妊娠期肝内胆汁淤积症妇女产科和围产期并发症中细胞因子状况的特点

Ya. I. Bik-Mukhametova, T. N. Zakharenkova, N. M. Golubykh
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The course of COP is accompanied by a decrease in the concentrations of IL-6 and IL-4 cytokines and a lower ratio of IL-4/IL-6 (P(U)IL-6=0.041; P(U)IL-4=0.0007 and P(U)IL4/IL-6=0.008). The concentration of IL-6 in blood serum that is > 2.53 pg/ml (Se=83.3 %, Sp=73.9 %; AUC=0.822; 95 % CI 0.636–0.938; p=0.004) and IL-4 concentration that is > 41.99 pg/ml in symptomatic COP (Se=100.0 %, Sp=78.6 %; AUC=0.839; 95 % CI 0.593–0.965; p=0.011) are regarded as a risk factor for preterm labor (PL) in women with COP. The concentration of IL-6 > 3.07 pg/ml in women with COP and negative vaginal discharge culture can be considered as a predictor of meconium staining of amniotic fluid (MSAF) (Se=100.0 %, Sp=62.9 %; AUC=0.770; 95 % CI 0.597–0.895; p=0.024). Conclusions. 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引用次数: 0

摘要

背景妊娠肝内胆汁淤积症(COP)是妊娠最常见的并发症,发生在妊娠的第2至3个月,并伴有肝损伤,表现为胆汁淤积和细胞溶解。客观的确定细胞因子反应在COP的发病机制及其产科和围产期并发症中的作用。材料和方法。对87例孕妇进行了检查:妊娠期肝内胆汁淤积症57例,对照组30例。通过酶联免疫吸附测定法测定促炎细胞因子(白细胞介素6)和抗炎细胞因子(红细胞介素4)的水平,并评估其作为COP妇女产科和围产期并发症预测指标的预后意义。后果COP的过程伴随着IL-6和IL-4细胞因子浓度的降低以及IL-4/IL-6的比率的降低(P(U)IL-6=0.041;P(U)IL-4=0.0007和P(U。COP和阴道分泌物培养阴性妇女的IL-6浓度>3.07 pg/ml可被视为羊水胎粪染色(MSAF)的预测指标(Se=1000%,Sp=62.9%;AUC=0.770;95%CI 0.597–0.895;p=0.024)。结论。COP伴有较低水平的IL-6;非典型免疫偏离,没有向正常妊娠特征的Th2免疫应答转变;以及细胞因子反应的失衡与抗炎联系的减少。COP患者早产与妊娠期IL-6水平升高有关。患有COP的女性羊水中胎粪的释放(根据阴道分泌物培养的结果,在没有显著致病性和机会性微生物群的情况下)与血液中较高浓度的IL-6相关。
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PECULIARITIES OF THE CYTOKINE STATUS IN OBSTETRIC AND PERINATAL COMPLICATIONS IN WOMEN WITH INTRAHEPATIC CHOLESTASIS OF PREGNANCY
Background. Intrahepatic cholestasis of pregnancy (COP) is the most common complication of pregnancy that occurs during the 2nd-3rd trimester and is accompanied by liver damage manifested as cholestasis and cytolysis. Objective. To establish the role of cytokine response in the pathogenesis of COP as well as its obstetric and perinatal complications. Material and methods. 87 pregnant women were examined: 57 with intrahepatic cholestasis of pregnancy and 30 patients of the comparison group. The levels of pro-inflammatory (interleukin 6) and anti-inflammatory (interleukin 4) cytokines were determined by enzyme-linked immunosorbent assay, and their prognostic significance as predictors of obstetric and perinatal complications in women with COP was estimated. Results. The course of COP is accompanied by a decrease in the concentrations of IL-6 and IL-4 cytokines and a lower ratio of IL-4/IL-6 (P(U)IL-6=0.041; P(U)IL-4=0.0007 and P(U)IL4/IL-6=0.008). The concentration of IL-6 in blood serum that is > 2.53 pg/ml (Se=83.3 %, Sp=73.9 %; AUC=0.822; 95 % CI 0.636–0.938; p=0.004) and IL-4 concentration that is > 41.99 pg/ml in symptomatic COP (Se=100.0 %, Sp=78.6 %; AUC=0.839; 95 % CI 0.593–0.965; p=0.011) are regarded as a risk factor for preterm labor (PL) in women with COP. The concentration of IL-6 > 3.07 pg/ml in women with COP and negative vaginal discharge culture can be considered as a predictor of meconium staining of amniotic fluid (MSAF) (Se=100.0 %, Sp=62.9 %; AUC=0.770; 95 % CI 0.597–0.895; p=0.024). Conclusions. COP is accompanied by a lower level of IL-6; an atypical immune deviation with no shift towards the Th2 immune response that is characteristic of a normal pregnancy; as well as an imbalance in the cytokine response with a decrease in the anti-inflammatory link. Preterm birth in patients with COP is associated with higher levels of IL-6 during pregnancy. The release of meconium into amniotic fluid in women with COP (in the absence of significant pathogenic and opportunistic microflora according to the results of vaginal discharge culture) correlates with higher concentrations of IL-6 in the blood.
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