FETAL FIBRONECTIN IN CERVICAL AND VAGINAL SECRETIONS AS A PREDICTOR OF PRETERM DELIVERY
FETAL FIBRONECTIN IN CERVICAL AND VAGINAL SECRETIONS AS A PREDICTOR OF PRETERM DELIVERY
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DOI：
10.1056/nejm199109053251001
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发表时间：
1991-09-05
影响因子：
158.5
通讯作者：
GARITE, TJ
中科院分区：
文献类型：
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作者：
LOCKWOOD, CJ;SENYEI, AE;GARITE, TJ
背景。 早产是美国新生儿死亡的主要原因，但由于无法准确预测哪些妊娠存在风险，解决这一问题的努力受到阻碍。 我们推测胎膜损伤可能会将胎儿纤连蛋白释放到子宫颈和阴道中，从而产生早产的生化标记物。方法。 我们使用单克隆抗体 FDC-6 通过灵敏的免疫测定法测量了宫颈和阴道分泌物、羊水和母体血浆中的胎儿纤连蛋白浓度。 免疫组织化学研究用于确定胎儿纤连蛋白在胎盘和羊绒毛膜中的分布，并确定其细胞来源。结果。 妊娠 21 至 37 周期间，足月分娩的无并发症妊娠女性 (n = 163) 的宫颈阴道胎儿纤连蛋白浓度很少高于每毫升 0.05 μg（267 个宫颈样本中的 11 个 [4%]，267 个阴道样本中的 9 个 [3%]）。 93.8% 的胎膜早破妇女 (n = 65) 的羊水以及宫颈或阴道分泌物中检测到高水平的胎儿纤连蛋白。 50.4% 患有早产子宫收缩且胎膜完整的女性 (n = 117) 中也存在宫颈或阴道胎儿纤连蛋白，并且其存在可识别足月前分娩的女性 (n = 60)，敏感性为 81.7%，特异性为 82.5%。 在胎盘和胎膜中，在与子宫壁的接触点发现了胎儿纤连蛋白。结论。 妊娠中期和晚期宫颈阴道胎儿纤连蛋白的存在可识别出早产高风险的女性亚群。 这种现象可能反映了绒毛膜与子宫蜕膜层的分离，细胞外基质的完整或降解的绒毛膜成分释放到宫颈和阴道分泌物中。
Background. Preterm delivery is the leading cause of neonatal mortality in the United States, but efforts to address the problem are hampered by the inability to predict accurately which pregnancies are at risk. We postulated that damage to the fetal membranes may release fetal fibronectin into the cervix and vagina, giving rise to a biochemical marker for preterm delivery.Methods. We measured fetal-fibronectin concentrations in cervical and vaginal secretions, amniotic fluid, and maternal plasma with a sensitive immunoassay using the monoclonal antibody FDC-6. Immunohistochemical studies were used to determine the distribution of fetal fibronectin in the placenta and amniochorionic membranes and to ascertain its cell of origin.Results. Women with uncomplicated pregnancies (n = 163) who delivered at term rarely had cervicovaginal fetal-fibronectin concentrations above 0.05-mu-g per milliliter between 21 and 37 weeks of gestation (11 of 267 cervical samples [4 percent] and 9 of 267 vaginal samples [3 percent]). High levels of fetal fibronectin were detected in amniotic fluid and in the cervical or vaginal secretions of 93.8 percent of the women with preterm rupture of membranes (n = 65). Cervical or vaginal fetal fibronectin was also present in 50.4 percent of the women with preterm uterine contractions and intact membranes (n = 117), and its presence identified the women who delivered before term (n = 60) with a sensitivity of 81.7 percent and a specificity of 82.5 percent. In the placenta and membranes, fetal fibronectin was found at points of contact with the uterine wall.Conclusions. The presence of cervicovaginal fetal fibronectin in the second and third trimesters of pregnancy identifies a subgroup of women who are at high risk for preterm delivery. This phenomenon may reflect the separation of the chorion from the decidual layer of the uterus, with the release of intact or degraded chorionic components of the extracellular matrix into the cervical and vaginal secretions.