母血、羊水、脐血中MMP-9及其组织抑制物TIMP-1水平变化与胎膜早破关系的临床研究

Clinical significance of MMP - 9/TTMP-1 imbalance in maternal serum, amniotic fluid ,umbilical cord serum in patients with premature rupture of the membranes.

目的 探讨母血、羊水、脐血中基质金属蛋白酶9(MMP-9)及其组织抑制物1(TIMP-1)的水平变化与胎膜早破 发生的相关性,分析其作为一种新型的生物学标志物对绒毛膜羊膜炎和新生儿预后判断的临床价值。方法 采用双抗体夹 心酶联免疫吸附法检测58例胎膜早破母血、羊水、脐血中MMP-9/TIMP-1水平的水平变化,同时进行胎膜的病理检查。结 果 胎膜早破组母血、羊水、脐血中MMP-9的含量均高于对照组,尤以羊水中MMP-9水平升高更明显,而TIMP-1水平变 化则明显低于对照组(P<0．05,P<0．01)。MMP-9的含量随破膜时间的延长而增高,尤其破膜时间超过24h增高更为明显。 而TIMP-1则随破膜时间的延长而下降,尤其破膜时间超过24h降低更为明显。并发绒毛膜羊膜炎者其MMP-9水平明显高 于非绒毛膜羊膜炎患者,而TIMP-1水平则明显低于非绒毛膜羊膜炎患者(P<0．05,P<0．01)。胎膜早破组产妇所生新生儿 Apgar评分≤7分者,其MMP-9的含量显著高于Apgar≥8分的新生儿,而,TIMP-1的含量则显著低于Apgar≥8分的新生儿(P <0．05,P<0．01)。结论 MMP-9的异常升高及其抑制物TIMP-1的显著下降是胎膜早破发生的重要发病机制。MMP-9/ TIMP-1含量变化可以成为一种新的生物学标志物用于胎膜早破并绒毛膜羊膜炎特别是尚处于亚临床感染状态的孕妇进行 早期诊断,并有助于评估新生儿预后。

Objective：To investigate the clinical roles of matrix metalloproteinase （MMP- 9） and tissue inhibitom of matrix metalloproteinase （TIMP- 1） in predicting premature rupture of the membranes（PROM） and chorloamnionitis. Methods： The levels of MMP - 9 and TIMP - 1 were detected by enzyme linked immunosorbent assay in maternal serum, amniotic fluid , umbilical cord serum of 58 pregnant women with PROM and 38 women with nomaal pregnancies. Results： The levels of MMP- 9 were significantly higher and TIMP- 1 were significantly lower in maternal serum, amniotic fluid , umbilical cord serum in patients with PROM group than those of the control group（ P 〈 0.05, P 〈 0.01 ）. The longer the duration from rupture of membrances to delivery was , the more serious chorloamnlonitis was, and the higher the levels of MMP - 9 and the lower of TIMP- 1 were. The levels of MMP- 9 were significantly higher and TIMP - 1 were significantly lower in patients with chorioamnionitis than those of non-chofioamnionitis（ P 〈 0.05, P 〈 0.01）. The levels of MMP - 9 were significantly higher and TIMP - 1 were significantly lower in neonates whose Apgar score≤7 than those of neonates whose Apgar score≥8. Conclusions： It is suggested that preterm PROM is associated with increased MMP - 9 and decreased TIMP - 1 levels. MMP - 9 and TIMP - 1 were the valuable clinical biological markers for identifying the chorioamnionitis and predicting neonates prognosis.