Systemic Inflammatory Response to Malaria During Pregnancy Is Associated With Pregnancy Loss and Preterm Delivery
Systemic Inflammatory Response to Malaria During Pregnancy Is Associated With Pregnancy Loss and Preterm Delivery
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DOI：
10.1093/cid/cix623
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发表时间：
2017-11-15
影响因子：
11.8
通讯作者：
Duffy, Patrick E.
中科院分区：
文献类型：
--
作者：
Fried, Michal;Kurtis, Jonathan D.;Duffy, Patrick E.
背景。妊娠期疟疾会诱发促炎性免疫反应。我们发现，CXCL9 等疟疾相关全身炎症反应与流产和早产风险相关。妊娠期疟疾 (PM) 与促炎性免疫反应相关，其特征是细胞因子和趋化因子（如肿瘤坏死因子-α、干扰素-γ、白细胞介素 10 (IL-10) 和 CXCL9）水平升高。这些变化与不良结局相关，包括低出生体重分娩和孕产妇贫血。然而，目前尚不清楚疟疾期间的炎症途径是否与流产和早产 (PTD) 有关。方法。在马里 Ouelessebougou 进行的一项纵向队列研究中，测量了 638 名妇女在入组、妊娠 30-32 周和分娩时的母亲外周血以及胎盘血中的细胞因子和趋化因子水平。每次就诊时均通过血涂片显微镜评估恶性疟原虫感染。结果。 PM 与细胞因子和趋化因子（包括 IL-10 和 CXCL9）水平升高相关。在针对已知协变量进行调整的竞争风险模型中，怀孕期间外周血中检测到的高 CXCL9 水平与流产和 PTD 风险增加相关。分娩时，母血中高 IL-10 水平与妊娠丢失增加相关，胎盘血液中 IL-1 β 水平升高与妊娠丢失和 PTD 相关。结论。 PM 与胎盘和母体外周血中促炎细胞因子和趋化因子水平升高有关。怀孕期间对疟疾的全身炎症反应预示着流产和 PTD 的风险增加。
Background. Pregnancy malaria induces a proinflammatory immune response. We find that malaria-related systemic inflammatory responses such as CXCL9 are associated with risks of pregnancy loss and preterm delivery.Pregnancy malaria (PM) is associated with a proinflammatory immune response characterized by increased levels of cytokines and chemokines such as tumor necrosis factor-alpha, interferon-gamma, interleukin 10 (IL-10), and CXCL9. These changes are associated with poor outcomes including low birthweight delivery and maternal anemia. However, it is unknown if inflammatory pathways during malaria are related to pregnancy loss and preterm delivery (PTD).Methods. Cytokine and chemokine levels were measured in maternal peripheral blood at enrollment, gestational week 30-32, and delivery, and in placental blood, of 638 women during a longitudinal cohort study in Ouelessebougou, Mali. Plasmodium falciparum infection was assessed by blood smear microscopy at all visits.Results. PM was associated with increased levels of cytokines and chemokines including IL-10 and CXCL9. In a competing risks model adjusted for known covariates, high CXCL9 levels measured in the peripheral blood during pregnancy were associated with increased risk of pregnancy loss and PTD. At delivery, high IL-10 levels in maternal blood were associated with an increase in pregnancy loss, and increased IL-1 beta levels in placental blood were associated with pregnancy loss and PTD.Conclusions. PM is associated with increased proinflammatory cytokine and chemokine levels in placental and maternal peripheral blood. Systemic inflammatory responses to malaria during pregnancy predict increased risk of pregnancy loss and PTD.