Bacterial vaginosis, vaginal fluid neutrophil defensins, and preterm birth
Bacterial vaginosis, vaginal fluid neutrophil defensins, and preterm birth
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DOI：
10.1016/s0029-7844(03)00042-5
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发表时间：
2003-05-01
影响因子：
7.2
通讯作者：
Heine, RP
中科院分区：
文献类型：
--
作者：
Balu, RB;Savitz, DA;Heine, RP
目的：探讨细菌性阴道病、阴道液中性粒细胞防御素与早产的关系。方法：采用病例-队列研究设计，收集242例早产儿和507例非早产儿的24~29周阴道分泌液标本。用革兰氏染色和Nugent评分检测细菌性阴道病，用酶联免疫吸附试验检测中性粒细胞防御素。细菌性阴道病被研究为一个类别变量(阴性、中间和阳性)，而防御素被研究为一个连续的、类别的(基于百分位数)和二分的衡量标准(存在和不存在)。三个胎龄分界点被用来定义早产。用改良的Cox比例风险模型评价细菌性阴道病、防御素、早产程度(小于32周、小于34周和小于37周)和早产类型(胎膜早破、早产)之间的关系。结果：37周前阴道液中性粒细胞防御素升高与出生无关。与没有检测到阴道液体防御素的女性相比，防御素水平较高的女性(0-2.8、2.8-8.2和大于8.2-8.2)在32周前分娩的风险更大。调整了孕妇种族和孕期阴道出血的危险比和这些防御素水平的95%可信区间分别为1.7(6.4，6.9)，2.4(0.7，7.9)和3.1(1.0，9.8)。细菌性阴道病的状况不影响防御素与早产的关系。结论：妊娠24~29周阴道液中性粒细胞防御素浓度升高可预示32周前早产。《妇科杂志》2003；101：862-8。(C)2003年由美国妇产科医师学会提供)。
OBJECTIVE: To examine the association between bacterial vaginosis, vaginal fluid neutrophil defensins, and preterm birth.METHODS: Vaginal fluid specimens were obtained at 24-29 weeks' gestation from 242 cases with preterm birth and 507 noncases sampled using a case-cohort study design. We tested for bacterial vaginosis by Gram staining and Nugent scores and assayed for neutrophil defensins by enzymelinked immunosorbent assay. Bacterial vaginosis was studied as a categoric variable (negative, intermediate, and positive), whereas defensins were studied as a continuous, categoric (based on percentiles), and dichotomous measure (presence versus absence). Three gestational age cut points were used to define preterm birth. Modified Cox proportional hazard models were used to evaluate the associations between bacterial vaginosis, defensins, and degree (less than 32, less than 34, and less than 37 weeks) and type (premature rupture of membranes, preterm labor) of preterm birth.RESULTS: Elevated vaginal fluid neutrophil defensins were not associated with birth before 37 weeks. Compared with women who did not have measurable vaginal fluid defensins, women with higher defensin levels (0-2.8 mug/mL, 2.8-8.2 mug/mL, and greater than 8.2 mug/mL) had a greater risk of delivering before 32 weeks. Hazard ratios adjusted for maternal race and vaginal bleeding during pregnancy and 95% confidence intervals for these defensin levels were 1.7 (6.4, 6.9), 2.4 (0.7, 7.9), and 3.1 (1.0, 9.8), respectively. Bacterial vaginosis status did not influence the association between defensins and preterm birth.CONCLUSION: Elevated concentrations of vaginal fluid neutrophil defensins at 24-29 weeks' gestation might predict preterm birth before 32 weeks. (Obstet Gynecol 2003; 101:862-8. (C) 2003 by The American College of Obstetricians and Gynecologists).