背景:母体和羊水(AF)对局部或全身感染的免疫反应包括急性期反应物IL-6,C反应蛋白(CRP)和降钙素原(PCT)。如果这些分子可以在疾病的亚临床阶段用作羊膜腔内感染(IAI)的非侵入性生物标志物,则仍未完全了解。
方法:我们使用时间匹配的母体血清,100名孕妇的尿液和AF进行了羊膜穿刺术,以排除早产中的IAI,PPROM或全身性炎症反应(SIR:肾盂肾炎,阑尾炎,肺炎)感染。在一组病例中分析脐带血。我们使用敏感的免疫测定来量化母体血液中的炎症标志物水平,尿液和AF室。微生物测试和胎盘病理用于建立感染和组织学绒毛膜羊膜炎。
结果:PCT在任何研究区室中都不是IAI的有用生物标志物。亚临床IAI女性孕妇血液中IL-6和CRP水平升高。与临床表现明显的绒毛膜羊膜炎组相比,患有SIR的女性具有较高的母体血液IL-6水平,这对于这种疾病具有一定的边际诊断益处.尿液不是使用这三种炎性生物标志物中的任一种评估IAI的有用生物样品。
结论:在患有亚临床IAI的女性中,母体血液中IL-6,CRP和PCT水平的重叠置信区间较大,截止值不同,可能使临床决策难以解释其绝对值.
BACKGROUND: The arsenal of maternal and amniotic fluid (AF) immune response to local or systemic infection includes among others the acute-phase reactants IL-6, C-Reactive Protein (CRP) and Procalcitonin (PCT). If these molecules can be used as non-invasive biomarkers of intra-amniotic infection (IAI) in the subclinical phase of the disease remains incompletely known.
METHODS: We used time-matched maternal serum, urine and AF from 100 pregnant women who had an amniocentesis to rule out IAI in the setting of preterm labor, PPROM or systemic inflammatory response (SIR: pyelonephritis, appendicitis, pneumonia) to infection. Cord blood was analyzed in a subgroup of cases. We used sensitive immunoassays to quantify the levels of inflammatory markers in the maternal blood, urine and AF compartment. Microbiological testing and placental pathology was used to establish infection and histological chorioamnionitis.
RESULTS: PCT was not a useful biomarker of IAI in any of the studied compartments. Maternal blood IL-6 and CRP levels were elevated in women with subclinical IAI. Compared to clinically manifest chorioamnionitis group, women with SIR have higher maternal blood IL-6 levels rendering some marginal diagnostic benefit for this condition. Urine was not a useful biological sample for assessment of IAI using either of these three inflammatory biomarkers.
CONCLUSIONS: In women with subclinical IAI, the large overlapping confidence intervals and different cut-offs for the maternal blood levels of IL-6, CRP and PCT likely make interpretation of their absolute values difficult for clinical decision-making.