生殖道感染对足月和未足月胎膜早破孕妇宫颈分泌液MMP-2、MMP-9表达及不良母婴结局的影响

Effects of reproductive tract infections on the expressions of MMP-2 and MMP-9 in cervical secretions and the adverse maternal-infant outcomes in pregnant women with term premature rupture of membrane and in pregnant women with preterm premature rupture of membrane

目的分析生殖道感染对足月和未足月胎膜早破(PROM)孕妇基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)表达及不良母婴结局的影响。方法招募2021年6月至2023年6月就诊于湖北医药学院附属十堰市太和医院的110例PROM孕妇作为研究对象。根据生殖道感染情况和孕周将其分为未足月胎膜早破(pPROM)感染组(34例)、pPROM非感染组(26例)、足月胎膜早破(tPROM)感染组(34例)、tPROM非感染组(16例)。比较四组一般资料、宫颈分泌液MMP-2和MMP-9表达水平以及不良母婴结局发生情况,采用多因素logistic回归分析PROM孕妇发生不良母婴结局的影响因素。结果四组年龄、孕次、体质量指数、吸烟史、饮酒史比较差异无统计学意义(P>0.05)。四组宫颈分泌液MMP-2、MMP-9表达水平比较差异有统计学意义(P<0.05),其中pPROM感染组宫颈分泌液MMP-2、MMP-9表达水平高于pPROM非感染组和tPROM非感染组,tPROM感染组宫颈分泌液MMP-2、MMP-9表达水平高于tPROM非感染组,差异有统计学意义(P<0.05)。四组绒毛膜羊膜炎及不良母婴结局总发生率比较差异有统计学意义(P<0.05),其中pPROM感染组绒毛膜羊膜炎发生率高于tPROM感染组和tPROM非感染组,不良母婴结局总发生率高于pPROM非感染组和tPROM非感染组,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,生殖道感染及较高的宫颈分泌液MMP-2、MMP-9表达水平是PROM孕妇发生不良母婴结局的独立危险因素(P<0.05)。结论生殖道感染可增加足月和未足月PROM孕妇宫颈分泌液MMP-2、MMP-9表达水平,生殖道感染及较高的宫颈分泌液MMP-2、MMP-9表达水平是PROM孕妇发生不良母婴结局的独立危险因素。

Objective To analyze the effects of reproductive tract infections on the expressions of matrix metalloproteinase-2(MMP-2)and matrix metalloproteinase-9(MMP-9)and the adverse maternal-infant outcomes in pregnant women with term premature rupture of membrane(tPROM)and in pregnant women with preterm premature rupture of membrane(pPROM).Methods A total of 110 pregnant women with premature rupture of membrane(PROM)who saw a doctor in Taihe Hospital,Hubei University of Medicine from June 2021 to June 2023 were recruited as the study subjects.According to the situation of reproductive tract infections and gestational weeks,the patients were divided into pPROM infection group(34 cases),pPROM non-infection group(26 cases),tPROM infection group(34 cases)and tPROM non-infection group(16 cases).The general data,the levels of MMP-2 and MMP-9 expressions in cervical secretions,and adverse maternal-infant outcomes were compared among the four groups.Multivariate logistic regression was used to analyse the influencing factors of adverse maternal-infant outcomes in the PROM pregnant women.Results There were no significant differences in age,gravidity,body mass index,smoking history and alcohol drinking history among the four groups(P>0.05).The levels of MMP-2 and MMP-9 expressions in cervical secretions were significantly different among the four groups(P<0.05),and the levels of MMP-2 and MMP-9 expressions in cervical secretions in the pPROM infection group were higher than those in the pPROM non-infection group and the tPROM non-infection group,and the levels of MMP-2 and MMP-9 expressions in cervical secretions in the tPROM infection group were higher than those in the tPROM non-infection group,and the differences were statistically significant(P<0.05).The overall incidence rates of chorioamnionitis and adverse maternal-infant outcomes were significantly different among the four groups(P<0.05),and the incidence rate of chorioamnionitis in the pPROM infection group was higher than that in the tPROM infection group and the tPROM non-infection group,and the overall incidence rate of adverse maternal-infant outcomes in the pPROM infection group was higher than that in the pPROM non-infection group and the tPROM non-infection group,and the differences were statistically significant(P<0.05).The results of multivariate logistic regression analysis showed that reproductive tract infections and higher levels of MMP-2 and MMP-9 expressions in cervical secretions were independent risk factors of adverse maternal-infant outcomes in the PROM pregnant women(P<0.05).Conclusion Reproductive tract infections can increase the levels of MMP-2 and MMP-9 expressions in cervical secretions of pregnant women with tPROM and in cervical secretions of pregnant women with pPROM.Reproductive tract infections and higher levels of MMP-2 and MMP-9 expressions in cervical secretions are independent risk factors of adverse maternal-infant outcomes in PROM pregnant women.