【摘要】 目的探讨母血、羊水、脐血中基质金属蛋白酶9(MMP-9)及金属蛋白酶组织抑制物1(TIMP-1)的水平变化与胎膜早破发病的关系。方法采用双抗体夹心酶联免疫吸附法,动态检测58例胎膜早破患者(胎膜早破组)及38例正常孕妇(对照组)的母血、羊水、脐血中MMP-9及TIMP-1的水平,同时进行胎膜组织的病理检查,对合并绒毛膜羊膜炎的患者也进行相应的MMP-9及TIMP-1的水平检测。结果(1)胎膜早破组母血、脐血及羊水中MMP-9水平分别为(141·9±84·6)、(138·2±81·4)及(85·6±27·5)ng/L,其水平均明显高于对照组,两组比较,差异有统计学意义(P<0·05、P<0·05及P<0·01);胎膜早破组母血、羊水、脐血中TIMP-1水平分别为(378·1±220·2)、(44·6±24·0)及(257·2±98·8)ng/L,其水平均明显低于对照组,两组比较,差异有统计学意义(P<0·05、P<0·05及P<0·01)。(2)母血、羊水、脐血中MMP-9的水平随破膜时间的延长而升高,尤其破膜时间超过24h时升高更为明显;而TIMP-1则随破膜时间的延长而下降,尤其破膜时间超过24h时降低更为明显。(3)两组共合并绒毛膜羊膜炎患者15例,其中胎膜早破组13例(13/58,22%),绒毛膜羊膜炎患者的母血、脐血、羊水中MMP-9水平分别为(183·8±84·7)、(171·2±92·9)及(95·5±21·1)ng/L,其水平均明显高于非绒毛膜羊膜炎患者(81例),两者比较,差异有统计学意义(P<0·05、P<0·05及P<0·01)。绒毛膜羊膜炎患者的母血、羊水、脐血中TIMP-1水平分别为(269·7±144·4)、(32·1±16·6)及(210·6±81·9)ng/L,其水平均明显低于非绒毛膜羊膜炎患者,两者比较,差异有统计学意义(P<0·05、P<0·05及P<0·01)。(4)胎膜早破组的新生儿Apgar评分≤7分者,其母血、脐血、羊水中MMP-9水平分别为(234·4±79·4)、(222·1±120·1)及(108·5±42·2)ng/L,其水平均明显高于Apgar评分≥8分者,两者比较,差异有统计学意义(P<0·05、P<0·05及P<0·01);与之相反,胎膜早破组的新生儿Apgar评分≤7分者,母血、羊水、脐血中TIMP-1的水平分别为(225·3±121·7)、(25·2±15·8)及(181·7±135·2)ng/L,其水平均明显低于Apgar评分≥8分者,两者比较,差异有统计学意义(P<0·05、P<0·05及P<0·01)。结论MMP-9水平的异常升高及TIMP-1水平的显著下降,是胎膜早破发病的重要机制。MMP-9及TIMP-1的水平检测可作为一种新的生物学标志物用于胎膜早破并绒毛膜羊膜炎感染的诊断,尤其适用于亚临床感染状态的早期诊断,并有助于评估新生儿预后。更多还原

【Abstract】 Objective To investigate the roles of matrix metalloproteinase (MMP)-9 and tissue inhibitors of matrix metalloproteinase (TIMP)-1 in maternal serum, amniotic fluid and umbilical cord serum in predicting premature rupture of the membranes(PROM) and chorioamnionitis. Methods The levels of MMP-9 and TIMP-1 were detected by enzyme linked immunosorbent assay in maternal serum, amniotic fluid, umbilical cord serum of 58 pregnant women with PROM and 38 women with normal pregnancies. Chorioamnionitis was histopathologically confirmed after delivery. Results (1) The levels of MMP-9 in maternal serum, umbilical cord serum and amniotic fluid were (141.9±84.6) ng/L , (138.2±81.4) ng/L and (85.6±27.5) ng/L respectively, significantly higher in patients with PROM than those of the control group(P<0.05, P<0.05 and P<0.01 respectively), while the levels of TIMP-1 in maternal serum, amniotic fluid and umbilical cord serum were (378.1±220.2) ng/L , (44.6±24.0) ng/L and (257.2±98.8) ng/L respectively, significantly lower in patients with PROM than those of the control group(P<0.05, P<0.05 and P<0.01 respectively).(2)The longer the duration from rupture of membranes to delivery was , the more serious chorioamnionitis was, and the higher the levels of MMP-9 and the lower the TIMP-1 levels in maternal serum, amniotic fluid , and umbilical cord serum were.(3) The levels of MMP-9 in maternal serum, umbilical cord serum and amniotic fluid were (183.8±84.7) ng/L, (171.2±92.9) ng/L and (95.5±21.1)ng/L respectively, significantly higher in patients with chorioamnionitis than those of non-chorioamnionitis(P<0.05, P<0.05 and P<0.01 respectively), while the levels of TIMP-1 in maternal serum, amniotic fluid and umbilical cord serum were (269.7±144.4) ng/L , (32.1±16.6) ng/L and (210.6±81.9) ng/L respectively, significantly lower in patients with chorioamnionitis than those of non-chorioamnionitis(P<0.05, P<0.05 and P<0.01 respectively).(4) The levels of MMP-9 in maternal serum, umbilical cord serum and amniotic fluid were (234.4±79.4) ng/L, (222.1±120.1) ng/L and (108.5±42.2) ng/L respectively, significantly higher in neonates whose Apgar score≤7 than those of neonates whose Apgar score≥8(P<0.05, P<0.05 and P<0.01 respectively), while the levels of TIMP-1 in maternal serum, amniotic fluid and umbilical cord serum were (225.3±121.7)ng/L , (25.2±15.8) and (181.7±135.2) ng/L respectively, significantly lower in neonates whose Apgar score≤7 than those of neonates whose Apgar score≥8 (P<0.05, P<0.05 and P<0.01 respectively). Conclusions It is suggested that preterm PROM is associated with increased MMP-9 and decreased TIMP-1 levels. MMP-9 and TIMP-1 are valuable clinical biological markers for identifying chorioamnionitis and predicting neonates prognosis.更多还原