摘要
目的 探讨胎盘NOD样受体热蛋白结构域相关蛋白3(NLRP3)、Toll样受体4(TLR4)、脂肪酸合成酶配体(Fasl)对未足月胎膜早破产妇宫内感染的诊断价值.方法 回顾性分析2021年3月—2023年3月四川省人民医院收治的未足月胎膜早破产妇172例的临床资料,根据宫内感染分为感染组53例和非感染组119例;分析两组临床资料,归纳未足月胎膜早破产妇宫内感染的危险因素;采用免疫组化法和实时荧光定量聚合酶链反应(RT-qPCR)分别检测胎盘NLRP3阳性率及Toll样受体4(TLR4)、脂肪酸合成酶l(Fasl)水平;比较两组胎盘NLRP3阳性率、TLR4、Fasl表达水平;采用受试者工作特征(ROC)曲线分析NLRP3、TLR4、Fasl单独及联合检测对未足月胎膜早破产妇宫内感染的诊断价值.结果 阴道检查次数、破膜孕周、中性粒细胞与淋巴细胞比值(NLR)、红细胞分布宽度(RDW)及降钙素原(PCT)是未足月胎膜早破产妇宫内感染的危险因素(P＜0.05);感染组胎盘NLRP3阳性表达率及TLR4、Fasl水平均高于非感染组(P＜0.05);绘制ROC曲线获得NLRP3、TLR4、Fasl单独及联合检测诊断未足月胎膜早破产妇宫内感染的曲线下面积(AUC)分别为0.787、0.744、0.721和0.917,联合检测的AUC高于各项单独检测(P＜0.05),且联合检测的敏感度和特异度为84.90％,84.00％.结论 未足月胎膜早破产妇宫内感染患者胎盘NLRP3、TLR4、Fasl呈高表达;联合检测NLRP3、TLR4、Fasl有助于诊断未足月胎膜早破产妇宫内感染;阴道检查次数、破膜孕周、NLR、RDW及PCT是未足月胎膜早破产妇宫内感染的危险因素.
Abstract
OBJECTIVE To investigate the diagnostic value of the Nod-like receptor heat protein domain associated protein 3,(NOd-like receptor heat protein domain associated protein 3,NLRP3),Toll-like receptor 4(TLR4)and Fatty acid synthase ligand(Fasl)levels in intrauterine infection in preterm women with premature rupture of membranes.METHODS Clinical data of 172 preterm women with premature rupture of membranes admitted to Si-chuan People's Hospital from Mar.2021 to Mar.2023 were retrospectively analyzed,and they were divided into the infected group of 53 cases and the non-infected group of 119 cases according to the intrauterine infection.The clinical data of the two groups were analyzed,and the risk factors of intrauterine infection in women with preterm premature rupture of membranes were summarized.The positive rate of NLRP3 expression,and the levels of TLR4 and Fasl in placenta were detected by immunohistochemistry and RT-qPCR,respectively.The positive rate of NLRP3 and the expression levels of TLR4 and Fasl were compared between the two groups.The receiver oper-ating characteristic(ROC)curve was used to analyze the diagnostic value of NLRP3,TLR4 and Fasl alone and in combination for intrauterine infection in preterm premature rupture of membranes.RESULTS The number of vagi-nal examinations,pregnancy week,NLR,RDW and PCT were the risk factors of intrauterine infection in preterm women with premature rupture of membranes(P＜0.05).The positive expression rate of NLRP3,and the levels of TLR4 and Fasl were higher in the infected group than in the non-infected group(P＜0.05).According to ROC curve,AUC of NLRP3,TLR4 and Fasl alone and in combination for the diagnosis of intrauterine infection in pre-term women with premature rupture of membranes were 0.787,0.744,0.721 and 0.917,respectively,and the AUC of combined tests was higher than that of each single test(P＜0.05),and with the sensitivity and specificity of the combined detection being 84.90％and 84.00％,respectively.CONCLUSION The placenta NLRP3,TLR4 and Fasl were highly expressed in intrauterine infection patients with preterm premature rupture of membranes.The combined detection of NLRP3,TLR4 and Fasl was helpful for the diagnosis of intrauterine infection in pre-term women with premature rupture of membranes.The number of vaginal examinations,pregnancy week,NLR,RDW and PCT were risk factors for intrauterine infection in preterm women with premature rupture of membranes.
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