Microbial burden and inflammasome activation in amniotic fluid of patients with preterm prelabor rupture of membranes

被引：30

作者：

Theis, Kevin R. ^{[1
,2
,9
]}

Romero, Roberto ^{[1
,2
,3
,4
,5
,6
,7
]}

Motomura, Kenichiro ^{[1
,2
,8
]}

Galaz, Jose ^{[1
,2
,8
,10
]}

Winters, Andrew D. ^{[1
,2
,9
]}

Pacora, Percy ^{[1
,2
,8
]}

Miller, Derek ^{[1
,2
,8
]}

Slutsky, Rebecca ^{[1
,2
]}

Florova, Violetta ^{[1
,2
,8
]}

Levenson, Dustyn ^{[1
,2
,8
]}

Para, Robert ^{[1
,2
,8
]}

Varrey, Aneesha ^{[1
,2
,8
]}

Kacerovsky, Marian ^{[1
,2
,8
]}

Hsu, Chaur-Dong ^{[1
,2
,8
,11
]}

Gomez-Lopez, Nardhy ^{[1
,2
,8
,9
]}

机构：

[1] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Perinatol Res Branch, Div Obstet & Maternal Fetal Med, Div Intramural Res,NIH,US Dept HHS, Bethesda, MI 20892 USA

[2] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Perinatol Res Branch, Div Obstet & Maternal Fetal Med, Div Intramural Res,NIH,US Dept HHS, Detroit, MI 48202 USA

[3] Univ Michigan, Dept Obstet & Gynecol, Ann Arbor, MI 48109 USA

[4] Michigan State Univ, Dept Epidemiol & Biostat, E Lansing, MI 48824 USA

[5] Wayne State Univ, Ctr Mol Med & Genet, Detroit, MI 48202 USA

[6] Detroit Med Ctr, Detroit, MI 48201 USA

[7] Florida Int Univ, Dept Obstet & Gynecol, Miami, FL 33199 USA

[8] Wayne State Univ, Sch Med, Dept Obstet & Gynecol, Detroit, MI 48201 USA

[9] Wayne State Univ, Sch Med, Dept Biochem Microbiol & Immunol, Detroit, MI 48201 USA

[10] Pontificia Univ Catolica Chile, Fac Med, Dept Obstet & Gynecol, Santiago, Chile

[11] Wayne State Univ, Sch Med, Dept Physiol, Detroit, MI 48201 USA

来源：

JOURNAL OF PERINATAL MEDICINE | 2020年 / 48卷 / 02期

基金：

美国国家卫生研究院;

关键词：

culture; microbial invasion of the amniotic cavity; PPROM (preterm prelabor rupture of membranes); quantitative real-time PCR (qPCR); sterile intra-amniotic inflammation; POLYMERASE-CHAIN-REACTION; BLOOD-CELL COUNT; FACTOR-KAPPA-B; MOLECULAR-PATTERN MOLECULES; GAMMA-INDUCING FACTOR; NON-CULTURABLE STATE; PREMATURE RUPTURE; UREAPLASMA-UREALYTICUM; INTRAAMNIOTIC INFECTION; CLINICAL-SIGNIFICANCE;

D O I：

10.1515/jpm-2019-0398

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

Background: Intra-amniotic inflammation, which is associated with adverse pregnancy outcomes, can occur in the presence or absence of detectable microorganisms, and involves activation of the inflammasome. lntra-amniotic inflammasome activation has been reported in clinical chorioamnionitis at term and preterm labor with intact membranes, but it has not yet been investigated in women with preterm prelabor rupture of membranes (preterm PROM) in the presence/absence of detectable microorganisms. The aim of this study was to determine whether, among women with preterm PROM, there is an association between detectable microorganisms in amniotic fluid and intra-amniotic inflammation, and whether intra-amniotic inflammasome activation correlates with microbial burden. Methods: Amniotic fluids from 59 cases of preterm PROM were examined for the presence/absence of microorganisms through culture and 16S ribosomal RNA (rRNA) gene quantitative real-time polymerase chain reaction (qPCR), and concentrations of interleukin-6 (IL-6) and ASC [apoptosis-associated spec-like protein containing a caspase recruitment domain (CARD)], an indicator of inflammasome activation, were determined. Results: qPCR identified more microbe-positive amniotic fluids than culture. Greater than 50% of patients with a negative culture and high IL-6 concentration in amniotic fluid yielded a positive qPCR signal. ASC concentrations were greatest in patients with high qPCR signals and elevated IL-6 concentrations in amniotic fluid (i.e. intra-amniotic infection). ASC concentrations tended to increase in patients without detectable microorganisms but yet with elevated IL-6 concentrations (i.e. sterile intraamniotic inflammation) compared to those without intraamniotic inflammation. Conclusion: qPCR is a valuable complement to microbiological culture for the detection of microorganisms in the amniotic cavity in women with preterm PROM, and microbial burden is associated with the severity of intra-amniotic inflammatory response, including inflammasome activation.

引用

页码：115 / 131

页数：17