【作者】 王虹；

【导师】 张学勤； 章小琴； 杨丽华；

【作者基本信息】 昆明医学院 ， 妇产科学， 2010， 硕士

【摘要】 目的：检测核转录因子-κB亚基p65亲和肽(Nuclear Transcription Factor-KBp65, NF-κBp65)及白细胞介素-18(interleukin-18, IL-18)在未足月胎膜早破(preterm premature rupture the membrane, pPROM)、足月胎膜早破(premature rupture the membrane of term, tPROM)、足月胎膜未破孕妇(对照组)静脉血中浓度及分析二者在亚临床绒毛膜羊膜炎、非绒毛膜羊膜炎孕妇静脉血中水平,探讨NF-κBp65及IL-18在胎膜早破、亚临床绒毛膜羊膜炎发生、发展机制中的作用,及二者在胎膜早破、亚临床绒毛膜羊膜炎中的相关性,评价其预测亚临床绒毛膜羊膜炎的意义。方法：采用酶联免疫吸附法(即ELISA法)分别检测未足月胎膜早破(pPROM)、足月胎膜早破(tPROM)及足月胎膜未破(对照组)各25例孕妇外周血中NF-κBp65和IL-18的水平；同时采用苏木精伊红(HE)染色的方法对所有胎膜早破产妇的胎膜进行亚临床绒毛膜羊膜炎的诊断,将其分为亚临床绒毛膜羊膜炎及非绒毛膜羊膜炎组,分析两组中的NF-κBp65和IL-18水平变化。用SPSS16.0软件统计包整理与分析数据。结果：1、未足月胎膜早破(pPROM)、足月胎膜早破(tPROM)、对照组孕妇静脉血NF-κBp65浓度分别为(2127.5±380.84)ng/ml、(1732.54±441.81)ng/ml、(1432.96±371.40)ng/ml,与对照组比较,NF-κBp65水平在pPROM组与tPROM组明显增加(P<0.05,P<0.05),且pPROM组NF-κBp65水平较tPROM组明显增加(P<0.05)。2、未足月胎膜早破(pPROM)、足月胎膜早破(tPROM)、对照组孕妇静脉血IL-18浓度分别为(51.16±6.52)ng/ml、(47.92±5.67)ng/ml、(42.20±6.42)ng/ml,与对照组比较,IL-18水平在pPROM组与tPROM组明显增加(P<0.05,P<0.05),且pPROM组IL-18水平较tPROM组明显增加(P<0.05)。3、亚临床绒毛膜羊膜炎孕妇静脉血NF-Bp65浓度(2176.78±428.86)ng/ml明显高于非绒毛膜羊膜炎组中NF-κBp65的浓度(1664.72±311.14)ng/ml,经统计学分析,两组间有统计学意义(P<0.05)。4、亚临床绒毛膜羊膜炎母血IL-18浓度(55.32±5.63)ng/ml明显高于非绒毛膜羊膜炎组中IL-18的浓度(46.29±5.10)ng/ml,两组间有统计学意义(P<0.05)。5、NF-κBp65与IL-18在胎膜早破孕妇静脉血中的水平呈正相关关系(r=0.840,p<0.05),在正常对照组中NF-κBp65与IL-18无相关关系(r=0.382,P=0.059>0.05);母血NF-κBp65与IL-18在亚临床绒毛膜羊膜炎与非绒毛膜羊膜炎组呈正相关关系(r=0.806,P<0.05；r=0.776,P<0.05)。结论：1、胎膜早破母血中NF-κBp65、IL-18的水平升高,推测二者可能参与了胎膜早破的发生与发展。2、合并亚临床绒毛膜羊膜炎的未足月胎膜早破母血中NF-κBp65、IL-18的水平更高,推测二者水平升高除与胎膜早破发生有关还与感染的发生有关。3、NF-κBp65、IL-18水平在有亚临床绒毛膜羊膜炎的胎膜早破孕妇静脉血中较无绒毛膜羊膜炎组升高,推测二者参与了亚临床绒毛膜羊膜的发生与发展。4、母血NF-κBp65、IL-18水平升高在胎膜早破、亚临床绒毛膜羊膜炎中呈正相关关系,推测二者相互作用共同诱导胎膜早破及亚临床绒毛膜羊膜炎的发生,可作为预测亚临床绒毛膜羊膜炎的新指标。更多还原

【Abstract】 Objectives:To investigate the pathogenesis of premature rupture of membrane (PROM)and of subclinical chorioamnionitis by detecting the level of Nuclear Transcription Factor-κBp65 (NF-κBp65) and interleukin-18 (IL-18) in maternal blood with premature rupture of membrane and subclinical chorioamnionitis.To discuss the relevance between the two factors, then to estimate their clinieal value in predieting subelinical chorioamnionitis.Methods:pregnant women of preterm premature rupture the membrane、premature rupture the membrane of term and normal pregnant women in term with intact membranes, every 25 cases were studied.The concentration of NF-κBp65 and IL-18 in maternal blood were determined by solid phase sandwi-ch enzyme linked immuno-sorbent assay(ELISA).And subclinical chorioamnionitis or not subclinical chorioamnionitis were diagnosed by HE among fifty puerperants. They were divided into two groups. The level of NF-κBp65 and IL-18 were analysed between the two groups. These experimental data were analized by the software SPSS 16.0.Results:(1) The level of NF-κBp65 in maternal blood pPROM group (2127.5±380.84)ng/ml and tPROM group (1732.54±441.81)ng/ml are significantly higher than the nomal group(1432.96±371.40)ng/ml,each group has statistically deviation(P＜0.05,P＜0.05),and the level of pPROM group is significantly higher than tPROM group(P＜0.05).(2) The level of IL-18 in maternal blood of pPROM group (51.16±6.52)ng/ml and tPROM group(47.92±5.67)ng/ml are significantly higher than the nomal group(42.20±6.42)ng/ml, each group has statistically deviation(P＜0.05,P＜0.05), and the level of pPROM group is significantly higher than tPROM group(P＜0.05).(3)The level of NF-κBp65 in maternal blood of subclinical chorioamnionitis group is (2176.78±428.86)ng/ml, The level of NF-κBp65 in maternal blood of Non-chorioamnionitis group is (1664.72±311.14)ng/ml, the level of subclinical chorioamnionitis group is significantly higher than Non-chorioamnionitis group, the two groups have statistically deviation (p＜0.05).(4)The level of IL-18in maternal blood of subclinical chorioamnionitis group is (55.32±5.63)ng/ml, The level of IL-18 in maternal blood of Non-chorioamnionitis group is (46.29±5.10)ng/ml, the level of subclinical chorioamnionitis group is significantly higher than Non-chorioamnionitis group, the two groups have statistically deviation (p＜0.05).(5)The level of NF-κBp65 and IL-18 inmaternal blood in premature rupture of membranes group is positive correlation (r=0.840,p＜0.05), but in the normal group is on correlation (r=0.382,P=0.059＞0.05); between subclinical chorioamnionitis group and Non-chorioamnionitis group is positive correlation (r=0.95,P＜0.05;r= 0.97, P＜0.05).Conclution:1、The higher level of NF-κBp65 and IL-18 in maternal blood of premature rupture the membrane may lead to premature rupture of membrane.2、The highest level of NF-κBp65 and IL-18 in maternal blood of pPROM group with subclinical chorioamnionitis, the highest level of these are correlated with infection expect PROM.3、The higher level of NF-κBp65 and IL-18 in maternal blood of subclinical chorioamnionitis group may lead to subclinical chorioamnionitis.4、The higher level of NF-κBp65 and IL-18 in maternal blood of PROM and subclinical chorioamnionitis,NF-κBp65 and IL-18 can interact with each other leading to PROM and subclinical chorioamnionitis,and identify the chorioamnionitis as valuable clinical index.更多还原