Inflammatory Cytokines and Spontaneous Preterm Birth in Asymptomatic Women A Systematic Review
Inflammatory Cytokines and Spontaneous Preterm Birth in Asymptomatic Women A Systematic Review
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DOI：
10.1097/aog.0b013e3181e6dbc0
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发表时间：
2010-08-01
影响因子：
7.2
通讯作者：
Luo, Zhong-Cheng
中科院分区：
文献类型：
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作者：
Wei, Shu-Qin;Fraser, William;Luo, Zhong-Cheng
目的：为了评估炎性细胞因子与无症状妇女自发性早产风险之间的关系，数据来源：我们使用以下关键词检索了PubMed、EMBASE和科克伦图书馆中截至2010年2月的人类文献电子数据库：“早产/早产+（出生/分娩）”和“细胞因子”或“炎症/炎症+标记物/生物标记物”。“研究选择方法：我们纳入了观察性研究，这些研究报告了无症状妇女中常见炎性细胞因子与自发性早产之间的相关性。比值比（OR）和95%置信区间（CI）采用固定和随机效应models.TABULATION，INTEGRATION，和结果计算：十七个主要研究，包括6,270名参与者符合纳入标准。自然早产与中期宫颈阴道液中白细胞介素-6（IL-6）水平升高密切相关（OR 3.05，95% CI 2.00-4.67）（需要治疗的数量= 7，以确定额外的早产）和羊水（OR 4.52，95% CI 2.67-7.65）（需要治疗的数量= 7），但在血浆标本中无相关性（OR 1.5，95% CI 0.7-3.0）。自发性早产与孕中期羊水中C反应蛋白（CRP）水平升高密切相关（OR 7.85，95% CI 3.88-15.87）（需要治疗的数量= 3），但血浆标本中的相关性较弱（OR 1.53，95% CI 1.22-1.90）。数据不足（少于3项研究）用于其他炎性细胞因子的荟萃分析。宫颈阴道液中的炎性细胞因子IL-6和羊水中的IL-6和CRP与无症状妇女的自发性早产密切相关，这表明母胎界面的炎症，而不是全身性炎症，可能在这种自发性早产的病因学中起主要作用。
OBJECTIVE: To estimate the association between inflammatory cytokines and the risk of spontaneous preterm birth in asymptomatic women.DATA SOURCES: We searched electronic databases of the human literature in PubMed, EMBASE, and the Cochrane Library up to February 2010 using the following key words: "preterm/pre-term + (birth/delivery)" and "cytokine" or "inflammation/inflammatory + marker/biomarker."METHODS OF STUDY SELECTION: We included observational studies that reported the association between common inflammatory cytokines and spontaneous preterm birth as an outcome in asymptomatic women. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using fixed and random effects models.TABULATION, INTEGRATION, AND RESULTS: Seventeen primary studies comprising 6,270 participants met the inclusion criteria. Spontaneous preterm birth was strongly associated with increased levels of interleukin-6 (IL-6) in midtrimester cervicovaginal fluid (OR 3.05, 95% CI 2.00-4.67) (number needed to treat = 7 for identifying an additional preterm delivery) and amniotic fluid (OR 4.52, 95% CI 2.67-7.65) (number needed to treat = 7), but there was no association in plasma specimen (OR 1.5, 95% CI 0.7-3.0). Spontaneous preterm birth was strongly associated with increased C-reactive protein (CRP) levels in midtrimester amniotic fluid (OR 7.85, 95% CI 3.88-15.87) (number needed to treat = 3), but the association was weak in plasma specimen (OR 1.53, 95% CI 1.22-1.90). There were insufficient data (fewer than three studies) for meta-analysis in other inflammatory cytokines.CONCLUSION: Inflammatory cytokine IL-6 in cervicovaginal fluid and IL-6 and CRP in amniotic fluid but not in plasma are strongly associated with spontaneous preterm birth in asymptomatic women, suggesting that inflammation at the maternal-fetal interface, rather than systemic inflammation, may play a major role in the etiology of such spontaneous preterm births.