可溶性人白细胞抗原G与妊娠合并绒毛膜羊膜炎的临床相关性研究

Clinical correlation between the concentration of soluble human leukocyte antigen-G and the presence of chorioamnionitis

目的探讨可溶性人白细胞抗原G(sHLA-G)与妊娠合并绒毛膜羊膜炎的关系。方法选取早产及胎膜早破孕产妇90例及正常足月分娩孕产妇40例,通过双抗体夹心酶联免疫吸附试验(ELISA)检测上述研究对象终止妊娠前外周血和羊水中sHLA-G的水平,同时对其产后胎膜行病理检查,判断有无绒毛膜羊膜炎。结果通过对产后胎膜组织进行病理检查共检测出绒毛膜羊膜炎患者54例(研究组),另外76例无绒毛膜羊膜炎患者作为对照组。研究组患者羊水中sHLA-G的水平均值为79.38±19.08U/ml,显著高于对照组(43.77±14.09U/ml),差异有统计学意义(P<0.001);而外周血中sHLA-G的水平研究组平均为45.98±10.05U/ml,亦显著高于无绒毛膜羊膜炎者(28.66±10.88U/ml),差异有统计学意义(P<0.001)。结论患者发生绒毛膜羊膜炎时,羊水和血清中sHLA-G水平均升高,这提示sHLA-G可能参与羊膜腔感染的宿主免疫反应调节,血清中sHLA-G水平可作为绒毛膜羊膜炎的辅助诊断指标。

Objective To determine if the concentration of sHLA-G（soluble human leukocyte antigen-G） change with the presence of histologic chorioamnionitis.Methods Total of 40 cases with normal pregnancy and 90 pregnant women with premature rupture of membranes or preterm delivery were enrolled in this study.sHLA-G concentrations of amniotic fluid（AF） or serum sample were determined by ELISA.Results Among the 130 patients,54 patients were diagnosed as histologic chorioamnionitis through pathological examination.The median sHLA-G concentrations in AF was elevated in patients with histologic chorioamnionitis than those without chorioamninitis（79.38 ± 19.08 U/ml vs 43.77 ± 14.09 U/ml,P 0.001）.Similarly,median concentration of sHLA-G in blood of patients with histologic chorioamnionitis were higher than those without chorioamninitis（45.98 ± 10.05 U/ml vs 28.66 ± 10.88 U/ml,P 0.001）.Conclusions Patients with chorioamnionitis had a higher median sHLA-G concentration in both AF and serum samples than those without histologic inflammation.So we propose that sHLA-G may participate in the regulation of host immune response against intraamniotic infection,and we can take it as a diagnostic index of chorioamnionitis.