About one-half of early spontaneous preterm deliveries can be identified by a rapid matrix metalloproteinase-8 (MMP-8) bedside test at the time of mid-trimester genetic amniocentesis.
About one-half of early spontaneous preterm deliveries can be identified by a rapid matrix metalloproteinase-8 (MMP-8) bedside test at the time of mid-trimester genetic amniocentesis.
复制标题
DOI：
10.3109/14767058.2015.1094049
复制
发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Yoon BH
中科院分区：
文献类型：
--
作者：
Kim SM;Romero R;Lee J;Chaemsaithong P;Lee MW;Chaiyasit N;Lee HJ;Yoon BH
妊娠中期羊膜穿刺术继续用于染色体异常和其他遗传疾病的产前诊断。分析在妊娠中期遗传羊膜穿刺术中获得的羊水，确定那些有早期自发性早产风险的患者。这是基于大量确凿的证据，发现亚临床羊膜内炎症/感染与早期自发性早产有因果关系。虽然已经提出了几种生物标志物来识别羊膜内炎症，但积累的数据表明羊水基质金属蛋白酶-8 （MMP-8）或中性粒细胞胶原酶的测定是自发性早产的有力预测因子。MMP-8是炎症细胞对微生物产物或“危险信号”的反应而释放的。已经开发出一种快速的即时检测方法，可以在20分钟内在床边检测MMP-8，而且不需要实验室设备。本研究的目的是确定羊水中MMP-8的升高，通过快速点护理测试来测量，是否可以识别中期遗传羊膜穿刺术后有自发性早产风险的患者。一项病例对照研究旨在从无症状的单胎孕妇中获得羊水，这些孕妇接受了中期遗传羊膜穿刺术。采用MMP-8床边试验分析64例早期自发性早产（<30周）患者和128例正常妊娠结局的对照者的羊水。1)自发性早产患者的MMP-8床边试验（Yoon’s MMP-8 Check™）阳性比例为42.2%(27/64)，对照组无阳性（0/128）（p<0.001）；2) MMP-8床边试验预测中期遗传性羊膜穿刺术后自发性早产（<30周）的敏感性为42.2%，特异性为100%；(3)自发性早产患者中，MMP-8床边试验阳性的患者羊膜穿刺术后2周和4周内的自然分娩率明显更高[40.7%（11/27）比5.4% (2/37)]；63.0% (17/27) vs. 24.3%(9/37))，分娩间隔时间比阴性患者短[分娩间隔：中位数（范围），16天（0-95天）vs. 42天（2-91天）；P <0.05]。我们得出的结论是，42%的早期自发性早产（<30周）患者在进行中期遗传羊膜穿刺术时可以通过快速MMP-8床边测试来识别。MMP-8床边试验是无症状孕妇早期自发性早产的有力预测指标。
Mid-trimester amniocentesis continues to be used for the prenatal diagnosis of chromosomal anomalies and other genetic disorders. Analysis of amniotic fluid obtained at the time of mid-trimester genetic amniocentesis identifies those patients who are at risk for early spontaneous preterm delivery. This is based on a solid body of evidence that found subclinical intra-amniotic inflammation/infection to be causally linked to early spontaneous preterm birth. Although several biomarkers have been proposed to identify intra-amniotic inflammation, the accumulated data suggest that the determination of amniotic fluid matrix metalloproteinase-8 (MMP-8), or neutrophil collagenase, is a powerful predictor of spontaneous preterm delivery. MMP-8 is released by inflammatory cells in response to microbial products or “danger signals.” A rapid point-of-care test has been developed to determine MMP-8 at the bedside within 20 minutes, and without the requirement of laboratory equipment. The objective of this study was to determine whether an elevation of MMP-8 in the amniotic fluid, measured by a rapid point-of-care test, can identify those patients at risk for spontaneous preterm delivery after a mid-trimester genetic amniocentesis. A case-control study was designed to obtain amniotic fluid from asymptomatic singleton pregnant women who underwent mid-trimester genetic amniocentesis. An MMP-8 bedside test was performed to analyze the amniotic fluid of 64 patients with early spontaneous preterm delivery (<30 weeks) and 128 matched controls with normal pregnancy outcomes. 1) The MMP-8 bedside test (Yoon’s MMP-8 Check™) was positive in 42.2% (27/64) of patients with spontaneous preterm delivery but in none (0/128) of the control cases (p<0.001); 2) the MMP-8 bedside test had a sensitivity of 42.2%, and a specificity of 100% in the prediction of spontaneous preterm delivery (<30 weeks) following a mid-trimester genetic amniocentesis; and 3) among the patients with spontaneous preterm delivery, those with a positive MMP-8 bedside test had a significantly higher rate of spontaneous delivery within 2 weeks and 4 weeks of an amniocentesis [40.7% (11/27) vs. 5.4% (2/37); 63.0% (17/27) vs. 24.3% (9/37)] and a shorter interval-to-delivery period than those with a negative test [interval-to-delivery: median (range), 16 days (0–95 days) vs. 42 days (2–91 days); p<0.05 for each]. We conclude that 42% of patients with an early spontaneous preterm delivery (<30 weeks) could be identified by a rapid MMP-8 bedside test at the time of their mid-trimester genetic amniocentesis. The MMP-8 bedside test is a powerful predictor of early spontaneous preterm birth in asymptomatic pregnant women.