宫内炎症及宫内感染机制的研究进展

宫内炎症(intrauterine inflammation,IUI)在排卵、着床、蜕膜化、胎盘形成和分娩过程中均起关键作用,并对母体和胎盘健康以及胎儿的生长发育产生影响.宫内感染(intrauterine infection,IAI)可激活炎症机制从而导致早产,并且IAI可导致高的胎儿死亡率及存活儿童残疾率.然而,目...     

宫内感染与妊娠结局

宫内感染是指孕妇受病原体感染后所引起的胎儿感染。其特点是孕妇往往无明显临床表现或仅有轻微症状,但对围产儿则产生严重危害,尤其是妊娠早期的感染对胎儿威胁更大。本文就宫内感染对妊娠的影响结局浅述如下。1宫内感染的病原体     

胎盘Hofbauer细胞与HBV宫内感染

Hofbauer细胞起源于绒毛问质,是胎盘巨噬细胞,不仅能够吞噬入侵的病原微生物,参与母胎免疫反应;还可表达DC—SIGN、Fc等多种受体,这些受体分子可与乙肝病毒颗粒相互作用,使病毒通过跨膜转运进入细胞内。同时HofDauer细胞能够在母体间游走,当HBV感染Hofbauer细胞后,可借助HoPoauer细胞游走性介导HBV宫内感染。     

新生儿胃液乙肝标志物与宫内感染关系的研究

目的:探讨新生儿外周血及胃液HBeAg、HBsAg等标志物与乙型肝炎病毒宫内感染的关系.方法:连续收集母亲外周血标本和新生儿外周血及胃液标本,ELISA检测HBeAg、HBsAg,PCR方法检测HBVDNA;以ABBOTT试剂检测新生儿股静脉血的HBsAg.采用X2检验、精确检验等统计学方法对结果进行分析.结果:共收集133例母亲、新生儿血标本和胃液标本.5例新生儿发生宫内感染;133例新生儿中单纯胃液HBsAg阳,阳性有58例,单纯胃液HBeAg阳性9例,胃液HBsAg和HBeAg同时阳性7例,胃液HBeAg、HBsAg均阴性73例.PCR检测显示.胃液标本HBVDNA均阴性.统计学检验显示新生儿胃液HBsAg与乙肝病毒宫内感染有关系,而胃液HBeAg与乙肝病毒宫内感染无关系.结论:新生儿胃液HBsAg与乙肝病毒宫内感染有关,但是由于所有标本HBVDNA均阴性,尚不支持乙肝病毒宫内感染的胃液途径.     

乙型肝炎病毒外膜大蛋白和HBVDNA血清学诊断价值

目的探讨乙型肝炎病毒外膜大蛋白和HBV-DNA在乙肝患者中的血清学诊断价值。方法收集乙肝两对半(HBV-M)中HBsAg阳性血清标本260例作为乙肝研究组,乙肝两对半(HBV-M)阴性血清标本100例作为正常对照组;在不同乙肝模式中采用酶联免疫吸附试验(ELISA)检测血清HBV-LP和Pre-S1,荧光定量PCR检测HBV DNA;比较HBeAg血清中HBV-LP与HBV-DNA和不同HBV-DNA拷贝数的条件下HBV-LP与HBV-DNA剂量关系。结果HBsAg阳性血清中HBV-LP、HBV-DNA和Pre-S1阳性率分别为68.46%、63.08%和24.23%;HBeAg阳性标本中HBV-LP、HBV-DNA和Pre-S1阳性率分别为94.87%、94.87%和79.49%;HBeAg阴性标本中HBV-LP、HBV-DNA和Pre-S1阳性率分别为62.64%、49.45%和0.55%,HBV-LP和HBV-DNA二者检出一致率为67.03%[(50+72)/182];HBV-LP吸光度(A值)与HBV DNA呈正相关。结论HBV-LP与HBV-DNA在HBeAg阳性血清中代表病毒复制具有较高检出一致率;HBV-LP与HBV-DNA在HBeAg阴性血清中具有较大的差异性,HBV-DNA阴性血清中检测HBV-LP反应乙肝病毒复制对乙肝抗病毒治疗更有重要意义;HBV DNA拷贝数与HBV-LP含量呈正相关系。     

PI3K 与乙型肝炎病毒宫内感染的相关研究

慢性乙型肝炎病毒(Hepatitis B virus,HBV)感染是全世界关注的公共卫生问题。我国是乙肝高流行区,每年约有150万乙肝病毒携带者分娩,近半数胎儿通过母婴垂直传播感染乙肝。由于婴幼儿期感染乙肝后形成的免疫耐受,往往成为慢性甚至终身携带者,逐渐发展为肝硬化、肝癌。近年来的研究发现,PI3-Akt信号通路与妊娠生及或病理过程关系密切,在感染HBV的胎盘组织中发现PI3K-Akt信号通路中相关蛋白表达异常增高,且HBx Ag干扰该通路调节凋亡功能。推断HBx Ag通过调节PI3K-Akt信号通路活性影响胎盘功能,是HBV宫内感染的一种重要分子机制。为今后阻断HBV宫内感染提供新的研究方向。     

新婚夫妇HBV感染的研究

为了研究性因素在乙型肝炎传播中的意义,对1697对婚前登记的男女用RIA法检测血清HBV指征(HBsAg、抗-HBs、抗-HBc)。选出57对一方HBsAg和抗-HBc阳性,另一方为HBV易感者做为实验观察组,61对双方均为HBV易感者做为对照观察组。婚后27个月第二次抽血,双份血清用同一批RIA试剂检测HBV指征。结果,实验组HBV易感方HBsAg阳转率为14.04％,HBV感染率为52.63％;对照组HBsAg阳转率为1.64％,HBV感染率为16.03％。两组比较,相对危险性为:HBsAg RR=8.6,HBV RR=3.1,差异非常显著,P <0.01。     

胎膜早破后羊水残余量与宫内感染和新生儿发病率的相关性分析

目的：探讨胎膜早破后残余羊水量与宫内感染和新生儿发病率的相关性。方法：根据产妇胎膜早破后残余羊水指数（Amnitic Fluid Index,AFI）的监测结果,将本组120例产妇分为三组：羊水量正常组82例;羊水量较少组20例;羊水量过少组18例。所有产妇入院后行胎膜早破常规处理,回顾分析并统计三组产妇宫内感染率,胎儿窘迫率和新生儿发病率。结果：在宫内感染发生率上,三组比较,差异具有显著性,羊水量较少组、羊水量过少组宫内感染的发生率明显高于羊水量正常组（P〈0．01）。在胎儿窘迫发生率上,三组比较,差异无统计学意义（P〉0．05）。在新生儿发病率上,三组比较,差异具有显著性,羊水量较少组、羊水量过少组新生儿的发病率明显高于正常纽（P〈0．01）。Logistic回归分析发现羊水量、产妇基础性疾病和分娩孕周为孕产妇宫内感染和新生儿发病的关键影响因素。结论：胎膜早破后残余羊水量过少与宫内感染和新生儿发病=翠的升高密切相关,产妇于胎膜早破后应加强残余羊水量的监测,以采取有效措施降低宫内感染和新生儿发病的发生率。     

孕中期巨细胞病毒宫内感染与血Free-β-HCG水平的相关性研究

目的:通过检测孕中期妇女人巨细胞病毒(HCMV)活动性感染、宫内感染以及血Free-β-HCG水平,分析血Free-β-HCG水平与HCMV宫内感染的相关性,初步探讨其可能影响机制.方法:通过酶免法测孕妇血HCMV-IgM和定荧光定量PCR对孕中期妇女血清和羊水中HCMV-DNA的检测以及DILFIA法(时间分辨免疫荧光法)定量检测孕中期妊娠妇女血Free-β-HCG的含量,研究HCMV感染状况与Free-β-HCG之间的相关性,探讨HCMV对母血Free-β-HCG水平的影响.结果:718例样本中共检出HCMV-IgM阳性和(或)HCMV-DNA阳性者共43例并进一步行产前诊断羊水HCMV-DNA阳性14例.孕中期HCMV活动性感染率为5.98％,HCMV宫内感染率为2.22％.孕中期感染组Free-β-HCG含量:7.32± 2.25 ng/ml,非感染组:8.47± 3.17 ng/ml,对照组:10.10± 3.67 ng/ml.结论:HCMV宫内感染组比非感染组孕中期外周血Free-β-hcG的测定水平降低,两者结果之间的差异具有统计学意义.HCMV可通过损伤胎盘绒毛滋养层细胞,使Free-β-hcG的分泌减少.     

重庆地区乙肝血清特殊模式患者HBV基因分型及临床自然病程分析

目的了解重庆地区乙肝病毒（HBV）血清学标志物为特殊模式的HBV感染患者病毒基因型的分布情况,分析其临床特征及自然病程。方法从1000例HBV感染者中检测到48例乙肝病毒血清学标志物为特殊模式的患者（HBsAg与抗一HBs同时阳性,HBeAg与抗一HBe同时阳性）。采用巢式聚合酶链式反应（nPCR）对特殊模式患者的HBV进行基因分型,同时对两组特殊模式患者的临床资料和HBV感染的自然史进行分析。结果48例乙肝病毒血清学标志物为特殊模式的HBV感染者中,36例患者HBsAg与抗-HBs同时阳性,12例患者HBeAg与抗-HBe同时阳性。HBeAg＋／抗-HBe＋患者组的年龄较HBsAg＋／抗-HBs＋患者组的小（P〈0．05）。HBsAg＋／抗-HBs＋患者中,3例（8．3％）为B2亚型,12例（33．3％）为c2亚型,21例（58．4％）未分型;HBeAg＋／抗-HBe＋患者中,8例（66．7％）为B2亚型,1例（8．3％）为c2亚型,3例（25．0％）未分型,两组在HBV基因型的分布上差异具有统计学意义（Y2=17．44,P〈0．05）。在HBsAg＋／抗-HBs＋患者中,2例（4．2％）处于免疫清除期,14例（29．2％）处于低复制期,7例（14．6％）处于再活动期。HBeAg＋／抗-HBe＋患者中,5例（10．4％）处于免疫清除期。两组在HBV感染的自然病程中的分布差异具有统计学意义（X2=18．26,P〈0．05）。结论重庆地区乙肝病毒血清学标志物为特殊模式的慢性HBV感染者中,HBeAg与抗-HBe同时阳性的HBV感染者中B2亚型为优势基因型;HBsAg与抗-HBs同时阳性的HBV感染者中,HBV基因型以C2亚型为主。     

HIV infection in pregnant women in Chelyabinsk

Data on HIV infection in pregnant women in Chelyabinsk are presented. Starting from 1999, a considerable rise in the number of HIV-infected persons was registered in this city. The social and epidemiological characteristics of HIV-infected pregnant women, as well as the main routes and factors of the infective agent transmission, are given. Relationship between the spread of HIV-infection and drug addiction is revealed. The occurrence of different opportunistic infections in HIV-infected pregnant women is determined.     

Social determinants associated with Zika virus infection in pregnant women

This study aims to describe the sociodemographic determinants associated with exposure to Zika Virus (ZIKV) in pregnant women during the 2015–2016 epidemic in Salvador, Brazil.MethodsWe recruited women who gave birth between October 2015 and January 2016 to a cross-sectional study at a referral maternity hospital in Salvador, Brazil. We collected information on their demographic, socioeconomic, and clinical characteristics, and evaluated their ZIKV exposure using a plaque reduction neutralization test. Logistic regression was then used to assess the relationship between these social determinants and ZIKV exposure status.ResultsWe included 469 pregnant women, of whom 61% had a positive ZIKV result. Multivariate analysis found that lower education (adjusted Prevalence Rate [aPR] 1.21; 95%CI 1.04–1.35) and food insecurity (aPR 1.17; 95%CI 1.01–1.30) were positively associated with ZIKV exposure. Additionally, age was negatively associated with the infection risk (aPR 0.99; 95%CI 0.97–0.998).ConclusionEve after controlling for age, differences in key social determinants, as education and food security, were associated with the risk of ZIKV infection among pregnant women in Brazil. Our findings elucidate risk factors that can be targeted by future interventions to reduce the impact of ZIKV infection in this vulnerable population.     

Pregnancy-associated inflammatory markers are elevated in pregnant women with systemic lupus erythematosus

During normal pregnancy a dampening in T cell-mediated immunity is compensated by an increased pro-inflammatory activity. Likewise, the autoimmune disease systemic lupus erythematosus (SLE) is associated with inflammatory activity and pregnancy complications occur frequently in women with SLE. The aim of this study was to elucidate how SLE influences the chemokine and cytokine balance during and after pregnancy. Blood samples were taken from pregnant women with or without SLE at second and third trimester and 8-12 weeks after pregnancy. Cytokines (interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-10, IL-12p70, IL-17A, TNF, IFN-γ and IFN-α), chemokines (CXCL8/IL-8, CXCL9/MIG, CXCL10/IP-10, CCL2/MCP-1, CCL5/RANTES and CCL17/TARC), soluble IL-6 receptor (sIL-6R) and soluble glycoprotein 130 (gp130) were measured in serum using cytometric bead array (CBA) or enzyme-linked immunosorbent assay (ELISA). Women with SLE had increased serum concentrations of CXCL8/IL-8, CXCL9/MIG, CXCL10/IP-10 and IL-10 compared to controls both during and after pregnancy. Further, when dividing the patients based on disease activity, the women with active disease had the highest levels. Importantly, women with SLE seemed to respond to pregnancy in a similar way as controls, since the changes of cytokines and chemokines over the course of pregnancy were similar but with overall higher levels in the patient group. In conclusion, changes in pro- and anti-inflammatory serum components during pregnancy in women with SLE, occurring on top of already more pro-inflammatory levels, might increase their risk for pregnancy complications and flares. How their children are affected by this heightened inflammatory milieu during pregnancy needs further investigation.     

Effect of IL-18 on intrauterine infection of HBV in mice on cell molecular level

ObjectiveThe objective of this study is to investigate the effect of IL-18 on intrauterine infection of HBV (Hepatitis B Virus) in mice based on cellular and molecular level, and to analyze its mechanism, as well as the relationship between IL-18 and intrauterine infection of HBV.MethodsPregnant rats are taken as the study subjects and divided into two groups according to infection and non-infection, namely the study group and the control group. Firstly, the peripheral blood of rats and the blood of newborn mice are collected for the determination of hepatitis B in two-and-a-half pairs. Then, the levels of interleukin-18 (IL-18), interferon-γ (IFN-γ) and interleukin-4 (IL-4) in peripheral serum are detected by ELISA (Enzyme Linked Immunosorbent Assay). Finally, the two groups of horizontal values are compared and analyzed. The effect of IL-18 on intrauterine infection of HBV in mice is investigated based on the level of cell and molecular.ResultsThe levels of IL-18, IFN-γ, IL-4 and IFN-γ/IL-4 in the two groups are compared and analyzed. The levels of IL-18, IFN-γ and IFN-γ/IL-4 in the study group are significantly lower than those in the control group, with statistical significance. However, the level of IL-4 in the study group is higher than that in the control group, with statistical significance.ConclusionIt is found that the decrease of HL-type specific response and the enhancement of Th2-type specific response in pregnant mice are closely related to HBV intrauterine infection. Moreover, the decrease of IL-18 secretion in peripheral blood may cause intrauterine infection of HBV. This study can make people better realize the mechanism of HBV intrauterine infection, and effectively help clinical prevention and treatment of intrauterine infection.     

Toxoplasma gondii infection in pregnant women in China

Toxoplasmosis, caused by the protozoan parasite Toxoplasma gondii, is one of the most common parasitic infections in humans. Primary infection in pregnant women can be transmitted to the fetus leading to miscarriage or congenital toxoplasmosis. Carefully designed nationwide seroprevalence surveys and case-control studies of risk factors conducted primarily in Europe and America, have shaped our view of the global status of maternal and congenital infection, directing approaches to disease prevention. However, despite encompassing 1 in 5 of the world's population, information is limited on the status of toxoplasmosis in China, partly due to the linguistic inaccessibility of the Chinese literature to the global scientific community. By selection and analysis of studies and data, reported within the last 2 decades in China, this review summarizes and renders accessible a large body of Chinese and other literature and aims to estimate the seroprevalence in Chinese pregnant women. It also reviews the prevalence trends, risk factors, and clinical manifestations. The key findings are (1) the majority of studies show that the overall seroprevalence in Chinese pregnant women is less than 10%, considerably lower than a recently published global analysis; and (2) the few available appropriate studies on maternal acute infection suggested an incidence of 0·3% which is broadly comparable to studies from other countries.     

Differential expression of uterine NO in pregnant and nonpregnant rats with intrauterine bacterial infection

Previous studies have demonstrated that nitric oxide (NO) is involved in the uterine host defense against bacterial infection. In nonpregnant rats, NO production in the uterus was shown to be lower, and inducible NO synthase (NOS) expression was undetectable. However, studies in pregnant rats show abundant expression of inducible NOS with significant elevation in NO production in the uterus. We have recently reported that intrauterine Escherichia coli infection caused a localized increase in uterine NO production and inducible NOS expression in the nonpregnant rat. In our present study, we examined whether the uterine NO production, NOS expression, and uterine tumor necrosis factor-alpha protein are increased in pregnant rats with intrauterine pathogenic Escherichia coli infection. Unlike the nonpregnant state, the NO production in the infected uterine horn of pregnant rats was not significantly elevated after bacterial inoculation compared with the contralateral uterine horn. The expression of uterine NOS (types II and III) also did not show significant upregulation in the infected horn. This is in contrast to that in nonpregnant animals, in which type II NOS was induced in the uterus on infection. Moreover, intrauterine infection induced an elevated expression of tumor necrosis factor-alpha protein in the infected horn both of nonpregnant and of pregnant rats. These data suggest that the sequential stimulation of NOS expression, especially the inducible isoform, and generation of uterine NO are lacking during pregnancy despite an elevated tumor necrosis factor-alpha after infection. In summary, NO synthesis response may be maximal at pregnancy, and infection may not further induce the NO system. Present studies, together with our previous report that intrauterine infection-induced lethality in pregnancy rats was amplified with the inhibition of NO, suggest that pregnancy is a state predisposed for increased complications associated with intrauterine infection and that the constitutively elevated uterine NO during pregnancy may help contain or even reduce the risk of infection-related complications.     

Incidence of actinomycetes infection in women using intrauterine contraceptive devices

Pancervicovaginal smears taken from 350 women using an intrauterine contraceptive device (IUD) were screened for the presence of actinomycetes organisms. Of the 12 cases in which actinomycetes-like organisms were seen in Papanicolaou-stained smears, the presence of actinomycetes organisms was confirmed by immunofluorescence in 10 cases. The prevalence of actinomycetes infection was thus 2.8% (10 of 350 cases) in the IUD users. Eight (4.3%) of 173 symptomatic subjects had actinomycetes infections. Two of the positive cases were asymptomatic. Eight of the ten patients with confirmed actinomycetes infection were using the Cu T device while two were wearing the Lippes Loop IUD. Seven of the ten patients had been using an IUD for more than two years. The time of insertion of the IUD (postpuerperal, postmenstrual or after medical termination of pregnancy) did not show any correlation with the presence of actinomycetes infection. Actinomyces israelii was responsible for the infection in eight cases while Arachnia propionica was seen in two cases. The organisms could not be grown in culture.