Sterile and microbial-associated intra-amniotic inflammation in preterm prelabor rupture of membranes.
Sterile and microbial-associated intra-amniotic inflammation in preterm prelabor rupture of membranes.
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DOI：
10.3109/14767058.2014.958463
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发表时间：
2015-08
期刊：
影响因子：
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通讯作者：
Kim YM
中科院分区：
文献类型：
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作者：
Romero R;Miranda J;Chaemsaithong P;Chaiworapongsa T;Kusanovic JP;Dong Z;Ahmed AI;Shaman M;Lannaman K;Yoon BH;Hassan SS;Kim CJ;Korzeniewski SJ;Yeo L;Kim YM
本研究的目的是：1)检测早产胎膜破裂(PROM)患者的羊水(AF)微生物学；2)研究有无微生物的羊水内炎症(无菌炎症)与早产胎膜早破患者不良妊娠结局的关系。对59例早产胎膜早破孕妇的房颤标本进行了培养技术(需氧菌、厌氧菌和生殖支原体培养)和广谱聚合酶链式反应-电喷雾电离质谱仪(PCR/ESI-MS)分析。用双抗体夹心酶联免疫吸附试验测定血清IL-6浓度。两项测试的结果都与房颤、IL-6浓度以及产科/围产期不良结局的发生有关。1)PCR/ESI-MS、AF培养和这两种方法的联合检测，分别在早产胎膜早破孕妇中检出微生物的比例分别为36%(21/59)、24%(14/59)和41%(24/59)：2)羊膜腔内最常见的微生物是Sneathia种和解脲支原体；3)微生物相关性和无菌羊膜内炎的发生频率大致相似[29%(17/59)]：-然而，每种方法的患病率因胎膜早破的胎龄而不同；4)早产胎膜早破时胎龄越早，微生物相关性羊膜内炎症和无菌羊水内炎症的发生率越高；5)早产胎膜早破发生时，羊膜内对微生物的炎症反应较强；6)有微生物相关性羊膜内炎症的急性胎盘炎(组织学绒毛膜羊膜炎和/或胃底炎)的发生率显著高于无羊膜内炎症的患者[93.3%(14/15)vs.38%(6/16)；p=0.001]。1)培养和PCR/ESI-MS检测早产儿胎膜早破的微生物频率为40%；2)PCR/ESI-MS检测到的早产儿胎膜早破患者房颤中的微生物比房颤培养多50%；3)29%的患者出现无菌羊水内炎症，在妊娠24周后但不是在24周之前出现的患者中，与微生物相关的羊水内炎症一样常见或更常见。
The objectives of this study were to: 1) determine the amniotic fluid (AF) microbiology of patients with preterm prelabor rupture of membranes (PROM); and 2) examine the relationship between intra-amniotic inflammation with and without microorganisms (sterile inflammation) and adverse pregnancy outcomes in patients with preterm PROM. AF samples obtained from 59 women with preterm PROM were analyzed using cultivation techniques (for aerobic and anaerobic bacteria as well as genital mycoplasmas) and with broad-range polymerase chain reaction coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). AF concentration of interleukin-6 (IL-6) was determined using ELISA. Results of both tests were correlated with AF IL-6 concentrations, and the occurrence of adverse obstetrical/perinatal outcomes. 1) PCR/ESI-MS, AF culture, and the combination of these two tests, each identified microorganisms in 36% (21/59), 24% (14/59) and 41% (24/59) of women with preterm PROM, respectively; 2) the most frequent microorganisms found in the amniotic cavity were Sneathia species and Ureaplasma urealyticum; 3) the frequency of microbial-associated and sterile intra-amniotic inflammation was overall similar [ 29% (17/59)]: - however, the prevalence of each differed according to the gestational age when PROM occurred ; 4) the earlier the gestational age at preterm PROM, the higher the frequency of both microbial-associated and sterile intra-amniotic inflammation; 5) the intensity of the intra-amniotic inflammatory response against microorganisms is stronger when preterm PROM occurs early in pregnancy; and 6) the frequency of acute placental inflammation (histologic chorioamnionitis and/or funisitis) was significantly higher in patients with microbial-associated intra-amniotic inflammation than in those without intra-amniotic inflammation [93.3% (14/15) vs. 38% (6/16); p=0.001]. 1) The frequency of microorganisms in preterm PROM is 40% using both cultivation and PCR/ESI-MS; 2) PCR/ESI-MS identified microorganisms in the AF of 50% more women with preterm PROM than did AF culture; and 3) sterile intra-amniotic inflammation was present in 29% of these patients, and it was as or more common than microbial-associated intra-amniotic inflammation among those presenting after, but not before, 24 weeks of gestation.