Abstract：
To examine whether the severity of spontaneous preterm birth (SPTB) risk after rescue cerclage for acute cervical insufficiency (CI) is linked to the degree of inflammatory response in the amniotic fluid (AF) based on the concentrations of various inflammatory proteins and prior obstetric history.
We conducted a retrospective cohort study of 65 singleton pregnant women (17-25 weeks) who underwent rescue cerclage following the diagnosis of acute CI and were subjected to amniocentesis. EN-RAGE, IL-6, IL-8, and IP-10 as inflammatory mediators and kallistatin, MMP-2/8, and uPA as extracellular matrix remodeling-related molecules were assayed in the AF using ELISA. The level of each inflammatory mediator was divided into quartiles.
Intra-amniotic inflammation (IAI; AF IL-6 level ≥2.6 ng/mL) was independently associated with SPTB after cerclage placement. The odds of SPTB at < 32 weeks, even after adjusting for confounders, increased significantly with each increasing quartile of baseline AF levels for each inflammatory mediator (p for trend < .05). Kaplan-Meier survival curves showed that the cerclage-to-delivery intervals were significantly shorter as the quartiles of AF EN-RAGE and MMP-8 increased (log-rank test, p < .01 each). Neither previous term birth nor prior PTB was associated with SPTB risk or cerclage-to-delivery interval after rescue cerclage. Multiparous women who experience CI after term birth showed significantly elevated levels of MMP-8 and reduced kallistatin levels in the AF.
In patients with CI, SPTB risk (especially risk severity) after rescue cerclage is associated with the degree of the inflammatory response in AF as well as the presence of IAI but not with prior obstetric history.
We conducted a retrospective cohort study of 65 singleton pregnant women (17-25 weeks) who underwent rescue cerclage following the diagnosis of acute CI and were subjected to amniocentesis. EN-RAGE, IL-6, IL-8, and IP-10 as inflammatory mediators and kallistatin, MMP-2/8, and uPA as extracellular matrix remodeling-related molecules were assayed in the AF using ELISA. The level of each inflammatory mediator was divided into quartiles.
Intra-amniotic inflammation (IAI; AF IL-6 level ≥2.6 ng/mL) was independently associated with SPTB after cerclage placement. The odds of SPTB at < 32 weeks, even after adjusting for confounders, increased significantly with each increasing quartile of baseline AF levels for each inflammatory mediator (p for trend < .05). Kaplan-Meier survival curves showed that the cerclage-to-delivery intervals were significantly shorter as the quartiles of AF EN-RAGE and MMP-8 increased (log-rank test, p < .01 each). Neither previous term birth nor prior PTB was associated with SPTB risk or cerclage-to-delivery interval after rescue cerclage. Multiparous women who experience CI after term birth showed significantly elevated levels of MMP-8 and reduced kallistatin levels in the AF.
In patients with CI, SPTB risk (especially risk severity) after rescue cerclage is associated with the degree of the inflammatory response in AF as well as the presence of IAI but not with prior obstetric history.
摘要：
目的：根据各种炎症蛋白的浓度和既往产科史，探讨急性宫颈机能不全（CI）抢救环扎术后自发性早产（SPTB）风险的严重程度与羊水（AF）炎症反应的程度是否相关。
方法：我们对65名单胎妊娠妇女（17-25周）进行了回顾性队列研究，这些妇女在诊断为acuteCI后接受了抢救环扎术，并接受了羊膜穿刺术。EN-RAGE,IL-6，IL-8和IP-10作为炎症介质和kallistatin，使用ELISA在AF中测定MMP-2/8和uPA作为细胞外基质重塑相关分子。将每种炎症介质的水平分为四分位数。
结果：羊膜腔内炎症（IAI；AFIL-6水平≥2.6ng/mL）与环扎放置后的SPTB独立相关。SPTB在<32周时的几率，即使在调整了混杂因素之后，随着每种炎症介质的基线AF水平的四分位数的增加，显着增加（趋势p<0.05）。Kaplan-Meier存活曲线显示，随着AFEN-RAGE和MMP-8四分位数的增加，环扎至分娩间隔明显缩短（对数秩检验，每个p<0.01）。先前的足月分娩或先前的PTB均与SPTB风险或抢救环扎后的环扎至分娩间隔无关。足月出生后经历CI的多胎妇女在AF中显示出MMP-8水平显着升高和kallistatin水平降低。
结论：在CI患者中，抢救环扎后的SPTB风险（尤其是风险严重程度）与AF的炎症反应程度以及IAI的存在有关，但与先前的产科病史无关。
方法：我们对65名单胎妊娠妇女（17-25周）进行了回顾性队列研究，这些妇女在诊断为acuteCI后接受了抢救环扎术，并接受了羊膜穿刺术。EN-RAGE,IL-6，IL-8和IP-10作为炎症介质和kallistatin，使用ELISA在AF中测定MMP-2/8和uPA作为细胞外基质重塑相关分子。将每种炎症介质的水平分为四分位数。
结果：羊膜腔内炎症（IAI；AFIL-6水平≥2.6ng/mL）与环扎放置后的SPTB独立相关。SPTB在<32周时的几率，即使在调整了混杂因素之后，随着每种炎症介质的基线AF水平的四分位数的增加，显着增加（趋势p<0.05）。Kaplan-Meier存活曲线显示，随着AFEN-RAGE和MMP-8四分位数的增加，环扎至分娩间隔明显缩短（对数秩检验，每个p<0.01）。先前的足月分娩或先前的PTB均与SPTB风险或抢救环扎后的环扎至分娩间隔无关。足月出生后经历CI的多胎妇女在AF中显示出MMP-8水平显着升高和kallistatin水平降低。
结论：在CI患者中，抢救环扎后的SPTB风险（尤其是风险严重程度）与AF的炎症反应程度以及IAI的存在有关，但与先前的产科病史无关。
