母体血浆胎盘亮氨酸氨肽酶和白介素-6与自发性早产的关系

Correlation of maternal plasma placental leucine aminopepticlase and interleukin-6 with spontaneous preterm labor

目的分析自发性早产孕妇孕晚期血浆中胎盘亮氨酸氨肽酶(P-LAP)和白介素-6(IL-6)的变化情况。方法酶联免疫吸附试验(ELISA法)测定并比较早产组(n=52)、先兆早产组(n=33)和对照(足月分娩)组(n=137)孕妇孕晚期血浆中P-LAP和IL-6的水平。在早产组中,比较早产伴亚临床绒毛膜羊膜炎(SC)孕妇(n=41)与早产不伴SC孕妇(n=11)P-LAP和IL-6水平的差异。受试者工作特征(ROC)曲线分析自发性早产孕妇血浆中P-LAP和IL-6水平预测不可避免早产的截点;Pearson检验分析P-LAP和IL-6的相关性。结果早产组血浆P-LAP和IL-6水平均低于先兆早产组和对照组(P<0.01);而对照组与先兆早产组比较,差异无统计学意义(P>0.05)。伴或不伴SC的早产孕妇血浆P-LAP和IL-6比较,差异均无统计学意义(P>0.05)。根据ROC曲线得出,以P-LAP≤38.12 U/L和IL-6≥3.40 pg/mL为截点,可用来预测不可避免早产;P-LAP与IL-6联合预测不可避免早产的约登指数较单独检测明显提高(P<0.05)。自发性早产孕妇血浆P-LAP和IL-6水平相关(r=-0.311,P=0.025)。结论对有自发性早产先兆的孕妇进行P-LAP和IL-6联合检测,能更准确地预测早产;IL-6等促炎症细胞因子分泌增多,导致P-LAP水平下降,可能是自发性早产的关键因素。

Objective To analyse the changes of maternal plasma placental leucine aminopepticlase （P-LAP） and interleukin-6 （IL-6） levels during third trimester in spontaneous preterm labor. Methods Maternal plasma P-LAP and IL-6 levels were detected by enzyme-linked immunosorbent assay in preterm labor group（ n = 52）, threatened preterm labor group （n =33） and control （normal labor）group（ n = 137）. In preterm labor group, the P-LAP and IL-6 levels of the pregnant women with subclinical chorioamnionitis （SC） （n = 41）were compared with those without SC （n = 11）. ROC curve was employed to analyse the maternal plasma P-LAP and IL-6 levels of spontaneous preterm labor to predict the inevitable preterm labor, and the correlation of P-LAP and IL-6 was explored with Pearson analysis. Results The plasma P-LAP and IL-6 levels in preterm labor group were lower than those in threatened preterm labor group and control group（ P 〈 0.01）, while there was no significant difference between control group and threatened preterm labor group（P 〉 0.05）. There was no significant difference in plasma P-LAP and IL-6 levels between the pregnant women with SC and those without SC （P 〉 0.05）. It was revealed by ROC curve analysis that P-LAP ≤ 38.12 U/L and IL-6 ≥3.40 pg/mL could be adopted as criteria to predict the inevitable preterm labor, and the Youden＇s index of the combination use of the parameters of P-LAP and IL-6 was significantly higher than that of the single use of each parameter（ P 〈 0.05）. Maternal plasma P-LAP level was correlated to IL-6 level（ r = - 0. 311, P 〈 0.01）. Conclusion Preterm labor can be more accurately predicted by combination detection of plasma P-LAP and IL-6. The oversecretion of IL-6 may lead to the decrease of P-LAP, which may be the key factor for spontaneous preterm labor.