绒毛膜羊膜炎与围生儿脑损伤的细胞因子水平变化

Changes of cytokines in patients with chorioamnionitis and perinatal brain injury

目的探讨未足月胎膜早破并发绒毛膜羊膜炎及围生儿脑损伤中细胞因子的变化。方法收集2013年1月-2016年12月在该院产科确诊的未足月胎膜早破患者73例。所有研究对象采用酶联免疫吸附法检测血清和脐血中的IL-6、IL-4、IL-10、IFN、TNF-α含量;结合临床症状和胎盘脐带病理学检查将研究对象分为观察组(绒毛膜羊膜炎,30例)和对照组(非绒毛膜羊膜炎,43例)。检测IL-6、IL-4、IL-10、干扰素(IFN)及肿瘤坏死因子-α(TNF-α)在未足月胎膜早破患者血清、脐血中的含量。结果该院同期妊娠妇女中,未足月胎膜早破发生率为9.6‰,绒毛膜羊膜炎发生率为3.9‰,而在未足月胎膜早破中绒毛膜羊膜炎发生率为41.1%;观察组及围生儿脑损伤组血清、脐血中IL-6、TNF-α水平高于对照组及无脑损伤组(P<0.05);观察组及围生儿脑损伤组血清及脐血中IL-4、IL-10含量均较对照组与无脑损伤组低(P<0.05);IFN水平在4组血清及脐血中的含量均无明显差别(P>0.05)。观察组发生围生儿脑损伤9例;对照组发生围生儿脑损伤3例,差异有统计学意义(P<0.05)。结论妊娠妇女血清、脐血中IL-6、IL-4、IL-10、TNF-α水平变化与未足月胎膜早破并发绒毛膜羊膜炎有关,围生儿脑损伤组细胞因子变化与绒毛膜羊膜炎一致,绒毛膜羊膜炎患者中围生儿脑损伤发生率增加,早诊断、早治疗可改善围生预后。

Objective To explore the changes of cytokines in patients with preterm premature rupture of membranes（ PPROM） combined with chorioamnionitis and perinatal brain injury. Methods From January 2013 to December 2016,73 patients diagnosed as PPROM in Department of Obstetrics in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine were collected,ELISA was used to detect the levels of IL-6,IL-4,IL-10,IFN,and TNF-α in serum and umbilical cord blood. The patients were divided into observation group（ 30 patients with chorioamnionitis） and control group（ 43 patients without chorioamnionitis） according to clinical symptoms and pathological examination of placenta and umbilical cord. The levels of IL-6,IL-4,IL-10,interferon（ IFN）,and tumor-necrosis factor-α（ TNF-α） in serum and umbilical cord blood of patients in the two groups were detected. Results From January 2013 to December 2016,the incidence rates of PPROM and chorioamnionitis among pregnant women in the hospital were 9. 6‰ and 3. 9‰,respectively,the incidence rate of chorioamnionitis among the patients with PPROM was 41. 1%. The levels of IL-6 and TNF-α in serum and umbilical cord blood of patients in observation group and perinatal brain injury group were statistically significantly higher than those in control group and non-perinatal brain injury group（ P〈0.05）. The levels of IL-4 and IL-10 in serum and umbilical cord blood of patients in observation group and perinatal brain injury group were statistically significantly lower than those in control group and non-perinatal brain injury group（ P〈0.05）. There was no statistically significant difference in the levels of IFN in serum and umbilical cord blood among the four groups（ P〈0.05）. There were 9 cases complicating with perinatal brain injury in observation group and 3 cases complicating with perinatal brain injury in control group,there was statistically significant difference between the two groups（ P〈0.05）. Conclusion The changes of IL-6,IL-4,IL-10,and TNF-α in serum and umbilical cord blood of pregnant women are correlated with PPROM complicated with chorioamnionitis. The changes of cytokines in perinatal brain injury group are consistent with chorioamnionitis. The incidence rate of perinatal brain injury increases in patients with chorioamnionitis. Early diagnosis and early treatment can improve perinatal outcome.