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母体循环血清TLR-1、2、4、6水平与胎膜早破及亚临床绒毛膜羊膜炎关系的研究
作者:朱林凤1  王久阳2  惠玉洁1  王硕1 
单位:1. 北京市平谷区医院 妇产科, 北京 101200;
2. 北京市平谷区医院 病理科, 北京 101200
关键词:胎膜早破 亚临床绒毛膜羊膜炎 Toll样受体 血清 胎膜组织 
分类号:R714.25
出版年·卷·期(页码):2021·40·第一期(33-41)
摘要:

目的:研究母体循环血清Toll样受体-1(Toll-like receptor 1,TLR-1)、TLR-2、TLR-4、TLR-6水平与胎膜早破(PROM)及亚临床绒毛膜羊膜炎的关系。方法:收集2019年1月至12月本院520例PROM孕妇(PROM组),包括249例足月(tPROM组)孕妇和271例未足月(pPROM组)孕妇。另外各选取50例未足月和足月正常分娩孕妇作为对照组。收集入院时孕妇的血清样本以及新鲜胎膜组织标本。ELISA法检测血清TLR-1、2、4、6水平;qRT-PCR法和免疫组化法检测胎膜组织中TLR-1、2、4、6 mRNA及蛋白的表达。根据组织病理学检测,诊断PROM孕妇是否合并亚临床绒毛膜羊膜炎。结果:与对照组相比,PROM组孕妇血清和胎膜组织TLR-2、TLR-4表达升高(P<0.05),且PROM孕妇血清TLR-1、2、4、6水平与胎膜组织中相应的mRNA表达量呈正相关(P<0.001)。根据组织病理学诊断,tPROM组和pPROM组分别有53例(21.29%)及116例(42.80%)孕妇合并亚临床绒毛膜羊膜炎。与未合并亚临床绒毛膜羊膜炎孕妇相比,合并亚临床绒毛膜羊膜炎的孕妇血清TLR-2、TLR-4水平均升高(P<0.05)。经多因素Logistic回归分析,血清TLR-2、TLR-4水平升高是发生亚临床绒毛膜羊膜炎的独立危险因素(P<0.05);且两者用于预测tPROM孕妇和pPROM孕妇是否合并亚临床绒毛膜羊膜炎,ROC曲线下面积分别为0.657(95%CI:0.579~0.743)、0.668(95%CI:0.584~0.759)以及0.793(95%CI:0.711~0.918)、0.813(95%CI:0.725~0.942)。结论:孕妇血清TLR-2、TLR-4水平升高与PROM以及合并亚临床绒毛膜羊膜炎有关。检测血清TLR-2、TLR-4水平对于PROM合并亚临床绒毛膜羊膜炎有一定的早期预测价值。

Objective: To investigate the relationship between maternal circulating serum toll like receptor 1(TLR-1), TLR-2, TLR-4, TLR-6 levels and premature rupture of membranes(PROM) or subclinical chorioamnionitis. Methods: 520 PROM pregnant women(PROM group), including 249 term(tPROM group) pregnant women and 271 preterm(pPROM group) pregnant women, were enrolled from January 2019 to December 2019 in our hospital. In addition, 50 term and 50 preterm pregnant women with normal delivery were selected into control group. Serum samples at admission and fresh fetal membranes after delivery were collected. The serum levels of TLR-1,-2,-4,-6 were detected by ELISA; mRNA and protein expressions of TLR-1,-2,-4,-6 in fetal membranes were detected by qRT-PCR and immunohistochemistry. According to the histopathological examination, the diagnosis of subclinical chorioamnionitis was performed in PROM pregnant women. Results: Compared with the control group, the levels of TLR-2 and TLR-4 in serum or fetal membranes were significantly increased in PROM group(P<0.05). The serum levels of TLR-1,-2,-4,-6 were positively correlated with the relative expression of TLRs mRNA in fetal membranes(P<0.001). According to the histopathological diagnosis, 53 cases(21.29%) in tPROM group and 116 cases(42.80%) in pPROM group had subclinical chorioamnionitis. Compared with the pregnant women without subclinical chorioamnionitis, the serum levels of TLR-2 and TLR-4 in tRPOM or pPROM pregnant women with subclinical chorioamnionitis were significantly higher(P<0.05). Multivariate logistic regression analysis showed that the increased serum TLR-2 and TLR-4 were the independent risk factors of subclinical chorioamnionitis(P<0.05). The area under ROC curve of serum TLR-2 and TLR-4 for predicting subclinical chorioamnionitis in tPROM or pPROM pregnant women were 0.657(95% CI:0.579-0.743), 0.668 (95% CI:0.584-0.759) and 0.793 (95% CI:0.711-0.918), 0.813 (95% CI:0.725-0.942), respectively. Conclusion: The increase of serum TLR-2 and TLR-4 levels is related with PROM or subclinical chorioamnionitis, which mainly reflects the activation of TLR-2 and TLR-4 in fetal membranes of PROM pregnant women. The detection of serum TLR-2 and TLR-4 levels has an early predictive value for PROM complicated with subclinical chorioamnionitis.

参考文献:

[1] 姜海利,周建新,路畅,等.胎膜早破早产的诊治进展[J].医学综述,2020,26(15):2992-2996.
[2] 王美藏,高建宏,杨雅琴,等.子宫颈HPV感染与MCM2表达及阴道环境因素的相关性分析[J].现代医学,2017,42(1):23-27.
[3] 程丽历,唱凯,韩梅,等.五项炎性指标在未足月胎膜早破亚临床绒毛膜羊膜炎的诊断价值[J].中华检验医学杂志,2019,42(7):540-544.
[4] STRAUSS J F,ROMERO R,GOMEZ-LOPEZ N,et al.Spontaneous preterm birth:advances toward the discovery of genetic predisposition[J].Am J Obstet Gynecol,2018,218(3):294-314.
[5] TRIANTAFILOU M,DE GLANVILLE B,ABOKLAISH A F,et al. Synergic activation of toll-like receptor (TLR) 2/6 and 9 in response to ureaplasma parvum & urealyticum in human amniotic epithelial cells[J].PLoS One,2013,8(4):e61199.
[6] 张晓杰.妇产科病理学[M]. 北京:人民卫生出版社,2013:245-246.
[7] 曾文娟,黄启涛,王海臻,等.血清淀粉样蛋白A与未足月胎膜早破并发亚临床绒毛膜羊膜炎的关系研究[J].中国实用妇科与产科杂志,2017,33(4):414-417.
[8] MENON R,RICHARDSON L S. Preterm prelabor rupture of the membranes:a disease of the fetal membranes[J].Semin Perinatol,2017,41(7):409-419.
[9] KIM J S,KIM Y R,YANG C S. Latest comprehensive knowledge of the crosstalk between TLR signaling and mycobacteria and the antigens driving the process[J].J Microbiol Biotechnol,2019,29(10):1506-1521.
[10] BAHIA W,SOLTANI I,HADDAD A,et al. Links between SNPs in TLR-2 and TLR-4 and idiopathic recurrent pregnancy loss[J].Br J Biomed Sci,2020,77(2):64-68.
[11] 曾诗晨,余得水,曾丽,等.胎膜早破患者胎膜组织中人β防御素3与Toll样受体2蛋白表达的关系及临床意义[J].中国性科学,2020,27(9):70-73.
[12] 宋芳,杨美霞,贺帅,等.TLR4对母-胎界面滋养层细胞生物学行为的影响[J].中国计划生育学杂志,2019,27(7):839-843.
[13] WUJCICKA W,WILCZYNSKI J,NOWAKOWSKA D,et al. Genetic alterations within TLR genes in development of Toxoplasma gondii infection among Polish pregnant women[J].Adv Med Sci,2017,62(2):216-222.
[14] BOUVIER D,FOREST J C,BLANCHON L,et al. Risk factors and outcomes of preterm premature rupture of membranes in a cohort of 6968 pregnant women prospectively recruited[J].J Clin Med,2019,8(11):1987.
[15] ABRAHAMS V M,POTTER J A,BHAT G,et al. Bacterial modulation of human fetal membrane Toll-like receptor expression[J].Am J Reprod Immunol,2013,69(1):33-40.

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