胎膜早破产妇胎膜组织中骨形成蛋白2的表达水平变化及其临床意义

Expression of bone morphogenetic protein-2 in fetal membranes from pregnant women with premature rupture of membranes and its clinic significance

目的探讨胎膜组织中骨形成蛋白2（BMP-2）表达水平变化与胎膜早破发生的关系。方法选择2006年1月至2007年1月在重庆医科大学附属第一医院产科等4家医院住院分娩的产妇90例。根据有无胎膜早破及是否临产分为足月临产组（胎膜完整）、足月胎膜早破组、早产临产组（胎膜完整）、早产胎膜早破组及对照组（足月未临产产妇），每组18例。采用链霉菌抗生物素蛋白-过氧化物酶连接（SP）法检测各组产妇胎膜组织中BMP-2表达水平[以积分吸光度（IA）值表示]。分析胎膜早破合并绒毛膜羊膜炎者与BMP-2表达水平的关系。结果（1）各组产妇胎膜组织中的羊膜和绒毛膜上皮细胞及间质细胞中均可见位于胞质内的BMP-2阳性染色颗粒，呈棕黄色。（2）足月临产组、足月胎膜早破组、早产临产组和早产胎膜早破组产妇胎膜组织中BMP-2的表达水平分别为0．0137±0．0094．0．0269±0．0127．0．0273±0．0145和0．0456±0．0114，均显著高于对照组的0．0060±0．0079，分别与对照组比较。差异均有统计学意义（P〈0．01）。足月胎膜早破组产妇胎膜组织中BMP-2表达水平高于足月临产组，两组比较，差异有统计学意义（P〈0．01）。早产胎膜早破组产妇胎膜组织中BMP-2表达水平高于早产临产组，两组比较，差异有统计学意义（P〈0．01）。早产胎膜早破组产妇胎膜组织中BMP-2表达水平高于足月胎膜早破组，两组比较，差异有统计学意义（P〈0．01）。（3）胎膜组织病理检查结果显示，90例产妇中合并绒毛膜羊膜炎者17例，足月胎膜早破组和早产胎膜早破组产妇中，共有13例合并绒毛膜羊膜炎（36％，13／36），绒毛膜羊膜炎者的胎膜组织中BMP-2表达水平为0．0201±0．0107，明显高于非绒毛膜羊膜炎者的BMP-2水平（0．0105±0．0092），两者比较，差异有统计学意义（P〈0．05）。结论胎膜早破产妇胎膜组织中BMP-2的表达水平升高，BMP-2表达水平变化与胎膜早破的发生密切相关。

Objective To study the relationship between bone morphogenetic protein-2 （BMP-2） and premature rupture of membranes （PROM）. Methods Ninety gravidas giving birth at 4 hospitals in Chongqing from January 2006 to January 2007 were selected and divided into 5 groups （18 in each） ： term labor group （ with intact membranes ）, term PROM group, preterm labor group （ with intact membranes ）, preterm PROM （PPROM） group and control group （term pregnancy not in labor）. The expression of BMP- 2 in the chofioamniotic membranes of each group were detected by streptavidin-perosidase methods and its relationship with PROM plus histological chorioamnionitis were analyzed. Results （ 1 ） BMP-2 was detected in the cytoplasm of epithelial and interstitial cells of membranes in each group. （2） BMP-2 expression in term labor group, term PROM group, preterm labor group and PPROM group were 0. 0137 ± 0. 0094, 0. 0269 ± 0. 0127, 0. 0273 ± 0. 0145, 0. 0456 ± 0. 0114, respectively, which higher than that of the control group 0. 0060 ±0. 0079 （P 〈0. 01 ）. BMP-2 expression in the term PROM group was higher than that of the term labor group （ P 〈 0. 01 ） , that in the PPROM was higher than in the preterm labor group and term PROM group （P 〈0. 01 ）. （3） Pathological examination found that 17 out of the 90 women with histologic chorioamnionitis, of which 13 （36%） came from the term PROM and PPROM group with a higher level of BMP-2 expression than those without chorioamnionitis （0. 0201 ± 0. 0107 vs 0. 0105 ± 0. 0092, P 〈 0.05 ）. Conclusion The expression of BMP-2 in chorioamniotic membranes is closely related to PROM.