The Role of Maternal Serum MMPs and SAA in the Pathogenesis of Preterm Premature Rupture of Membranes
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摘要:
目的 探讨金属基质蛋白-1（matrix metalloproteinase-1，MMP-1）、金属基质蛋白-3（matrix metalloproteinase-3，MMP-3）、金属基质蛋白-9（matrix metalloproteinase-9，MMP-9）和SAA（serum amyloid A，SAA）与未足月胎膜早破的关系。 方法 选择昆明医科大学第一附属医院产科住院未足月胎膜早破产妇30例、足月胎膜早破产妇30例、同期正常足月妊娠者30例作为对照。经ELISA（Enzyme-linked immunosorbent assay）法检测3组孕妇外周血中MMP-1、MMP-3、MMP-9及SAA水平，将3组孕妇胎盘组织进行病理学检测判断是否存在组织学绒毛膜羊膜炎。 结果 （1）MMP-1、SAA在PPROM（preterm premature rupture of membranes）组、PROM （premature rupture of membranes）组患者外周血中含量较对照组明显升高（P < 0.05），两两比较后，MMP-1和SAA在PPROM组中含量较PROM组明显升高（P < 0.05）。而MMP-3在PPROM组中含量明显高于PROM组和对照组（P < 0.05），但在PROM组和对照组间的浓度差异无统计学意义（P > 0.05）；MMP-9在3组孕妇之间的浓度差异无统计学意义（P > 0.05）；（2） PROM组70%（21/30）、PROM组33.3%（10/30）、对照组33.3%（10/30）。PPROM组产妇胎盘组织学绒毛膜羊膜炎阳性率较PROM组和对照组更高，差异有统计学意义（χ2 = 10.841，P < 0.05）。PROM组与对照组的差异无统计学意义（P > 0.05）。 结论 孕妇的血清MMP-1、MMP-3、SAA均与未足月胎膜早破并发早期绒毛膜羊膜炎有关。 Abstract:Objective To investigate the relationships of matrix metalloproteinase-1 （MMP-1）, matrix metalloproteinase-3 （MMP-3）, matrix metalloproteinase-9 （MMP-9） and serum amyloid A （SAA） with the premature rupture of membranes. Methods Thirty cases of premature rupture of fetal membranes, 30 cases of full-term premature rupture of fetal membranes and 30 cases of full-term pregnancies were chosen as controls. The levels of MMP-1, MMP-3, MMP-9 and SAA in the peripheral blood of the three groups of pregnant women were measured by ELISA. The placental tissues of the three groups of pregnant women were examined pathologically to determine the presence of histological chorioamnionitis. Results （1） The levels of MMP-1 and SAA of PPROM and PROM groups were significantly higher than those of the control group （P < 0.05）. After the comparison, MMP-1 and SAA of the PPROM group were significantly more than those of the PROM group （P < 0.05）. However, the content of MMP-3 in PPROM group was significantly higher than that in PROM group and the control group （P < 0.05）, but there was no significant difference in the concentration between PROM group and the control group （P＞0.05）. There was no significant difference in the concentration of MMP-9 among the three groups （P > 0.05）. （2） 70% （21/30） in the PROM group, 33.3% （10/30） in the PROM group and 33.3% （10/30） in the control group. The histological positivity rate of placenta in the PPROM group was elevated compaired with that in the PROM and control groups, and the difference was statistically significant （ χ2 = 10.841, P < 0.05）. There was no significant difference between the PROM and control groups （P > 0.05）. Conclusion Serum MMP-1, MMP-3 and SAA are closely associated with the premature rupture of membranes complicated by early chorioamnionitis. -
表 1 3组患者一般资料比较结果（
$\bar x \pm s $ ）Table 1. Comparison results of general data among three groups （
$\bar x \pm s $ ）组别 年龄（岁） 孕次（次） 产次（次） BMI( kg/m2 ) 入院体温（℃） PPROM 29.7 ± 3.7 2.3 ± 1.3 1.13 ± 0.17 23.46 ± 1.23 36.78 ± 0.32 PROM 30.2 ± 4.1 2.1 ± 1.5 1.21 ± 0.21 23.59 ± 1.14 36.61 ± 0.35 对照组 29.4 ± 3.2 2.5 ± 1.2 1.27 ± 0.13 24.06 ± 1.33 36.25 ± 0.29 F 2.871 1.934 2.353 0.296 1.572 P 0.125 0.174 0.089 0.752 0.120 
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表 2 各组患者外周血MMP-1、MMP-3、MMP-9及SAA水平检测结果（
$\bar x \pm s $ ）Table 2. Results of MMP-1，MMP-3，MMP-9 and SAA in peripheral blood of patients in each group （
$\bar x \pm s $ ）组别 MMP-1（pg/mL） MMP-3（ng/mL） MMP-9（ng/mL） SAA（ng/mL） PPROM 8532.78 ± 1601.41*# 8.41 ± 1.09* 3.26 ± 2.36 9.66 ± 1.98*# PROM 4816. 97 ± 1903.85 4.56 ± 0.99 3.34 ± 1.92 6.12 ± 1.93 对照组 738.38 ± 35.83 4.03 ± 1.48 3.06 ± 1.87 3.28 ± 0.86 F 3.552 3.793 3.497 4.530 P 0.008 0.029 0.697 0.039 与对照组比较，*P < 0.05；与PROM组比较，#P < 0.05。
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表 3 各组患者胎盘病理学检测结果[n（%）]
Table 3. Placental pathological test results of patients in each group [n（%）]
组别 阳性 阴性 χ2 P PPROM组（n = 30） 21（70）* 9（30） 10.841 0.002 PROM组（n = 30） 10（33.3） 20（66.7） 2.765 0.253 对照组（n = 30） 10（33.3） 20（66.7） 2.765 0.253 与PROM组和对照组比较，*P < 0.05。
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[1] Roberts C L,Wagland P,Torvaldsen S,et al. Childhood outcomes following preterm prelabor rupture of the membranes (PPROM):A population-based record linkage cohort study[J]. J Perinatol,2017,37(11):1230-1235. doi: 10.1038/jp.2017.123 [2] 吴甜,石晶,鲍珊,等. 胎膜早破对孕母感染及早产儿结局的影响[J]. 中国当代儿科杂志,2017,19(8):861-865. doi: 10.7499/j.issn.1008-8830.2017.08.004 [3] 周容,刘兴会. 重视胎膜早破的诊断[J]. 中华妇幼临床医学杂志(电子版),2014,10(2):131-135. doi: 10.3877/cma.j.issn.1673-5250.2014.02.002 [4] Menon R,Fortunato S J. Infection and the role of inflammation in preterm premature rupture of the membranes[J]. Best Pract Res Clin Obstet Gynaecol,2007,21(3):467-478. doi: 10.1016/j.bpobgyn.2007.01.008 [5] 刘文翠,白玉芳. 基质金属蛋白酶-2,7,9与胎膜早破的相关研究[J]. 临床医药文献电子杂志,2018,5(56):39. doi: 10.3877/j.issn.2095-8242.2018.56.032 [6] Wang Y W,Wang W S,Wang L Y,et al. Extracellular matrix remodeling effects of serum amyloid A1 in the human amnion:Implications for fetal membrane rupture[J]. Am J Reprod Immunol,2019,81(1):e13073. [7] 时春艳,漆洪波,杨慧霞. 胎膜早破的诊断与处理指南(2015)[J]. 中华围产医学杂志,2015,18(3):161-167. doi: 10.3760/cma.j.issn.1007-9408.2015.03.01 [8] Direnzo GC,Roura LC,Facchinetti F,et al. Guidelines for the management of spontaneous preterm labor:Identification of spontaneous preterm labor,diagnosis of preterm premature rupture of membranes,and preventive tools for preterm birth[J]. J Matern Fetal Neonatal Med,2011,24(5):659-667. doi: 10.3109/14767058.2011.553694 [9] 谢幸, 孔北华, 段涛. 妇产科学[M]. 第九版. 北京: 人民卫生出版社, 2018: 154-155. [10] 陈忠年. 妇产科病理学[M]. 上海: 上海医科大学出版社, 1996: 341-245. [11] Yagur Y, Weitzner O, Ravid E, et al. Can we predict preterm delivery in patients with premature rupture of membranes? [J]Arch Gynecol Obstet, 2019, 300（3）: 615-621. [12] Hwang H S,Park S J,Cheon E J,et al. Fibronectin fragment-induced expression of matrix metalloproteinases is mediated by MyD88-dependent TLR-2 signaling pathway in human chondrocytes[J]. Arthritis Res Ther,2015,17(12):320. [13] Yang C,Lim W,Bazer F W,et al. Myricetin suppresses invasion and promotes cell death in human placental choriocarcinoma cells through induction of oxidative stress[J]. Cancer Lett,2017,399(4):10-19. [14] Kowalik M K, Rekawiecki R, Kotwica J. Expression and localization of progesterone receptor membrane component 1 and 2 and serpine mRNA binding protein 1 in the bovine corpus luteum during the estrous cycle and the first trimester of pregnancy[J]. Theriogenology, 2014, 82（8）: 1086-1093. [15] 张晓佳,王钰莹,金贞爱. 未足月胎膜早破与MMPs基因多态性相关性研究进展[J]. 中国实用儿科杂志,2019,34(2):149-153,168. doi: 10.19538/j.ek2019020620 [16] 孔振兴,马恺,韩娜,等. 血清MMP-9、TIMP-1、TNF-α及IL-10在未足月胎膜早破而早产产妇中的表达及临床意义[J]. 现代生物医学进展,2020,20(21):4168-4171. doi: 10.13241/j.cnki.pmb.2020.21.038 [17] 裴文娟. 血清β-HCG、MMP-9、GBS联合检测对胎膜早破产妇宫内感染的预测价值[J]. 现代诊断与治疗,2021,32(4):574-575. [18] Çekmez Y,Çekmez F,Özkaya E,et al. Proadrenomedullin and serum amyloid A as a predictor of subclinical chorioamnionitis in preterm premature rupture of membranes[J]. J Interferon Cytokine Res,2013,33(11):694-699. doi: 10.1089/jir.2012.0134 [19] 曾文娟,黄启涛,王海臻,等. 血清淀粉样蛋白A与未足月胎膜早破并发亚临床绒毛膜羊膜炎的关系研究[J]. 中国实用妇科与产科杂志,2017,33(4):414-417. doi: 10.19538/j.fk2017040120 [20] 涂晓瑜,何玉玫,李苗. 血清淀粉样蛋白A预测未足月胎膜早破并发亚临床绒毛膜羊膜炎的临床价值分析[J]. 中国实用医药,2021,16(12):90-93. doi: 10.14163/j.cnki.11-5547/r.2021.12.032 -
