【作者】 王楠；

【导师】 周昌菊；

【作者基本信息】 中南大学 ， 妇产科学， 2009， 硕士

【摘要】 目的:通过检测胎膜早破孕妇母血、脐血、胎膜中IL-6、IL-18的表达水平,探讨其与胎膜早破的关系,评价其预测绒毛膜羊膜炎的可行性。方法:ELISA方法测定早产胎膜早破组(PPROM)、足月胎膜早破组(TPROM)及正常对照组孕妇母血、脐血中IL-6、IL-18的水平,免疫组织化学方法测定各组胎膜中IL-6、IL-18的表达水平。结果:1.足月胎膜早破组母血、脐血IL-6水平为(25.71±6.46,24.35±5.12)ng/ml,早产胎膜早破母血、脐血IL-6水平为(28.47±6.9,26.24±5.54),两者无统计学差异(P＞0.05),但都高于正常对照组(22.88±6.52,22.77±5.55)ng/ml(P＜0.05)。2.足月胎膜早破组母血、脐血IL-18水平为(32.74±9.64,27.74±6.64)ng/ml,早产胎膜早破组母血、脐血IL-18水平为(35.64±11.96,31.11±10.63)ng/ml,两者无统计学差异(P＞0.05),但都高于正常对照组(21.72±7.41,23.32±5.11)ng/ml(P＜0.05)。3.随胎膜病检炎症程度的加重,其母血、脐血、胎膜中IL-6、IL-18的表达水平升高,差别有统计学意义(P＜0.05)。病理绒毛膜羊膜炎分级与IL-6、IL-18在胎膜中的表达之间有正相关性,r分别为0.565、0.513。4.新生儿窒息组其对应的母血IL-6、IL-18的水平(34.95±11.12)、(51.54±16.06.)ng/ml高于正常组(24.63±8.18)、(27.6±+8.34)ng/ml,差别有统计学意义(P＜0.05)。但窒息组中绒毛膜羊膜炎组与非绒毛膜羊膜炎组的母血、脐血IL-6、IL-18表达无明显差异。5.母体外周血血清IL-18浓度为23.09 ng/ml时,预测绒毛膜羊膜炎的敏感性为88%,特异性为82%;IL-6浓度为24058 ng/ml时,预测绒毛膜羊膜炎的敏感性为72%,特异性为68%。结论:1.IL-6、IL-18与胎膜早破及绒毛膜羊膜炎有关,并可作为绒毛膜羊膜炎的早期监测指标。2.母血、脐血IL-6、IL-18水平有相关性,IL-6、IL-18与新生儿窒息可能有关。更多还原

【Abstract】 Objective:Through detect the expression of IL-6、IL-18 in maternal serum、umbilical code serum and fetal membrane in pregnant woman with premature rupture of membranes,to approach the relationship between them and premature rupture of membranes,the feasibility to anticipate chorioamnionitis.Methods:Women with premature rupture of membranes and normal women were studied,the expression of IL-6、IL-18 in maternal serum and umbilical code serum were measured by enzyme-linked immunosorbent assay.The expression of IL-6、IL-18 in fetal membrane were detected by immunohistochemistry.Results:1.The lever of IL-6 in maternal serum and umbilical code serum in TPROM was(25.71±6.46,24.35±5.12) ng/ml,the lever of IL-6 in maternal serum and umbilical code serum in PPROM was(28.47±6.9,26.24±5.54) ng/ml,the two group had no significant difference (P＞0.05),but both significantly higher than that in the control group (22.88±6.52,22.77±5.55) ng/ml(P＜0.05).2.The lever of IL-18 in maternal serum and umbilical code serum in TPROM was(32.74±9.64, 27.74±6.64) ng/ml,the lever of IL-18 in maternal serum and umbilical code serum in PPROM is(35.64±11.96,31.11±10.63) ng/ml,the two group had no significant difference(P＞0.05),both significantly higher than that in the control group(21.72±7.41,23.32±5.11) ng/ml(P＜0.05). 3.With the grade of chorioamnionitis raised,the expression of IL-6 and IL-18 in maternal serum、umbilical code serum、fetal membranes were set up(P＜0.05).There was positive correlation between chorioamnionitis and the expression of IL-6、IL-18 protein,R is 0.565、0.513.4.The level of IL-6、IL-18 in maternal serum(34.95±11.12)、(51.54±16.6) ng/ml whose got neonatal asphyxia is higher than the normal neonate group (24.63±8.18)、(27.69±8.34) ng/ml.But in neonatal asphyxia,the level of IL-6、IL-18 in maternal serum、umbilical code serum between chorioamnionitis and nonchorioamnionitis are not different.5.According to the method of Youden Index,when the level of IL-18 in maternal serum was divided 23.09 ng/ml,the sensitivity to predict chorioamnionitis was 88%, the specificity was 82%.;When the level of IL-6 in maternal serum was divided 24.58 ng/ml,the sensitivity to predict chorioamnionitis is 72%, the specificity was 68%.Conclusion.1.IL-6、IL-18 are concerned with PROM and chorioamnionitis.They are valuable clinical index for identifying the chorioamnionitis in patients with PROM.2.There is a positive correlation between level of IL-6、IL-18 in maternal serum and umbilical code serum.They are maybe associated with asphyxia of newborn.更多还原