宫内炎症及宫内感染机制的研究进展

Research progress on the mechanism of intrauterine inflammation and intrauterine infection

宫内炎症(intrauterine inflammation, IUI)在排卵、着床、蜕膜化、胎盘形成和分娩过程中均起关键作用,并对母体和胎盘健康以及胎儿的生长发育产生影响。宫内感染(intrauterine infection, IAI)可激活炎症机制从而导致早产,并且IAI可导致高的胎儿死亡率及存活儿童残疾率。然而,目前大量研究表明多数IUI激活导致的早产与IAI无关,临床多表现为无菌性炎症,抗感染并不能有效预防早产。因此,了解IUI的机制,并准确地辨别IAI性炎症与无菌性炎症,有助于孕产妇临床管理,减少母体及胎儿或新生儿不良结局的发生。本文综述了分娩过程中的IUI反应机制、IAI性炎症与无菌性炎症之间的异同,以及两者与早产的关系。

Intrauterine inflammation(IUI) plays a key role in the process of ovulation, implantation, decidualization, placenta formation and childbirth, and has an impact on maternal and placental health, the growth and development of the fetus. Intrauterine infection(IAI) can activate the inflammatory mechanism and lead to premature birth, and IAI can lead to high fetal mortality and disability rate of surviving children. However, a large number of current studies have shown that most of the preterm births caused by IUI activation have nothing to do with IAI. The clinical manifestations are mostly aseptic inflammation, and anti-infection can not effectively prevent premature birth. Therefore, understanding the mechanism of IUI and accurately distinguishing IAI inflammation and aseptic inflammation will help the clinical management of pregnant women and reduce the occurrence of adverse maternal and fetal or neonatal outcomes. This review discusses the IUI response mechanism during childbirth, the similarities and differences between IAI inflammation and aseptic inflammation, and the relationship between the two and preterm labor.