宫内感染孕妇羊水和脐血及血清中炎性指标和氧化应激水平

Inflammatory indicators and oxidative stress levels in amniotic fluid,umbilical blood and serum of pregnant women with intrauterine infection

目的探讨妊娠期宫内感染孕妇羊水、脐血及血清中白细胞介素-6(IL-6)、IL-8、丙二醛(MDA)、晚期氧化蛋白(AOPP)水平变化及临床意义。方法选取2016年8月-2018年8月石家庄市第四医院分娩的67例宫内感染孕妇设为感染组,另选取同期分娩的正常孕妇30例设为对照组;收集两组孕妇及其新生儿临床资料;检测两组羊水、脐血及血清中IL-6、IL-8、MDA和AOPP水平。结果感染组剖宫产、胎儿窘迫发生率均高于对照组(P<0.05),新生儿Apgar评分及新生儿体质量均低于对照组(P<0.05)。感染组母血、羊水及脐血中IL-6、IL-8水平均高于对照组(P<0.05);IL-6、IL-8联合诊断宫内感染的曲线下面积(AUC)大于IL-8、IL-6单独诊断宫内感染的AUC(P<0.05)。宫内感染孕妇新生儿窒息发生率为16.42%(11/67),新生儿窒息组脐血MDA、AOPP均高于非窒息组(P<0.05);脐血MDA、AOPP联合预测新生儿窒息的AUC大于MDA单项预测的AUC(P<0.05),与AOPP预测的AUC比较差异无统计学意义。结论妊娠期宫内感染孕妇血清IL-6、IL-8联合检测有助于宫内感染的早期诊断;脐血MDA、AOPP联合预测对于预测新生儿窒息具有较好的应用价值。

OBJECTIVE To explore the changes and clinical significance of interleukin-6(IL-6),interleukin-8(IL-8),malondialdehyde(MDA) and advanced oxidation protein products(AOPP) levels in amniotic fluid,umbilical blood and serum of women with intrauterine infection during pregnancy.METHODS A total of 67 pregnant women with intrauterine infection undergoing delivery in Shijiazhuang Fourth Hospital from Aug.2016 to Aug.2018 were selected as the infection group,another 30 normal pregnant women undergoing delivery during the same period were selected as the control group.The clinical data of pregnant women and their neonates of the two groups were collected.The levels of IL-6,IL-8,MDA and AOPP in amniotic fluid,umbilical blood and serum of the two groups were detected.RESULTS The incidence of cesarean section and fetal distress in the infection group was significantly higher than those in the control group(P<0.05),and the neonatal Apgar score and weight of the newborn were significantly lower than those in the control group(P<0.05).The levels of IL-6 and IL-8 in maternal serum,amniotic fluid and umbilical blood in the infection group were significantly higher than those in the control group(P<0.05).The area under the curve(AUC) of the combined diagnosis of IL-6 and IL-8 for intrauterine infection was significantly greater than that of IL-8 and IL-6 alone(P<0.05).The incidence of neonatal asphyxia in pregnant women with intrauterine infection was 16.42%(11/67).The levels of umbilical blood MDA and AOPP in neonatal asphyxia group were higher than those in non-asphyxia group(P<0.05).The AUC of combined prediction of umbilical blood MDA and AOPP for diagnosis of neonatal asphyxia was significantly greater than that of single MDA(P<0.05),and there was no significant difference compared with the AUC of AOPP.CONCLUSION The combined detection of serum IL-6 and IL-8 in pregnant women with gestational intrauterine infection was helpful for the early diagnosis of intrauterine infection.The combined prediction of umbilical blood MDA with AOPP was of good application value in predicting neonatal asphyxia.