iNOS和mTORC1在胎膜早破合并绒毛膜羊膜炎中的表达及其与巨噬细胞极化的关系  

Expression of iNOS and mTORC1 in premature rupture of membranes complicated by chorioamnionitis and its correlation with macrophage polarization

作　　者：王梦瑶 韩秋峪 WANG Mengyao;HAN Qiuyu(Graduate School,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;Department of Obstetrics and Gynecology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002)

机构地区：[1]徐州医科大学研究生院,江苏徐州221004 [2]徐州医科大学附属医院妇产科,江苏徐州221002

出　　处：《徐州医科大学学报》2024年第10期764-770,共7页Journal of Xuzhou Medical University

基　　金：徐州市重点研发计划(社会发展)项目(KC20087)。

摘　　要：目的探讨诱导型一氧化氮合酶(iNOS)、哺乳动物雷帕霉素靶蛋白C1(mTORC1)在胎膜早破(PROM)合并绒毛膜羊膜炎(CA)中的表达及其与巨噬细胞极化的关系,以期为临床早期诊断及干预提供依据。方法选取徐州医科大学附属医院于2022年10月—2023年10月收治的PROM孕产妇100例为研究组,均为剖宫产结束分娩。根据胎膜破裂的时间分为足月胎膜早破组(TPROM组)50例和未足月胎膜早破组(PPROM组)50例,根据胎膜病理结果是否存在CA,将2组分为4个亚组,分别为足月胎膜早破合并绒毛膜羊膜炎组(TPROM-CA+组)、未足月胎膜早破合并绒毛膜羊膜炎组(PPROM-CA+组)、足月胎膜早破未合并绒毛膜羊膜炎组(TPROM-CA-组)以及未足月胎膜早破未合并绒毛膜羊膜炎组(PPROM-CA-组)。对照组为正常妊娠足月剖宫产分娩的孕产妇30例。采用ELISA法检测各组孕妇血清中mTORC1的表达水平;所有胎膜均送病理检查,采用免疫组化法检测各组胎膜组织中iNOS、mTORC1的表达情况。结果①TPROM组CA的发生率为42%(21/50),PPROM组为56%(28/50),对照组为0,3组比较,差异有统计学意义(P<0.05);②血清中mTORC1的表达水平在TPROM-CA+组和PPROM-CA+组明显高于其余3组(P<0.05);TPROM-CA+组与PPROM-CA+组比较,差异无统计学意义(P>0.05);ROC曲线分析显示,PROM孕妇血清中mTORC1的表达水平对PROM合并CA有诊断价值;③免疫组化结果显示TPROM-CA+组及PPROM-CA+组胎膜组织中iNOS、mTORC1的表达水平明显高于其余3组(P<0.05);2因子在TPROM-CA+组与PPROM-CA+组比较,差异无统计学意义(P>0.05)。iNOS在CAⅠ期中的表达水平高于CAⅡ期和CAⅢ期,mTORC1则相反,差异有统计学意义(P<0.05)。结论血清中mTORC1水平升高可能对胎膜早破合并绒毛膜羊膜炎有预测价值;iNOS和mTORC1在PROM合并CA中的表达水平上调,提示iNOS和mTORC1可能通过诱导巨噬细胞极化参与CA的发生发展。Objective To explore the expression of inducible nitric oxide synthase(iNOS)and mammalian target of rapamycin complex 1(mTORC1)in premature rupture of membranes(PROM)complicated by chorioamnionitis(CA)and its correlation with macrophage polarization,in order to provide evidence for early clinical diagnosis and intervention.Methods A total of 100 pregnant women with PROM who underwent cesarean section at the Affiliated Hospital of Xuzhou Medical University from October 2022 to October 2023 were selected as a study group.According to the time of membrane rupture,they were divided into two subgroups(n=50):a term PROM(TPROM)group and a preterm PROM(PPROM)group.Based on the presence of CA,both groups were further subdivided into four groups:a PROM with chorioamnionitis(TPROM-CA+)group,a preterm PROM with chorioamnionitis(PPROM-CA+)group,a term PROM without chorioamnionitis(TPROM-CA-)group,and a preterm PROM without chorioamnionitis(PPROM-CA-)group.Meanwhile,30 pregnant women with normal full-term pregnancies who delivered via cesarean section was included in a control group.The levels of serum mTORC1 were measured by ELISA.All membrane samples were pathologically examined,and the expression of iNOS and mTORC1 in the membrane tissues was assessed by immunohistochemistry.Results The incidence of CA was 42%(21/50)in the TPROM group,56%(28/50)in the PPROM group,and 0(0/30)in the control group,with statistical differences among the three groups(P<0.05).The levels of serum mTORC1 in the TPROM-CA+and PPROM-CA+groups were significantly higher than the other three groups(P<0.05),but no statistical difference was found between the TPROM-CA+and PPROM-CA+groups(P>0.05).ROC curve analysis indicated that the expression of serum mTORC1 in PROM pregnant women has diagnostic value for CA in PROM patients.Immunohistochemical results showed that the levels of iNOS and mTORC1 in the membrane tissues of the TPROM-CA+and PPROM-CA+groups were significantly higher than the other three groups(P<0.05).There was no statistical difference in the

关 键 词：胎膜早破 绒毛膜羊膜炎 巨噬细胞极化 诱导型一氧化氮合酶 哺乳动物雷帕霉素靶蛋白C1 

分 类 号：R714.2[医药卫生—妇产科学]