宫颈阴道液中可溶性RAGE及其配体预测胎膜早破孕妇羊膜内感染的临床价值  

Clinical value of soluble RAGE and its ligand of cervical vaginal fluid in predicting intramniotic infection in pregnant women with premature rupture of membranes

作　　者：杨秋芬 周欣 董乐乐 YANG Qiufen;ZHOU Xin;DONG Lele(Department of Obstetrics,Northwest Women’s and Children’s Hospital,Xi’an,Shaanxi 710061,China)

机构地区：[1]西北妇女儿童医院产科,陕西西安710061

出　　处：《中国优生与遗传杂志》2023年第11期2266-2271,共6页Chinese Journal of Birth Health & Heredity

摘　　要：目的 探讨宫颈阴道液中可溶性晚期糖基化终产物受体(sRAGEs)、晚期糖基化终产物(AGEs)、高迁移率组盒1(HMGB1)、钙卫蛋白(S100A8/A9)在预测胎膜早破孕妇羊膜内感染中的价值,为胎膜早破孕妇羊膜内感染的早期诊断提供参考。方法 回顾性分析2018年11月至2022年7月在西北妇女儿童医院产科诊断为早产胎膜早破(pPROM)患者的临床资料,75例pPROM孕妇纳入研究。患者服用药物之前,采集羊水(AF)、母体血液和宫颈阴道液(CVF)样本,根据采样48 h内AF培养阳性结果将患者分为羊膜腔微生物入侵(MIAC)组(n=32)和非MIAC组(n=43)。通过酶联免疫吸附测定(ELISA)法检测AF、母体血液和CVF样本中sRAGEs、HMGB1、AGEs、S100A8/A9水平。结果 与非MIAC组相比,MIAC组中位胎龄较低,组织学绒毛膜羊膜炎的发生率较高(P<0.05)。Spearman相关性分析结果显示,AF样本中4种蛋白因子水平与CVF之间呈正相关(P<0.001),与母体血浆之间无显著相关性(P>0.05)。MIAC组AF和CVF样本中4种蛋白因子及母体血浆中AGEs水平较非MIAC组显著升高(P<0.05)。ROC曲线结果进一步证实AF和CVF样本中4种细胞分子水平对MIAC具有良好的预测价值,而母体血浆中只有AGEs的预测价值较好。多因素Logistic回归析显示,侵入性模型AF样本中AGEs(>2495.80pg/mL)和S100A8/A9(>2372.78 ng/mL)与MIAC有独立相关性(P<0.05);非侵入性模型中,抽样孕龄较早(≤31.4周)、CVF样本中AGEs(>315.73 ng/mL)和HMGB1(>749.18pg/mL)水平更高是MIAC的独立危险因素(P<0.05)。此外,两种模型预测MIAC的ROC曲线的AUC值、灵敏度和特异度之间差异无统计学意义(P=0.253)。结论 监测pPROM孕妇CVF样本中sRAGEs、AGEs、HMGB1、S100A8/A9水平,有利于早期诊断胎膜早破孕妇羊膜内感染。Objective To investigate the value of soluble receptor for advanced glycation end products(sRAGEs),advanced glycation end products(AGEs),high mobility group protein 1(HMGB1),human S100 calcium-binding protein A8/A9 complex(S100A8/A9)of cervical vaginal fluid in predicting intramniotic infection in pregnant women with premature rupture of membranes,and to provide reference for the early diagnosis of intramniotic infection in pregnant women with premature rupture of membranes.Methods Clinical data of patients diagnosed with preterm premature rupture of membranes(pPROM)in the Department of Obstetrics of Northwestern Women’s and Children’s Hospital from November 2018 to July 2022 were retrospectively analyzed,and 75 pregnant women with pPROM were included in the study.Amniotic fluid(AF),maternal blood and cervico-vaginal fluid(CVF)were collected before taking the drug.According to the AF positive culture results within 48 hours of sampling,the patients were divided into amniotic cavity microbial invasion(MIAC)group(n=32)and non-MIAC group(n=43).The levels of sRAGEs,HMGB1,AGEs and S100A8/A9 in AF,maternal blood and CVF samples were determined by enzymelinked immunosorbent assay(ELISA).Results Compared with non-MIAC group,the median gestational age was lower and the incidence of histological chorioamniotic infection was higher in the MIAC group(P<0.05).Spearman correlation analysis showed that the levels of four protein factors in AF samples were positively correlated with CVF(P<0.001),but had no significant correlation with maternal plasma(P>0.05).The levels of four protein factors in AF and CVF samples and AGEs in maternal plasma in MIAC group were significantly higher than those in non-MIAC group(P<0.05).ROC curve results further confirmed that the levels of four cell molecules in AF and CVF samples had good predictive value for MIAC,while only AGEs in maternal plasma had good predictive value for MIAC.Multivariate Logistic regression analysis showed that AGEs(>2495.80 pg/mL)and S100A8/A9(>2372.78 ng/mL)in invas

关 键 词：早产胎膜早破 宫颈阴道液 羊膜腔微生物入侵 羊水 可溶性晚期糖基化终产物受体及其配体 

分 类 号：R714.433[医药卫生—妇产科学]