Neutrophil elastase and secretory leukocyte protease inhibitor in prelabor rupture of membranes, parturition and intra-amniotic infection.
Neutrophil elastase and secretory leukocyte protease inhibitor in prelabor rupture of membranes, parturition and intra-amniotic infection.
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DOI：
10.1080/713605675
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发表时间：
2002-10-01
期刊：
影响因子：
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通讯作者：
Uldbjerg, N
中科院分区：
文献类型：
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作者：
Helmig, B R;Romero, R;Uldbjerg, N
目的：中性粒细胞弹性蛋白酶（NE）是一种储存在成熟中性粒细胞的嗜天青颗粒中的多功能丝氨酸蛋白酶，能够在吞噬作用期间在细胞内降解蛋白质，并且在炎症过程期间在细胞外降解结缔组织。分泌性白细胞蛋白酶抑制剂（SLPI）是一种天然NE抑制剂，存在于羊水、胎膜和宫颈粘液中。NE和SLPI之间的不平衡已被认为是慢性炎性疾病中异常组织破坏的机制。本研究的目的是确定是否分娩，胎膜早破（PROM）和微生物侵入羊膜腔与羊水NE和SLPI浓度的变化有关。研究设计：羊水通过羊膜穿刺术从以下组的380例患者中取出：（1）足月分娩（n = 13）或早产（n = 26）的未足月分娩和完整的羊膜，羊膜腔无微生物侵入，（2）胎膜早破伴羊膜腔微生物浸润34例，未伴羊膜腔微生物浸润51例;（3）足月妊娠无微生物侵入羊膜腔，胎膜完整，未临产（n = 63），临产（n = 158），非临产胎膜破裂26例。通过羊水微生物（包括需氧菌、厌氧菌和支原体）培养阳性来确定羊膜腔的微生物侵入。羊水NE和SLPI水平测定高度特异性和敏感性immunoassays.Results：早产胎膜早破与羊水NE浓度显着增加。微生物侵入羊膜腔与早产和胎膜完整妇女以及早产胎膜早破妇女羊水NE浓度显著增加相关。足月分娩和早产与羊水NE浓度显著增加相关。在没有微生物侵入的羊膜腔，早产和足月胎膜早破与SLPI的羊水浓度显着降低。结论：早产胎膜早破，微生物侵入的羊膜腔，分娩在长期和早产与显着增加的羊水浓度NE。胎膜早破与羊水SLPI浓度降低有关。
OBJECTIVE: Neutrophil elastase (NE), a multifunctional serine protease stored in azurophilic granules of mature neutrophils, is capable of intracellular degradation of proteins during phagocytosis and extracellular degradation of connective tissue during an inflammatory process. Secretory leukocyte protease inhibitor (SLPI) is a natural NE inhibitor present in amniotic fluid, fetal membranes and cervical mucus. An imbalance between NE and SLPI has been implicated as a mechanism of abnormal tissue destruction in chronic inflammatory diseases. The purpose of this study was to determine if parturition, premature rupture of the membranes (PROM) and microbial invasion of the amniotic cavity are associated with changes in amniotic fluid concentrations of NE and SLPI.STUDY DESIGN: Amniotic fluid was retrieved by amniocentesis from 380 patients in the following groups: (1) preterm labor and intact membranes without microbial invasion of the amniotic cavity who delivered at term (n = 13) or prematurely (n = 26), and preterm labor with microbial invasion of the amniotic cavity (n = 9); (2) preterm PROM with (n = 34) and without (n = 51) microbial invasion of the amniotic cavity; and (3) term gestation without microbial invasion of the amniotic cavity with intact membranes not in labor (n = 63), in labor (n = 158), and with rupture of membranes not in labor (n = 26). Microbial invasion of the amniotic cavity was determined by a positive amniotic fluid culture for micro-organisms including aerobic, anaerobic and Mycoplasma species. NE and SLPI amniotic fluid levels were determined by highly specific and sensitive immunoassays.RESULTS: Preterm PROM was associated with a significant increase in the amniotic fluid concentration of NE. Microbial invasion of the amniotic cavity was associated with a significant increase in the amniotic fluid concentration of NE in women with preterm labor and intact membranes, as well as in women with preterm PROM. Term and preterm parturition was associated with a significant increase in the amniotic fluid concentration of NE. In the absence of microbial invasion of the amniotic cavity, preterm and term PROM were associated with a significant reduction in the amniotic fluid concentration of SLPI.CONCLUSION: Preterm PROM, microbial invasion of the amniotic cavity, and parturition at term and preterm are associated with a significant increase in the amniotic fluid concentration of NE. PROM is associated with a reduced amniotic fluid concentration of SLPI.