胎膜早破患者羊水中可溶性人白细胞抗原G水平与绒毛膜羊膜炎的关系

Relationship between the concentrations of sHLA-G in amniotic fluid and chorioamnionitis in patients with premature rupture of membranes

目的探讨孕妇羊水中可溶性人白细胞抗原G(sHLA-G)的水平与胎膜早破合并绒毛膜羊膜炎的关系。方法运用双抗体夹心酶联免疫吸附(ELISA)法测定89例胎膜早破孕产妇(包括足月胎膜早破60例和未足月胎膜早破29例)及40例正常足月分娩孕产妇羊水中sHLA-G的水平,同时用散射比浊法测定上述研究对象分娩前血清中CRP的含量,最后对所有产后胎膜进行病理检查,判断有无绒毛膜羊膜炎。结果①胎膜早破患者羊水中sHLA-G的水平和血清中CRP中水平均显著高于正常足月孕妇(P<0.05);②胎膜早破并发绒毛膜羊膜炎的患者羊水中sHLA-G的水平显著高于未发生绒毛膜羊膜炎者(P<0.05);③以羊水sHLA-G≥53.46U/ml作为绒毛膜羊膜炎的诊断阈值,其敏感性、特异性及ROC曲线下面积分别为88%、89.7%、0.89,明显优于血清C-反应蛋白指标(70.0%,69.2%,0.74,诊断阈值为3.5mg/L)。结论发生绒毛膜羊膜炎时,羊水中sHLA-G的水平升高,与血清CRP相比,其诊断价值更高,可作为胎膜早破合并绒毛膜羊膜炎的可靠的辅助诊断指标。

Objective To determine if the concentrations of sHLA-G in amniotic fluid change with the presence of histologic chorioamnionitis in patients with premature rupture of membranes（PROM）.Methods Totally pregnant women with premature rupture of membranes and 40 cases of normal pregnancy were enrolled in this study.AF sHLA-G concentrations were determined by ELISA.CRP were detected simultaneously,and fetal membranes were collected to conduct pathological examinations.Results ①AF sHLA-G concentrations and serum CRP levels were significantly higher in women with PROM than that without it.②Patients with histologic chorioamnionitis had a higher median AF sHLA-G concentration than those without histologic inflammation（P0.05）.③The sensitivity,specificity and area under ROC curve of AF sHLA-G concentrations（cutoff 53.46U/ml） and serum CRP levels（cutoff 3.5 mg/L） for diagnosing chorioamnionitis were 88%、89.7%、0.89and 70.0%,69.2%,0.74,respectively;Conclusions AF sHLA-G concentrations are elevated in histologic chorioamnionitis.We propose that AF sHLA-G concentration is a more useful marker for early detection of histologic chorioamnionitis in patients with PROM than CRP.