The frequency and clinical significance of intra-amniotic inflammation defined as an elevated amniotic fluid matrix metalloproteinase-8 in patients with preterm labor and low amniotic fluid white blood cell counts
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Objective: To determine the frequency and clinical significance of intra-amniotic inflammation (IAI) defined as an elevated amniotic fluid (AF) matrix metalloproteinase-8 (MMP-8) concentration in patients with preterm labor and intact membranes (PTL) and low AF white blood cell (WBC) counts. Methods: Adverse pregnancy outcomes were compared according to the presence or absence of IAI in 220 singleton gestations who underwent amniocentesis due to PTL (gestational age<35.7 weeks) and had low AF WBC counts (<19 cells/mm3). Adverse pregnancy outcomes included preterm birth within 5 days of amniocentesis, acute histologic chorioamnionitis (acute-HCA) and positive AF culture. IAI was defined as an elevated AF MMP-8 concentration (≥23 ng/mL). Results: IAI was present in 19% of study population. Adverse pregnancy outcomes were significantly more frequent in patients with IAI than in those without IAI (preterm birth within 5 days of amniocentesis, 88% vs. 41%; acute-HCA, 47% vs. 11%; positive AF culture, 10% vs. 2%; each for P<0.05). Patients with IAI had a significantly shorter median amniocentesis-to-delivery interval than those without IAI (7.8 hours [0.01-3,307.3 hours] vs. 310.3 hours [0.01-2,973.8 hours]; P<0.001 from survival analysis). Multiple logistic regression analysis demonstrated that only an IAI (odds ratio, 3.3; 95% confidence interval, 1.5-7.3; P<0.005) retained a statistical significance in the prediction of acute-HCA after other confounding variables were adjusted. Conclusion: Approximately one-fifth of patients with PTL and low AF WBC counts have an evidence of IAI and are at risk for impending preterm delivery and acute-HCA when AF MMP-8 concentration is used.
Abstract
Objective: To determine the frequency and clinical significance of intra-amniotic inflammation (IAI) defined as an elevated amniotic fluid (AF) matrix metalloproteinase-8 (MMP-8) concentration in patients with preterm labor and intact membranes (PTL) and low AF white blood cell (WBC) counts. Methods: Adverse pregnancy outcomes were compared according to the presence or absence of IAI in 220 singleton gestations who underwent amniocentesis due to PTL (gestational age<35.7 weeks) and had low AF WBC counts (<19 cells/mm3). Adverse pregnancy outcomes included preterm birth within 5 days of amniocentesis, acute histologic chorioamnionitis (acute-HCA) and positive AF culture. IAI was defined as an elevated AF MMP-8 concentration (≥23 ng/mL). Results: IAI was present in 19% of study population. Adverse pregnancy outcomes were significantly more frequent in patients with IAI than in those without IAI (preterm birth within 5 days of amniocentesis, 88% vs. 41%; acute-HCA, 47% vs. 11%; positive AF culture, 10% vs. 2%; each for P<0.05). Patients with IAI had a significantly shorter median amniocentesis-to-delivery interval than those without IAI (7.8 hours [0.01-3,307.3 hours] vs. 310.3 hours [0.01-2,973.8 hours]; P<0.001 from survival analysis). Multiple logistic regression analysis demonstrated that only an IAI (odds ratio, 3.3; 95% confidence interval, 1.5-7.3; P<0.005) retained a statistical significance in the prediction of acute-HCA after other confounding variables were adjusted. Conclusion: Approximately one-fifth of patients with PTL and low AF WBC counts have an evidence of IAI and are at risk for impending preterm delivery and acute-HCA when AF MMP-8 concentration is used.
참고문헌 (32)
- Tschesche H, "Human neutrophil collagenase", Methods Enzymol, 248, pp.431~449 (1995)
- Woessner JF Jr, "Matrix metalloproteinases and their inhibitors in connective tissue remodeling", FASEB J, 5, pp.2145~2154 (1991)
- Birkedal-Hansen H, "Matrix metalloproteinases and inhibitors" (1992), Gustav Fischer
- Romero R, "Preterm labor, In Preterm labor", pp.29~49 (1997), Churchill Livingstone
- Maymon E, "Human neutrophil collagenase (matrix metalloproteinase 8) in parturition, premature rupture of the membranes, and intrauterine infection", Am J Obstet Gynecol, 183, pp.94~99 (2000)
- Matsubara S, "Polymorphonuclear leukocytes in the fetal membranes are activated in patients with preterm delivery: ultrastructural and enzyme-histochemical evidence", Placenta, 20, pp.185~188 (1999)
- Winkler M, "Parturition at term: parallel increases in interleukin-8 and proteinase concentrations and neutrophil count in the lower uterine segment", Hum Reprod, 14, pp.1096~1100 (1999)
- Been JV, "Histologic chorioamnionitis, fetal involvement, and antenatal steroids: effects on neonatal outcome in preterm infants", Am J Obstet Gynecol, 201, pp.587.e1~587.e8 (2009)
- Bersani I, "Chorioamnionitis: the good or the evil for neonatal outcome?", J Matern Fetal Neonatal Med, 25(Suppl 1), pp.12~16 (2012)
- Gervasi MT, "Midtrimester amniotic fluid concentrations of interleukin-6 and interferon-gamma-inducible protein-10: evidence for heterogeneity of intra-amniotic inflammation and associations with spontaneous early (<32 weeks) and late (>32 weeks) preterm delivery", J Perinat Med, 40, pp.329~343 (2012)
- Gomez R, "The fetal inflammatory response syndrome", Am J Obstet Gynecol, 179, pp.194~202 (1998)
- Greig PC, "Maternal serum interleukin-6 during pregnancy and during term and preterm labor", Obstet Gynecol, 90, pp.465~469 (1997)
- Jobe AH, "Antenatal infection", inflammation and postnatal lung maturation and injury, 2001, pp.2, 27~32
- Kallapur SG, "Contribution of inflammation to lung injury and development", Arch Dis Child Fetal Neonatal Ed, 91, pp.F132~F135 (2006)
- Kramer BW, "Prenatal inflammation and lung development", Semin Fetal Neonatal Med, 14, pp.2~7 (2009)
- Newnham JP, "The fetal maturational and inflammatory responses to different routes of endotoxin infusion in sheep", Am J Obstet Gynecol, 186, pp.1062~1068 (2002)
- Pacora P, "Funisitis and chorionic vasculitis : the histological counterpart of the fetal inflammatory response syndrome", J Matern Fetal Neonatal Med, 11, pp.18~25 (2002)
- Sadowsky DW, "Preterm labor is induced by intraamniotic infusions of interleukin-1beta and tumor necrosis factor-alpha but not by interleukin-6 or interleukin-8 in a nonhuman primate model", Am J Obstet Gynecol, 195, pp.1578~1589 (2006)
- Smulian JC, "Clinical chorioamnionitis and histologic placental inflammation", Obstet Gynecol, 94, pp.1000~1005 (1999)
- Kim KW, "A rapid matrix metalloproteinase-8 bedside test for the detection of intraamniotic inflammation in women with preterm premature rupture of membranes", Am J Obstet Gynecol, 197, pp.292.e1~292.e5 (2007)
- Maymon E, "A role for the 72 kDa gelatinase (MMP-2) and its inhibitor (TIMP-2) in human parturition, premature rupture of membranes and intraamniotic infection", J Perinat Med, 29, pp.308~316 (2001)
- Nien JK, "A rapid MMP-8 bedside test for the detection of intra-amniotic inflammation identifies patients at risk for imminent preterm delivery", Am J Obstet Gynecol, 195, pp.1025~1030 (2006)
- Park CW, "The antenatal identification of funisitis with a rapid MMP-8 bedside test", J Perinat Med, 36, pp.497~502 (2008)
- Park JS, "The relationship between amniotic fluid matrix metalloproteinase-8 and funisitis", Am J Obstet Gynecol, 185, pp.1156~1161 (2001)
- Shim SS, "Clinical significance of intra-amniotic inflammation in patients with preterm premature rupture of membranes", Am J Obstet Gynecol, 191, pp.1339~1345 (2004)
- Yoon BH, "An elevated amniotic fluid matrix metalloproteinase-8 level at the time of mid-trimester genetic amniocentesis is a risk factor for spontaneous preterm delivery", Am J Obstet Gynecol, 185, pp.1162~1167 (2001)
- Maymon E, "Amniotic fluid matrix metalloproteinase-8 in preterm labor with intact membranes", Am J Obstet Gynecol, 185, pp.1149~1155 (2001)
- Maymon E, "Value of amniotic fluid neutrophil collagenase concentrations in preterm premature rupture of membranes", Am J Obstet Gynecol, 185, pp.1143~1148 (2001)
- Yoon BH, "Fetal exposure to an intra-amniotic inflammation and the development of cerebral palsy at the age of three years", Am J Obstet Gynecol, 182, pp.675~681 (2000)
- Yoon BH, "Amniotic fluid interleukin-6: a sensitive test for antenatal diagnosis of acute inflammatory lesions of preterm placenta and prediction of perinatal morbidity", Am J Obstet Gynecol, 172, pp.960~970 (1995)
- Yoon BH, "Serum C-reactive protein, white blood cell count, and amniotic fluid white blood cell count in women with preterm premature rupture of membranes", Obstet Gynecol, 88, pp.1034~1040 (1996)
- Yoon BH, "Maternal blood C-reactive protein, white blood cell count, and temperature in preterm labor: a comparison with amniotic fluid white blood cell count", Obstet Gynecol, 87, pp.231~237 (1996)