血清MCP-1、sTNFR-Ⅰ、HMGB-1水平与绒毛膜羊膜炎及感染性早产的关系研究

Relationship between Serum MCP-1,sTNFR-Ⅰ,HMGB-1 Levels with Chorioamnionitis and Infectious Premature Delivery

目的:探讨血清单核细胞趋化蛋白-1(MCP-1)、可溶性肿瘤坏死因子受体-Ⅰ(s TNFR-Ⅰ)、高迁移率族蛋白-1(HMGB-1)水平与绒毛膜羊膜炎及感染性早产的关系,为感染性早产的防治提供参考。方法:选取2018年3月至2020年3月在重庆市妇幼保健院产检并住院分娩的产妇302例,根据是否发生绒毛膜羊膜炎分为绒毛膜羊膜炎组(74例)、非绒毛膜羊膜炎组(228例);根据分娩(足月产/早产)情况进一步分为感染性早产组(63例)、感染性足月产组(11例)、非感染性早产组(39例)、非感染性足月产组(189例)。检测并比较各组产妇血清MCP-1、s TNFR-Ⅰ、HMGB-1水平,分析以上指标与产妇发生绒毛膜羊膜炎的关系及对感染性早产的预测价值。结果:与非绒毛膜羊膜炎组比较,绒毛膜羊膜炎组产妇血清MCP-1、s TNFR-Ⅰ、HMGB-1水平均升高(P<0.05)。Logistic回归分析结果显示:血清MCP-1、s TNFR-Ⅰ、HMGB-1水平异常升高是产妇发生绒毛膜羊膜炎的危险因素(P<0.05)。感染性早产组产妇血清MCP-1、s TNFR-Ⅰ、HMGB-1水平均高于感染性足月产组、非感染性早产组、非感染性足月产组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示:血清MCP-1、s TNFR-Ⅰ、HMGB-1预测感染性早产的曲线下面积(AUC)分别为0.760、0.711、0.782,均具有一定预测准确性;血清MCP-1、s TNFR-Ⅰ、HMGB-1联合检测预测感染性早产的AUC为0.909,预测价值高于单项检测。结论:血清MCP-1、s TNFR-Ⅰ、HMGB-1水平异常升高与绒毛膜羊膜炎及感染性早产联系紧密,可作为感染性早产的预测指标,为及时采取积极防治措施提供辅助性指导,以改善母婴结局。

Objective:To investigate the relationship between serum monocyte chemoattractant protein-1(MCP-1),soluble tumor necrosis factor receptor-Ⅰ(s TNFR-Ⅰ),high mobility group box-1(HMGB-1)levels and chorioamnionitis and infectious premature delivery,and to provide reference for the prevention and treatment of infectious premature delivery.Methods:302 pregnant women who were examined and hospitalized in Chongqing Maternal and Child Health Hospital from March 2018 to March 2020 were selected.According to the occurrence of chorioamnionitis,the patients were divided into chorioamnionitis group(74 cases)and nonchorioamnionitis group(228 cases).According to the delivery(full-term delivery/preterm delivery),they were further divided into infectious preterm delivery group(63 cases),infectious full-term delivery group(11 cases),non-infectious preterm delivery group(39cases)and non-infectious full-term delivery group(189 cases).The serum MCP-1,s TNFR-Ⅰand HMGB-1 levels in each group were detected and compared,and the relationship between the above indicators and the occurrence of chorioamnionitis and the predictive value of infectious premature delivery were analyzed.Results:Compared with the non-chorioamnionitis group,the serum MCP-1,s TNFR-Ⅰand HMGB-1 levels in the chorioamnionitis group were increased(P<0.05).Logistic regression analysis showed that abnormally elevated serum MCP-1,s TNFR-Ⅰand HMGB-1 levels were risk factors for the occurrence of chorioamnionitis in parturients(P<0.05).The serum MCP-1,s TNFR-Ⅰand HMGB-1 levels in infectious preterm delivery group were higher than those in infectious full-term delivery group,non-infectious preterm delivery group and non-infectious term full-delivery group,and the differences were statistically significant(P<0.05).ROC curve analysis showed that the area under curve(AUC)of serum MCP-1,s TNFR-Ⅰand HMGB-1for predicting infectious preterm delivery was 0.760,0.711 and 0.782,respectively,which had certain prediction accuracy.The AUC of combined serum MCP-1,s TNFR-Ⅰand HMGB-1 in predicting infectious preterm delivery was 0.909,which was higher than that of single detection.Conclusion:Abnormal elevation of serum MCP-1,s TNFR-Ⅰand HMGB-1 levels is closely related to chorioamnionitis and infectious premature delivery.which can be used as a predictor of infectious premature delivery and provide supplementary guidance for timely active prevention and treatment measures to improve maternal and infant outcomes.