mother and child. There are many reasons for premature rupture of membranes, Such as mechanical injury and the twins, abnormal fetal position, the infection and so on.However, the exact pathogenesis has not yet entirely found. So to find the cause of PROM, to prevent the occurrence of PROM, thereby reducing the incidence of maternal and child is becoming the one of the hot issues in the current research field of obstetrics.
Infection is a major cause of PROM, and its subsequent infection of host inflammatory response can lead to an increase in vivo biological medium, the formation of immune micro-environment play an important role in the premature rupture of membranes.
The major components of membrane include theⅠ,Ⅲ,Ⅳ,Ⅴcollagen, proteoglycan and glycosaminoglycan, such as elastic fibers.
MMPs can degrade almost all extracellular matrix (ECM). In the infection, as a result of inflammatory cytokines IL-1β, IL-8, GM-CSF and metabolites of arachidonic acid to stimulate the cells to release matrix metalloproteinases, activation of MMPs can lead to degradation of collagen membrane rupture.
In our country, Periodontitis is one of common oral diseases in childbearing-age women. At present, periodontal disease is infectious disease that cause by plaque micro-organisms, the main source of infection is for the accumulation of the dental plaque in the neck and subgingival .first of all,it leads to gingival inflammation, when the inflammation extended to the deep periodontal organizations, caused by gingival and periodontal ligament collagen fibers dissolved destruction, and alveolar bone absorption, resulting in the formation of periodontal pocket. Periodontitis is a violation of gingival and periodontal supporting tissues destructive ,it is chronic inflammatory disease characterized by lesions of the support structure, including teeth - in the extracellular matrix of collagen fibers of periodontal destruction. Gingival inflammation, gingival crevicular fluid, saliva can check that the activity of MMP-9 increase.
Periodontitis in the mother may be the risk factors leading to premature rupture of membranes that has not been fully aware of and its mechanism may be due to periodontal disease caused by the original microbial activation and its elevated levelof MMP-9, through the degradation of fetal membrane cells extracellular matrix lead to the occurrence of premature rupture of membranes.
In this study, to analysis the periodontal status of normal pregnant women and pregnant women with premature rupture of membranes to find the relationship between them, To provide a theoretical basis for preventing the occurrence of premature rupture of membranes. Objective: To compare the periodontal status of premature rupture of membranes in pregnant women with normal pregnant women to analysis the relationship between the periodontal status and premature rupture of membranes. For the prevention of clinical cause for the occurrence of premature rupture of membranes and provide a theoretical basis.
Methods: Preterm Premature Rupture of Membranes (PPROM) in pregnant women in 18 cases, full-term premature rupture of membranes (PROM) as a study of 20 cases of pregnant women group, 28 cases of normal full-term pregnant women (Non-PROM) as a control group, check the record of plaque index (PLI), probing depth (PD) and gingival sulcus bleeding index (SBI), the use of immunohistochemical detection the distribution and expression of matrix metalloproteinase Department -9 (MMP-9) in cervical fetal membrane .
Results:
1. the plaque index and gingival sulcus bleeding index in premature rupture of membranes is higher than the normal control group, Among the three groups probing depth was no significant difference.
2.PPROM Group, PROM group and Non-PROM group PLI and SBI were statistically significant differences (P <0.05), PD was no significant difference. The PROM had the bad periodontal status.
3.MMP-9 positive signal located in the amniotic epithelial cells and chorionic cells in the PPROM, preterm PROM, we can see different levels of expression, non-membrane in the early break group has no expression or weakly positive expression. The study group and chorionic membrane in the expression of MMP-9 were significant differences (P <0.05).
4. The PD is not associated with expression of MMP-9 in chorionic, r = 0.053, P = 0.075; SBI is positive associated with expression of MMP-9 in chorionic, r = 0.433, P <0.05; PLI is positive associated with expression of MMP-9 in chorionic, r = 0.310, P <0.05. the PD is not associated with expression of MMP-9 in membrane, r = 0.077, P = 0.597; and BI are related, r = 0.430, P <0.05; with PLI positive correlation, r = 0.324, P <0.05.
Conclusion:
1. Premature rupture of membranes had worse periodontal status than the normal pregnant women, suggesting that periodontal disease may be one of the reasons that lead to premature rupture of membranes.
2. Membrane in the expression of MMP-9 higher than the PROM group PPROM group, PROM group than the Non-PROM group and the difference was statistically significant, suggesting that MMP-9 involved in the premature rupture of membranes and the pathogenesis of periodontal disease. Blood or urine testing of pregnant women in the level of MMP-9 can help to predict the occurrence of premature rupture of membranes for further study.
3. Oral health care and treatment of periodontal diseases should be carried out in pre-pregnancy to prevent the occurrence of adverse pregnancy outcomes.
引文
[1]Mercer BM. Preterm premature rupture of the membranes [J]. ObstetGynecol, 2003, 101 (1) : 17821931.
[2]ZHANG YL. Modern Obstetrics [M]. Beijing: People's Medical Publishing House, 2004: 379-384. Chinese.
[3]徐建平,金海燕,罗慧娟,等.胎膜早破与抗凋亡蛋白Bcl-2表达的研究[J].中国现代医学杂志,2005,1597):982-984.
[4]Malak TM,Ockleford CD ,Bell S ,et al . Confocal immunoflur- escence localization of collegan typeⅠ,Ⅱ,Ⅲ,Ⅳ,Ⅴand their ult- rastructure organization in termfetal membranes. Placenta ,1993 , 14(4) :385-406.
[5]Massova I ,Kotra LP ,Fridman R ,et al . Matrix metallopro- teinases :structures ,evolution and diversification. FASEB J ,1998 , 12 (12) :1075-1095.
[6]Maymon E, Romero R, Pacora P, etal.Evidence for the participa- tion of interstitial collagenase (matrix metalloproteinase 1 )in preterm premature rupture of membranes Am J Obstet Gynecol,2000, 183: 9142 9201.
[7]Lei H, Kalluri R, Furth EE, et al. Rat amniontype IV collagen composition and metabolism: implications formembrane breakdown Bio. Reprod, 1999, 60: 1762 1821.
[8]Mclaren M,Taylor DJ ,Bell SC. Increased concentration ofpromatrixmetalloproteinase 9 in termfetal membranes overlying the cervix before labor : Implication for membrane remodeing and rupture. AmJ Obstet Gynecol ,2000 , 182(2) :409-412.
[9]郭建新,李力,陈竹钦,等.羊水中明胶酶.白细胞介素8与胎膜早破关系的研究中华围产医学杂志,2004,7:252 28.
[10]Fortunato SJ ,Menon R ,Lombardi SJ ,et al . Amniochorion gela- tinase-gelatinase inhibitor imbalance in vitro : apossible infectious pathway to rupture.ObstetGynecol ,2000,95(2):240-244.
[11]Uwe Schonbeck ,Francois Mach ,Peter Libby. Generation of biologically active IL-1βby matrix metalloproteinases :A novel caspase-1 independent path-way of IL-1βprocessing. J Immunol ,1998 , 161 (7) :3340-3346.
[12]Locksmith GJ. Amniotic fluid concentrations of matrix- metallproteinase 9 and tissue inhibitor of metalloproteinase 1 during pregnancy and labor [J] .Am J ObstetGynecol ,2001 ,184 (2) :159-164.
[13]Vadillo OF, Hernandez A, Gonzalez A G, et al. Increased matrixmetalloproteinase activity and reduced tissue inhibitor of metalloproteinases 1 levels in amniotic fluids from pregnancies complicated by prematurerupture of membranes [J]. Am J Obstet Gynecol ,1996 ,174 (4) :1371-1376.
[14]Romero R , Chaiworaporgsa T, Espinoza J, et al. Fetal plasma MMP-9 concent rations are elevated in preterm premature rupture ofmembranes[J] . Am J Obstet Gynecol ,2002 ,187 (5) :1125-1130.
[15]Fortunato S J , Menon R , Lombardi S J . Role of tumor necrosis factor-αin premature rupture of membranes and preterm labor pathways[J] . Am J Obstet Gynecol ,2002 ,187 (5) :1159-1162.
[16]张静萍.龈沟液及酶水平的变化与牙周病.现代口腔医学杂志,2000, 14 (6) : 419-420.
[17]Lloyd G. Simonson , Perter J . Robinson Rory , J . Pranger , etal . Trepnema denticola and Porphyromonas as prognostic markers following periodontal treatment [J].J Periodontol 1992 ,63 : 2702273.
[18]陈莉丽,章锦才,严杰等主编.腔厌氧菌与牙周病.北京:人民卫生出版社, 1998 , 42243 , 73281 , 97.15 .
[19]Lawson DA , Meyer TF. Biochemical characterization of Porphyromonas(Bacteroides) gingivalis collagenase. Infect Immun , 1992 , 60 ( 4) :152421529.
[20]Bedi GS , Williams T. Purification and characterization of a collagende-grading protease from Porphyromonas gingivalis . J Biol Chem, 1994 .269(1) : 5992606.
[21]Bongkyu Choi,SeongHee Park , Yun Jung Yoo , etal . Detection of major putative periodontopathogens in Korean advced adult periodontitis patients using a nucleicacid-ased approach[J] . J Periodontol 2000,71 : 138721394.
[22]Meikle MC , Hembry RM, Holly J, et al.Immunolocalization ofmatrix metalloproteinases and TIMP in human gingival tissues from periodontitis patient [J] . J Periodont Res ,1994 ,29(2) :118.
[23]金钫,段银钟,李潇.大鼠牙齿移动过程中牙周组织中基质金属蛋白酶-2的表达与分布.牙体牙髓牙周病学杂志,2001 ,11(3)∶157–159.
[24]Soell M , EIKaim R , Tenenbaum H. Cathepsin C , matrix- metallproteinases and their tissue inhibitors in gingival crev- icular fluid from periodontitis affected patients [J] . Dent Res ,2002 ,81(3) .
[25]Korost of JM , Wang J F, Sarment DP, et al. Analysis of in situprotease activity in chronic adult periodontitis patients : expression of activated MMP-2 and a 40 kDa serine protease [J]. JPeriodontal, 2000,71(3):353- 360.
[26]Seguier S , Gogly B , Bodineau A , et al. Is collagen break- downduring periodontitis linked to inflammatory cells and expression of matrixmetalloproteinases and tissue inhibitors of metall- oproteinases in human gingival tissue [J] J Periodontol , 2001 , 72(10) :1398-1406.
[27]Offenbacher S,Lieff S,Murtha KA et al.Maternal periodon- ititis and Prematurity. Part II: Maternal infection and fetal exposure. Ann Periodontol, 2001, 6: 175-182.
[1]卞金有.预防口腔医学.[M]北京:人民卫生出版社,2008:55-59.
[2]Malak TM,Ockleford CD ,Bell S ,et al . Confocal immunoflur- escence localization of collegan typeⅠ,Ⅱ,Ⅲ,Ⅳ,Ⅴand their ult- rastructure organization in termfetal membranes. Placenta ,1993 , 14(4):385-406.
[3]Massova I ,Kotra LP ,Fridman R ,et al . Matrix metallopro- teinases :structures ,evolution and diversification. FASEB J ,1998 , 12(12):1075-1095.
[4]Maymon E, Romero R, Pacora P, etal.Evidence for the participa- tion of interstitial collagenase (matrix metalloproteinase 1 )in preterm premature rupture of membranes Am J Obstet Gynecol,2000, 183: 9142 9201.
[5]Fortunato SJ ,Menon R ,Lombardi SJ ,et al . Amniochorion gela- tinase-gelatinase inhibitor imbalance in vitro : apossible infectious pathway to rupture.ObstetGynecol ,2000,95(2):240-244.
[6]Uwe Schonbeck ,Francois Mach ,Peter Libby. Generation of biologically active IL-1βby matrix metalloproteinases:A novel caspase-1 independent path-way of IL-1βprocessing. J Immunol ,1998 , 161(7):3340-3346.
[7]Locksmith GJ. Amniotic fluid concentrations of matrixmet- allproteinase 9 and tissue inhibitor of metalloproteinase 1 duringpregnancy and labor [J]. Am J ObstetGynecol ,2001 ,184 (2) :159-164.
[8]Vadillo OF, Hernandez A, Gonzalez A G, et al. Increased matrix- metalloproteinase activity and reduced tissue inhibitor of metall- oproteinases 1 levels in amniotic fluids from pregnancies complicated by premature rupture of membranes [J] . Am J Obstet Gynecol ,1996 ,174 (4):1371-1376.
[9]Fortunato S J , Menon R , Lombardi S J . Role of tumor necrosis factor-αin premature rupture of membranes and preterm labor path- ways[J]. Am J Obstet Gynecol ,2002 ,187(5):1159-1162.
[10]张静萍.龈沟液及酶水平的变化与牙周病.现代口腔医学杂志,2000, 14(6): 419-420.
[11]Meikle MC , Hembry RM, Holly J, et al.Immunolocalization of matrix metalloproteinases and TIMP in human gingival tissues from periodontitis patient [J]. J Periodont Res ,1994 ,29(2) :118.
[12]金钫,段银钟,李潇.大鼠牙齿移动过程中牙周组织中基质金属蛋白酶-2的表达与分布.牙体牙髓牙周病学杂志,2001 ,11(3): 157-159.
[13]Soell M , EIKaim R , Tenenbaum H. Cathepsin C , matrixmetal- oproteinases and their tissue inhibitors in gingival crevicular fluid from periodontitis affected patients [J]. Dent Res ,2002 , 81(3).
[14]Korost of JM , Wang J F, Sarment DP, et al. Analysis of in situprotease activity in chronic adult periodontitis patients :expression of activated MMP-2 and a 40 kDa serine protease [J]. JPeriodontal, 2000,71(3):353-360.
[15]Seguier S , Gogly B , Bodineau A , et al. Is collagen breakd- ownduring periodontitis linked to inflammatory cells and expression of matrixmetalloproteinases and tissue inhibitors of metallopro- teinases in human gingival tissue [J] J Periodontol , 2001 , 72(10) : 1398-1406.
[2]ZHANG YL. Modern Obstetrics [M]. Beijing: People's Medical Publishing House, 2004: 379-384. Chinese.
[3]徐建平,金海燕,罗慧娟,等.胎膜早破与抗凋亡蛋白Bcl-2表达的研究[J].中国现代医学杂志,2005,1597):982-984.
[4]Malak TM,Ockleford CD ,Bell S ,et al . Confocal immunoflur- escence localization of collegan typeⅠ,Ⅱ,Ⅲ,Ⅳ,Ⅴand their ult- rastructure organization in termfetal membranes. Placenta ,1993 , 14(4) :385-406.
[5]Massova I ,Kotra LP ,Fridman R ,et al . Matrix metallopro- teinases :structures ,evolution and diversification. FASEB J ,1998 , 12 (12) :1075-1095.
[6]Maymon E, Romero R, Pacora P, etal.Evidence for the participa- tion of interstitial collagenase (matrix metalloproteinase 1 )in preterm premature rupture of membranes Am J Obstet Gynecol,2000, 183: 9142 9201.
[7]Lei H, Kalluri R, Furth EE, et al. Rat amniontype IV collagen composition and metabolism: implications formembrane breakdown Bio. Reprod, 1999, 60: 1762 1821.
[8]Mclaren M,Taylor DJ ,Bell SC. Increased concentration ofpromatrixmetalloproteinase 9 in termfetal membranes overlying the cervix before labor : Implication for membrane remodeing and rupture. AmJ Obstet Gynecol ,2000 , 182(2) :409-412.
[9]郭建新,李力,陈竹钦,等.羊水中明胶酶.白细胞介素8与胎膜早破关系的研究中华围产医学杂志,2004,7:252 28.
[10]Fortunato SJ ,Menon R ,Lombardi SJ ,et al . Amniochorion gela- tinase-gelatinase inhibitor imbalance in vitro : apossible infectious pathway to rupture.ObstetGynecol ,2000,95(2):240-244.
[11]Uwe Schonbeck ,Francois Mach ,Peter Libby. Generation of biologically active IL-1βby matrix metalloproteinases :A novel caspase-1 independent path-way of IL-1βprocessing. J Immunol ,1998 , 161 (7) :3340-3346.
[12]Locksmith GJ. Amniotic fluid concentrations of matrix- metallproteinase 9 and tissue inhibitor of metalloproteinase 1 during pregnancy and labor [J] .Am J ObstetGynecol ,2001 ,184 (2) :159-164.
[13]Vadillo OF, Hernandez A, Gonzalez A G, et al. Increased matrixmetalloproteinase activity and reduced tissue inhibitor of metalloproteinases 1 levels in amniotic fluids from pregnancies complicated by prematurerupture of membranes [J]. Am J Obstet Gynecol ,1996 ,174 (4) :1371-1376.
[14]Romero R , Chaiworaporgsa T, Espinoza J, et al. Fetal plasma MMP-9 concent rations are elevated in preterm premature rupture ofmembranes[J] . Am J Obstet Gynecol ,2002 ,187 (5) :1125-1130.
[15]Fortunato S J , Menon R , Lombardi S J . Role of tumor necrosis factor-αin premature rupture of membranes and preterm labor pathways[J] . Am J Obstet Gynecol ,2002 ,187 (5) :1159-1162.
[16]张静萍.龈沟液及酶水平的变化与牙周病.现代口腔医学杂志,2000, 14 (6) : 419-420.
[17]Lloyd G. Simonson , Perter J . Robinson Rory , J . Pranger , etal . Trepnema denticola and Porphyromonas as prognostic markers following periodontal treatment [J].J Periodontol 1992 ,63 : 2702273.
[18]陈莉丽,章锦才,严杰等主编.腔厌氧菌与牙周病.北京:人民卫生出版社, 1998 , 42243 , 73281 , 97.15 .
[19]Lawson DA , Meyer TF. Biochemical characterization of Porphyromonas(Bacteroides) gingivalis collagenase. Infect Immun , 1992 , 60 ( 4) :152421529.
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