论文部分内容阅读
【摘要】 目的 检测未足月胎膜早破(PPROM)与足月胎膜早破(PROM)孕妇血清高迁移率蛋白 1(HMGB1)的浓度,探讨其与胎膜早破的关系及对PPROM患者绒毛膜羊膜炎的预测价值。方法 选取PPROM患者55例,相同孕周健康孕妇40例;PROM患者40例,相同孕周健康孕妇40例,进行血清HMGB1检测,PROM及PPROM患者分娩后胎盘胎膜病理检查。结果 PROM及PPROM组孕妇血清中HMGB1含量均高于相应对照组(t=10.15,9.92,P<0.01);但PROM及PPROM组孕妇血清中HMGB1含量比较,差异无统计学意义(t=0.65,P>0.05)。PPROM组中存在组织学绒毛膜羊膜炎者比无绒毛膜羊膜炎者血清HMGB1含量明显升高(t=7.25,P<0.05)。结论 HMGB1在PPROM及孕PROM孕妇血清中浓度升高,对PPROM患者绒毛膜羊膜炎的预测有一定价值。
【关键词】胎膜早破;绒毛膜羊膜炎; 高迁移率蛋白 1
Relationship between maternal plasma HMGB1 and premature rupture of membranes
JIN Li,BAN Kai bin,HUANG You min.The Central People’s Hospital of Tengzhou,Shandong,Tenzhou 277500,China
【Abstract】 Objective To investigate the relationship between maternal plasma high mobility groupbox 1(HMGB1)and premature rupture of membranes(PROM)by detecting the concentration of HMGB1 in pregnant women,and to explore the significance of HMGB1 in the diagnosis of chorioamnion itis inpregnant women with PPROM.Methods The serum HMGB1 concentrations were measured in 55 pregnant women with PPROM and 40 healthy pregnant women at same pregnant term.40 pregnant women with PROM at term and 40 healthy pregnant women at same pregnant term,and Hematoxylin Eosin(HE)staining of placenta were performed after delivery of PPROM and PROM at term cases to observe the pathological changes of membranes of placenta.Results The plasma levers of HMGB1 in pregnant women with PPROM and PROM at term were significantly higher than those in control group(t=10.15,9.92,P<0.01),however,there was no significant difference in the levers of HMGB1 between pregnant women with PPROM and pregnant women with PROM(t=0.65,P>0.05).Furthermore there was significant difference in the levers of HMGB1 between PPROM group with chorioam nionitis(t=7.25,P<0.05).Conclusion The HMGB1 concentration in pregnant women with PPROM or PROM at term is increased,but its diagnostic value for chorioam nionitis in patients with PPROM needs to be researched further.
【Key words】Premature rupture of membranes(PROM); Chorioam nionitis; High mobility groupbox 1(HMGB1)
胎膜早破(PROM)包括足月胎膜早破及未足月胎膜早破(PPROM),相对足月PROM,PPROM对母儿的危害更大。其中绒毛膜羊膜炎是胎膜早破的一个重要并发症,对胎膜早破孕妇并发绒毛膜羊膜炎进行早期预测并给予及时治疗,是改善围生期预后的关键。高迁移率族蛋白 1(HMGB1)是近年发现的一种重要的炎症介质,与组织损伤后修复、炎症反应等方面关系密切[1]。本研究目的即探讨HMGB1与胎膜早破的关系及其对PPROM患者绒毛膜羊膜炎的预测价值。
1 资料与方法
1.1 一般资料 选择2009年6月至2010年1月在我院产科病房住院分娩及门诊产前检查的175例孕妇,分为4组。PPROM组55例,年龄(24.8±3.25)岁,妊娠(30.2±1.2)周;足月PROM组40例,年龄(25.6±3.25)岁,妊娠(38.2±1.1)周。2组均无宫缩,无临床感染征象,无其他母儿并发症及合并症,入院后均给予抗生素治疗、卧床抬高臀部,妊娠不足35周者给予地塞米松促胎肺成熟。选择同期在我院产科门诊检查的健康未足月孕妇40例作为未足月孕妇组;选择同期住院分娩的正常足月孕妇40例作为足月孕妇组,无宫缩,胎膜完整。4组均为单胎初产孕妇,年龄、孕周间不存在显著性差异,均无合并症及并发症。
1.2 诊断标准 PROM诊断标准参考妇产科学[2],符合下列条件之一者确诊为PROM:阴道窥器检查见阴道后穹窿有羊水积聚或有羊水自宫颈口流出; 阴道液pH值测定,pH值试纸由黄色变为蓝绿色,即pH值≥6.5,提示PROM;阴道液涂片检查,干燥后镜检可见羊齿植物叶状结晶为羊水。B型超声检查可辅助诊断。
1.3 检查方法 对入院后胎膜破裂4 h内的足月PROM及PPROM孕妇,用药前抽取静脉血5 mL,对照组采等量空腹静脉血,尽快注入硅化玻璃试管内,3000 r/min 离心10 min,分离血清, 70℃保存待检。采用酶联免疫法测定血清HMGB1水平,试剂购自美国R&D公司;测定采用意大利ALISEI全自动酶标仪,操作按试剂盒说明书进行,所有样品设立复孔,均在同一批内检测。
PROM组所有孕妇于分娩后取距破口5 cm处全层胎膜组织2 cm×2 cm,另取胎盘周边和中央胎盘各5 cm×5 cm,10%甲醛固定,石蜡包埋,切片后HE染色,显微镜检查。
【关键词】胎膜早破;绒毛膜羊膜炎; 高迁移率蛋白 1
Relationship between maternal plasma HMGB1 and premature rupture of membranes
JIN Li,BAN Kai bin,HUANG You min.The Central People’s Hospital of Tengzhou,Shandong,Tenzhou 277500,China
【Abstract】 Objective To investigate the relationship between maternal plasma high mobility groupbox 1(HMGB1)and premature rupture of membranes(PROM)by detecting the concentration of HMGB1 in pregnant women,and to explore the significance of HMGB1 in the diagnosis of chorioamnion itis inpregnant women with PPROM.Methods The serum HMGB1 concentrations were measured in 55 pregnant women with PPROM and 40 healthy pregnant women at same pregnant term.40 pregnant women with PROM at term and 40 healthy pregnant women at same pregnant term,and Hematoxylin Eosin(HE)staining of placenta were performed after delivery of PPROM and PROM at term cases to observe the pathological changes of membranes of placenta.Results The plasma levers of HMGB1 in pregnant women with PPROM and PROM at term were significantly higher than those in control group(t=10.15,9.92,P<0.01),however,there was no significant difference in the levers of HMGB1 between pregnant women with PPROM and pregnant women with PROM(t=0.65,P>0.05).Furthermore there was significant difference in the levers of HMGB1 between PPROM group with chorioam nionitis(t=7.25,P<0.05).Conclusion The HMGB1 concentration in pregnant women with PPROM or PROM at term is increased,but its diagnostic value for chorioam nionitis in patients with PPROM needs to be researched further.
【Key words】Premature rupture of membranes(PROM); Chorioam nionitis; High mobility groupbox 1(HMGB1)
胎膜早破(PROM)包括足月胎膜早破及未足月胎膜早破(PPROM),相对足月PROM,PPROM对母儿的危害更大。其中绒毛膜羊膜炎是胎膜早破的一个重要并发症,对胎膜早破孕妇并发绒毛膜羊膜炎进行早期预测并给予及时治疗,是改善围生期预后的关键。高迁移率族蛋白 1(HMGB1)是近年发现的一种重要的炎症介质,与组织损伤后修复、炎症反应等方面关系密切[1]。本研究目的即探讨HMGB1与胎膜早破的关系及其对PPROM患者绒毛膜羊膜炎的预测价值。
1 资料与方法
1.1 一般资料 选择2009年6月至2010年1月在我院产科病房住院分娩及门诊产前检查的175例孕妇,分为4组。PPROM组55例,年龄(24.8±3.25)岁,妊娠(30.2±1.2)周;足月PROM组40例,年龄(25.6±3.25)岁,妊娠(38.2±1.1)周。2组均无宫缩,无临床感染征象,无其他母儿并发症及合并症,入院后均给予抗生素治疗、卧床抬高臀部,妊娠不足35周者给予地塞米松促胎肺成熟。选择同期在我院产科门诊检查的健康未足月孕妇40例作为未足月孕妇组;选择同期住院分娩的正常足月孕妇40例作为足月孕妇组,无宫缩,胎膜完整。4组均为单胎初产孕妇,年龄、孕周间不存在显著性差异,均无合并症及并发症。
1.2 诊断标准 PROM诊断标准参考妇产科学[2],符合下列条件之一者确诊为PROM:阴道窥器检查见阴道后穹窿有羊水积聚或有羊水自宫颈口流出; 阴道液pH值测定,pH值试纸由黄色变为蓝绿色,即pH值≥6.5,提示PROM;阴道液涂片检查,干燥后镜检可见羊齿植物叶状结晶为羊水。B型超声检查可辅助诊断。
1.3 检查方法 对入院后胎膜破裂4 h内的足月PROM及PPROM孕妇,用药前抽取静脉血5 mL,对照组采等量空腹静脉血,尽快注入硅化玻璃试管内,3000 r/min 离心10 min,分离血清, 70℃保存待检。采用酶联免疫法测定血清HMGB1水平,试剂购自美国R&D公司;测定采用意大利ALISEI全自动酶标仪,操作按试剂盒说明书进行,所有样品设立复孔,均在同一批内检测。
PROM组所有孕妇于分娩后取距破口5 cm处全层胎膜组织2 cm×2 cm,另取胎盘周边和中央胎盘各5 cm×5 cm,10%甲醛固定,石蜡包埋,切片后HE染色,显微镜检查。