| Objective:1.To test the expression levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-17(IL-17)and placental alkaline phosphatase(PLAP)in maternal serum and umbilical cord serum in the different groups of patient with term premature rupture of membranes(TPROM),preterm premature rupture of membranes(PPROM),premature rupture of membranes(PROM)with chorioamnionitis(CS)or PROM with neonatal infection during perinatal.2.To investigate the clinical value of TNF-α,IL-6,IL-17 and PLAP in maternal serum and umbilical cord serum in predicting PROM with Adverse pregnancy outcomes associated with maternal and fetal infection.Methods:51 patients with PROM who had been admitted to obstetrics department of first affiliated Hospital of Kunming Medical University from January 2019 to November 2020 were enrolled as PROM group.Among them,40 patients with gestational ages≥37 weeks when premature rupture of membranes happened was selected as TPROM group.And 11 patients with gestational ages<37 weeks when premature rupture of membranes happened was selected as PPROM group.At the same time 20 normal Maternities delivered in our hospital were adopted to the control group.There are 18 patients with clinical chorioamnionitis(CCA)and/or histological chorioamnionitis(HCA)in PROM group were classified as PROM with CS group,and the other 33 cases of people without clinical chorioamnionitis or histological chorioamnionitis in PROM group were classified as PROM without CS group.41 patients without neonatal infection during perinatal in PROM group was classified as A1 group,and the other 11 patients with neonatal infection during perinatal in PROM group were classified as A1 group.3ml of peripheral venous blood were taken from Maternities before delivery(within 12h from the premature rupture of membranes)and 3ml umbilical vein blood were collected after delivery.Double antibody sandwich ELISA was used to detect The expression levels of IL-6,IL-17,TNF-α and PLAP in maternal serum and umbilical cord serum.The diagnostic criteria of PROM and CCA was based on the nine edition of Obstetrics and Gynecology.After delivery,the placental tissue was sent to pathology department of our hospital for histological examination of chorioamnionitis with 10%formaldehyde fixed.The diagnostic criteria of HCA was based on the Gynecologic and Obstetric Pathology.the diagnostic criteria of neonatal infection was based on the fifth edition of Practical Neonatology.Results:1.There was no statistical difference in age,pregnancy,pre-pregnancy BMI,pregnancy weight gain and body temperature of hospitalization between the control group,TPROM group and PPROM group(P>0.05).The mean gestational age of the PPROM group was less than the TPROM and the control groups,the differences was statistically significant(P<0.05),and There was no statistical difference of mean gestational age between the TPROM and the control group(P>0.05).2.The expression levels of TNF-α and IL-6 in maternal serum of the TPROM group were higher than those in the control group(P1<0.01,P2=0.041),The expression levels of IL-6(P=0.002)in umbilical cord serum of the TPROM group was higher than that of control group.The level of TNF-α in maternal serum of PPROM group was higher than that in the control group(P=0.020),The level of IL-6 in umbilical cord blood was higher than that of control group(P=0.029).There was no significant difference in IL-17,PLAP between the three groups whatever in maternal serum or in umbilical cord serum(P>0.05).Compared with the group of TPROM,There was no significant difference in the level of the TNF-α,IL-6,IL-17,PLAP whatever in maternal serum or in umbilical cord serum in the PPROM group(P>0.05).In diagnosing TPROM,ROC curve analysis showed that the individual area under ROC curve(AUC)of TNF-α,IL-6 in maternal serum were 0.835,0.698 corresponding to the optimal cut off 24.79pg/ml,8.07pg/ml respectively and The sensitivity value were 67.5%,70.0%,the specificity value were 90.0%,70.0%.The area under the ROC curves of TNFα+IL-6 in maternal serum were 0.840,The sensitivity value was 72.5%,the specificity value were 90.0%.In diagnosing PPROM,the AUC of TNF-α in maternal serum were 0.768 corresponding to the optimal cut off 24.79pg/ml.The sensitivity value were 63.6%,the specificity value were 90.0%.TNF-α in maternal serum had a highest value in diagnosing TPROM and PPROM among single markers.Two combined indexes of TNF-α and IL-6 in maternal serum were more valuable in diagnosing TPROM than single index.3.There was no significant difference in the composition ratio of people with chorioamnionitis between the TPROM group and the PPROM group(P>0.05).In the PROM group,the serum TNF-α,IL-6 levels in maternal and umbilical cord blood in PROM with CS group were higher than those in PROM without CS group and the control group(P<0.05).The levels of TNF-α in maternal blood and the IL-6 levels in umbilical cord blood in the PROM without CS group were higher than that in the control group(P<0.05).There was no significant difference in IL-17,PLAP levels of maternal or umbilical cord blood between the three groups(P>0.05).In Early diagnosis of PROM with CS,ROC curve analysis showed that the individual AUC of TNF-α,IL-6 in maternal serum were 0.763,0.702 corresponding to the optimal cut off 26.19pg/ml,12.32pg/ml respectively and the sensitivity value were83.3%,61.1%,the specificity value were 66.7%,81.8%.The individual AUC of TNF-α,IL-6 in umbilical cord serum were 0.614,0.673 corresponding to the optimal cut off 13.52pg/ml,11.59pg/ml respectively.The sensitivity value were83.3%,72.2%the specificity value were39.4%,66.7%.The AUC of TNF-α+IL-6 in maternal serum and the AUC of TNF-α+IL-6 in umbilical cord serum were 0.747,0.628,The sensitivity value were 77.8%,94.4%,the specificity value were 66.7%,35.4%.The AUC of combined four joint detections of TNF-α+IL-6 in maternal serum and in umbilical cord serum were 0.820,The sensitivity value were 72.2%,the specificity value were 87.9%.Among all single markers,TNF-α had a highest value in diagnosing PROM with CS,TNF-α had the highest diagnostic value in maternal blood and IL-6 had the highest diagnostic value in cord blood.Diagnostic effect of TNF-α,IL-6 in maternal serum was better than in cord blood;Four joint detections of TNF-α+IL-6 in maternal serum and in umbilical cord serum had the Highest diagnostic value in the diagnosis of PROM with CS than that of other single or combined indexes in this experiment.4.There was no significant difference in the composition ratio of people with neonatal infection during perinatal period between the TPROM group and the PPROM group(P>0.05).In PROM group patients whose newborns diagnosed with neonatal infection during perinatal period were divided to A2 group(n=10),those who without neonatal infection during perinatal period were divided to A1 group(n=41).Expression levels of TNF-α,IL-6 and IL-17 in maternal serum and umbilical cord serum of A2 group were statistically significantly higher than those of A1 group and the control group(P<0.05).The TNF-α in maternal serum and umbilical cord serum of A1 group were statistically significantly higher than the control group(P<0.05).There was no significant difference in PLAP levels of maternal or umbilical cord blood between the three groups(P>0.05).In Early diagnosis of PROM with neonatal infection during perinatal period,ROC curve analysis showed that the individual AUC of TNF-α,IL-6 and IL-17 in maternal serum were 0.787,0.800 and 0.735 corresponding to the optimal cut off26.19 pg/ml,8.75 pg/ml and 179.56pg/ml respectively.The sensitivity value were90.0%,100.0%and 60.0%,the specificity value were 56.1%,51.2%and 85.4%.The individual AUC of TNF-α,IL-6 and IL-17 in umbilical cord serum were 0.722,0.795 and 0.829corresponding to the optimal cut off 13.52pg/ml,14.18pg/ml and 53.00pg/ml respectively.The sensitivity value were100.0%,90.0%and 80%,the specificity value were39.0%,65.9%and78.0%.The AUC of TNF-α+IL-6 in maternal serum were 0.810,The sensitivity value were 100.0%,the specificity value were 51.2%.The AUC of combined three joint detections of TNF-α+IL-6+IL-17 in maternal serum were 0.766,The sensitivity value were 90.0%,the specificity value were 61.0%.The AUC of IL-6+IL-17 in umbilical cord serum were 0.863,The sensitivity value were 100.0%,the specificity value were 65.9%.The AUC of combined three joint detections of TNF-α+IL-6+IL-17 in umbilical cord serum were 0.866,The sensitivity value were 90.0%,the specificity value were 80.49%.The AUC of combined six joint detections of TNF-α+IL-6+IL-17 in maternal serum and in umbilical cord serum were 0.822,The sensitivity value were 90.0%,the specificity value were75.6%.Among all single markers,IL-17 in umbilical cord serum had a highest value in diagnosing PROM with neonatal infection during perinatal period.TNF-α had a highest diagnostic value in maternal blood and IL-17 had the highest diagnostic value in cord blood.Diagnostic effect of TNF-α,IL-6 in maternal serum was better than in cord blood;Diagnostic effect of IL-17 in umbilical cord serum was better than in maternal serum.Combined application of TNF-α,IL-6 in maternal serum had the highest diagnostic value in maternal blood.Combined application of TNF-α,IL-6 and IL-17 in umbilical cord serum had the higher diagnostic value in diagnosing PROM with neonatal infection during perinatal period than that of other single index or combined indexes in this experiment.5.The levels of TNF-α,IL-6,IL-17 in maternal serum and the levels of TNF-α,IL-6,IL-17 in umbilical cord serum were significantly positively correlated.Conclusion:1.TNF-α and IL-6 in in maternal serum and umbilical cord serum have good clinical value in predicting the complications associated with maternal and fetal infection of PROM.2.IL-17 in Maternal serum and umbilical cord serum are new indicators for predicting PROM with neonatal infection during perinatal period group.3.The diagnostic value of Combined detection of TNF-α、IL-6、IL-17 in Maternal serum and umbilical cord serum in early diagnosis of PROM with adverse pregnancy outcomes associated with maternal and fetal infection is superior to that of single index.4.The expression level of PLAP in maternal blood and umbilical cord blood is of limited value in the evaluation of Adverse pregnancy outcomes associated with maternal and fetal infection.5.Considering about the limitations of cord blood collection,detection of TNF-α,IL-6 and IL-17 in maternal blood also has a good application value in detecting complications related to mother and child infection. |
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