早产胎膜早破合并羊膜腔感染患者胎盘组织TLR2和TLR4的表达

Expression of TLR2 and TLR4 in placenta tissues of preterm premature rupture of membrane patients complicated with intra-amniotic infection

目的 分析早产胎膜早破(PPROM)合并羊膜腔感染(IAI)患者胎盘组织Toll样受体2(TLR2)、Toll样受体4(TLR4)的表达水平。方法 选取浙江省丽水市妇幼保健院81例PPROM住院患者为研究组,并选取同期50名正常晚期妊娠者为对照组,依据是否合并IAI,将研究组PPROM患者分为合并IAI组20例与未合并IAI组61例,IAI按照组织病理学检查结果分为轻度组10例、中度组5例、重度组5例。收集各组临床资料,以免疫组化法及实时定量荧光聚合酶链式反应(Real-time PCR)法测定胎盘组织TLR2、TLR4、TLR2 mRNA、TLR4 mRNA水平。结果 研究组与对照组胎盘组织TLR2、TLR4、TLR2 mRNA、TLR4 mRNA水平比较,无统计学差异;合并IAI组羊水过少患者例数、TLR4 mRNA水平高于未合并IAI组,差异有统计学意义(P<0.05);Logistic多因素分析显示,羊水过少、胎盘组织TLR4 mRNA为PPROM合并IAI独立危险因素(P<0.05);重度组TLR2、TLR4、TLR2 mRNA、TLR4 mRNA水平高于轻、中度组(P<0.05),且中度组高于轻度组(P<0.05)。结论 胎盘组织TLR2、TLR4、TLR2 mRNA、TLR4 mRNA水平与PPROM的发生无关,但均与PPROM合并IAI病情有关,IAI病情越严重,胎盘组织TLR2、TLR4、TLR2mRNA、TLR4mRNA水平越高。

OBJECTIVE To investigate the expression levels of Toll-like receptor 2(TLR2) and Toll-like receptor 4(TLR4) in placenta tissues of preterm premature rupture of membrane(PPROM) patients complicated with intra-amniotic infection(IAI). METHODS A total of 81 PPROM patients who were hospitalized in Lishui Maternal and Child Health Hospital were recruited as the study group, meanwhile, 50 normal late pregnancy patients were chosen as the control group. The PPROM patients of the study group were divided into the IAI group with 20 cases and the non-IAI group with 61 cases according to the status of IAI. The patients complicated with IAI were divided into the mild group with 10 cases, the moderate group with 5 cases and the severe group with 5 cases according to the result of histopathological examination. The clinical data were collected, and the levels of TLR2, TLR4, TLR2 mRNA and TLR4 mRNA in placenta tissues were detected by means of immunohistochemical method and real-time quantitative fluorescence polymerase chain reaction(real-time PCR). RESULTS There were no significant differences in the levels of placenta tissue TLR2, TLR4, TLR2 mRNA and TLR4 mRNA between the study group and the control group. The percentage of the patients with oligoamnios and the TLR4 mRNA were significantly higher in the IAI group than in the non-IAS group(P<0.05). Multivariate logistic regression analysis showed that oligoamnios and placenta tissue TLR4 mRNA were the independent risk factors for the IAI in the PPROM patients(P<0.05). The levels of TLR2, TLR4, TLR2 mRNA and TLR4 mRNA of the severe group were significantly higher than those of the mild group and the moderate group(P<0.05), and the levels of above indexes of the moderate group were significantly higher than those of the mild group(P<0.05). CONCLUSION The levels of placenta tissue TLR2, TLR4, TLR2 mRNA and TLR4 mRNA are not associated with the incidence of PPRO but are associated with the severity of IAI in the PPROM patients;the more severe the IAI, the higher the levels of placenta tissue TLR2, TLR4, TLR2 mRNA and TLR4 mRNA are.