| IntroductionPremature rupture of membrance ( PROM ) is fetal membrance rupture before formal stages of labor, a normal complication of obsterics, about 10 percent of the whole sum of delivery, 2. 0 ~ 3. 5 percent of the whole sum of premature delivery. Because of the vanished barrier action, it always follows many serious complications, such as intraamniotic infection , perinatal infection , premature delivery , asphyxia of fetus and etc, even a treat against pregnancy woman and fetus, so the investigations is still going on. But the mechanisms isnot clear , data display infection may be most associational with PROM.InibinA (INHA) and activinA (ACTA) are multifunction cell factor , mostly excreted by placenta and fetal membrane of pregnancy, can acceleerate the lighten and resum of infection , influence the fetal membrane excreting Prosta-glandin(PG). ACTA involve in adjustment of organism acute reactivity , effecting monocyte , is able to antagonistic Interleukin -6(IL - 6) ,Interleukin - 1b (IL - 1b) , its forecasting inferior - clinic infection has been reported both here and abroad. INHA can interdict ACTA in serious reactivitis, act as important role in immunological tolerance. This study discuss the relation between PROM and INHA, ACTA, through exzmining them in the serum or fetal membrance, in order to make a diagnosis and give treatment in clinic.Materials and MethodThe source of materialsI selected twenty - five PROM patients as examine cases. They all delivered at the second Affiliated Hospital of China Medical University from October, 2004 to June ,2005. The cases are all at the age of 23 to35, average 28.4 3.76, and gestation week from 37 to 41 +5. Including cases didn't use antibiotic drugs before, and havn't any clinical infection sign or other complication during pregnancy except PROM, the lasting time of the membrane rupture is not longer than 24 hours, the patients are primiparity, single birth, head presentation, before cera section.Nineteen normal pregnancy women act as the control cases. Compared with PROMcases, they have no obvious diffrence in age and gestation weeks (P > 0. 05).Using the analysis of pathological standards, these cases can also be divided into two groups;chorioamnionitis group and non — chorioamnionitis group.ReagentsHuman ACTA ELISA reagent box Human INHA ELISA reagent boxMethods1. I collected 2ml blood inelbow vein of all pregnancy women. The blood was certrifuged at 3000rpm for 20 minutes, and then stored at — 80T! for next step of measurement. I selected 2cm x 3cm x 0. 5cm fetal membrane close to the inner lervical oriface in 7cm, immediately after the labour of cases.2. Using HE - staining, we can diagnose whether chorioamnionitis exist or not3. Using ELISA(Enzyme - Linked immunosorbent assay) to test the quantity of INHA and ACTA in pregnancy women'serum.4. Statistical analysis: Using SPSS software. Significant level standard e-quals ( a = 0. 05 ) , when P < 0. 05, we say that the results have significant difference.Result1. The AVTA quantity in maternal blood and fetal membrane of PROM patients and those in non - PROM patients has statistical significance.2. The AVTA quantity of maternal blood and fetal membrane in the cases of Choroamnionitis and non - Choroamnionitis has statistical significance.3. The AVTA quantity in maternal blood of Choroamnionitis and non -Choroamnionitis of PROM are in positive proportion to the quantity of fetal membrane.4. The INHA quantity in maternal blood and fetal membrane of PROM patients and those in non - PROM patients has not statistical significance.5. The INHA quantity in maternal blood and fetal membrane of Choroamnionitis and non - Choroamnionitis has not statistical significance.DiscussionThe relation of AVTA and PROMAs multifunction cell factor AVTA take part in antibody immunoloregulation reactivity, infection reactivity in acute period. It mostly excretioned by tropho-blastic cell in pregnancy, and increase gradually with pregnancy. It has been investigated that AVTA could block IL - 6 biological effect , indicating the expression of AVTA in infection reaction can help prevent some injure of inflammatory reaction in body. At the same, the AVTA excretion of fetal membrane may adjust the quantity of IL -8^PGE2. But whether AVTA produce a marked effect is not clear.The result of my study shows that the quantity of ACTA in maternal blood and fetal membrane of Choroamnionitis and PROM obviously higher than that normal control, also has statistical significant, recovering ACTA involves onset of PROM. The mechanism may be: KACTA couldlnhibit the excretion of acute reaction protein, aid to prevent injury of overreacting in body. 2^induction cell-proliferation of T^Bcell and acceleration NK cell poison activity. 3^some investi-gation certificate the ACTA concentration of some range in fetal membrane can stimulate the produce of IL - 6 IL - 8 PGE2 resulting membrane tension rising in PROM , making produce MMP -9NMMPs/TIMPs equilibration destruction^ most collagen of fetal membrane degradation, so PROM happen. ACTA stimulate MMP expression that effectly degrate expression of extracellular matrix (ECM) , so that fetal membrane is easy to disrupt.It has been reported that ACTA level in fetal membrane of premature birth or normal labor is higher than the control, recovering ACTA take part in maintenance of term pregnancy and onset birth.the relation of INHA and PROMINHA is transforming growth factor ( TGF) as ACTA , play local action by paracrine and autocrine. TGF counsel a serious cell process(cell deaths proliferation N differentiation) as prototype factor , have immunogenicity. Its role include protection pregnabcy and immunoloregulation, and it is excreted by nourish cell. The concentration rise gradually in pregnancy process to the top at term. The result of my experiment indicate INHA has not statistical significance( P >0.05) with not parturien PROM and Choroamnionitis.ConclusionACTA react highly in PROM and Choroamnionitis. INHA has not statistical significance with PROM and Choroamnionitis.
|
PDF Full Text Request