Preterm birth: causes, pathogenesis, and management


Дәйексөз келтіру

Толық мәтін

Ашық рұқсат Ашық рұқсат
Рұқсат жабық Рұқсат берілді
Рұқсат жабық Рұқсат ақылы немесе тек жазылушылар үшін

Аннотация

Premature labor (PL) remains one of the most important obstetric problems, because perinatal morbidity and mortality are very high among premature babies. However, the pathogenesis of spontaneous PL remains unclear so far. Objective. To study the role of toll-like receptors (TLR2, TLR4, and TLR9) in the pathogenesis of spontaneous PL of unknown etiology at 25-33 weeks’ gestation. Subjects and methods. The investigation enrolled 165 pregnant women with a singleton pregnancy and threatened spontaneous PL at 25-33 weeks’ gestation; pregnant women with preeclampsia, placental insufficiency, infection, placenta previa, diabetes mellitus, fetal malformations or premature amniorrhea were excluded. After excluding the presence of an infectious agent in the cervix and vagina, the investigators selected 42 patients with the clinical presentations of threatened PL and 32 patients with uncomplicated pregnancy. The expression of TLR by the cervical canal epithelial cells was investigated by polymerase chain reaction. Results. The women with threatened PL had a history of high infection rates (71.4 and 21.9%; p <0.001). TLR2 expression by cervical canal epithelial cells in pregnant women with threatened PL was 3.65 times higher than in those with uncomplicated pregnancy (174.9 (132.3; 1996.3) and 48.0 (33.7; 109.1); p = 0.027), TLR4 expression was also higher (70.9 (28.3; 116.9) and 53.2 (17.7; 111.3); p = 0.072). At the same time, the expression of intracellular TLR9 was slightly lower in pregnant women with threatened PL (58.7 (17.1; 100.4) and 76.2 (57.0; 112.6)); p = 0.12). Conclusion. The findings may suggest that even with infectious agent exclusion and in the absence of an obvious inflammatory process in the vagina and cervix, the inflammatory process that results from TLR activation underlies the genesis of spontaneous PL.

Негізгі сөздер

Толық мәтін

Рұқсат жабық

Авторлар туралы

Vera Belousova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: desdemosha@mal.ru
candidate of medical sciences, associate professor of the Department of Obstetrics, Gynecology and Perinatology, Institute of Clinical Medicine

Alexander Strizhakov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: kafedra-agp@mail.ru
academician of the Russian Academy of Sciences, MD, professor, head of the Department of Obstetrics, Gynecology and Perinatology, Institute o f Clinical Medicine

Oksana Svitich

I.I. Mechnikov Research Institute of Vaccines and Sera

Email: svitichoa@yandex.ru
Corresponding Member of the Russian Academy of Sciences, MD, Professor, Director

Elena Timokhina

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: elena.timokhina@mail.ru
MD, professor of the Department of Obstetrics, Gynecology and Perinatology, Institute of Clinical Medicine

Polina Kukina

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: renoru47@gmail.com
Clinical Resident at the Institute of Clinical Medicine

Irina Bogomazova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: irinka.bogomazova@mail.ru
Candidate of Medical Sciences, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology, Institute of Clinical Medicine

Elena Pitskhelauri

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: elena-doc@rambler.ru
candidate of medical sciences, associate professor of the Department of Obstetrics, Gynecology and Perinatology, Institute of Clinical Medicine

Әдебиет тізімі

  1. Abrahams V.M., Stiehm R., Lockwood C.J. Immunology of the maternal-fetal interface//UptoDate, 2018. https://www.uptodate.com/contents/immunology-of-the-maternal-fetal-interface?search=Immunology%20of%20the%20 maternal-fetal%20interface&source=search_result&selectedTitle=1~150&usa ge_type=default&display_rank=1
  2. Wei S.Q., Fraser W., Luo Z.C. Inflammatory cytokines and spontaneous preterm birth in asymptomatic women: a systematic review. Obstet Gynecol. 2010; 116(2 Pt 1): 393-401. doi: 10.1097/A0G.0b013e3181e6dbc0.
  3. Ashford K., Chav an N.R., Wiggins A.T., Sayre M.M., Mc Cub bin A., Critchfield A.S., O’Brien J. Comparison of Serum and Cervical Cytokine Levels throughout Pregnancy between Preterm and Term Births. AJP Rep. 2018; 8(2): e113-e120. doi: 10.1055/s-0038-1656534
  4. Schatz F., Kayisli U.A., Vatandaslar E., Ocak N., Guller S., Abrahams V.M., Krikun G., Lockwood C.J. Toll-like receptor 4 expression in decidual cells and interstitial trophoblasts across human pregnancy. Am J. Reprod Immunol. 2012; 68(2):146-53. doi: 10.1111/j.1600-0897.2012.01148.x.
  5. Thaxton J.E., Nevers T.A., Sharma S. TLR-mediated preterm birth in response to pathogenic agents. Infect Dis Obstet Gynecol. 2010; 2010: pii: 378472. doi: 10.1155/2010/378472
  6. Стрижаков А.Н., Белоусова В.С., Свитич О.А. Клиническое значение toll-подобных рецепторов в патогенез преждевременных родов. Вопросы гинекологии, акушерства и перинатологии. 2016; 15(1): 35-41. doi: 10.20953/1726-1678-2016-1-35-40 doi: 10.20953/1726-1678-2016-1-35-40
  7. Mogo N.P., Martin L.F., Pereira A.C., Polettini J., Peragoli J.C., Coelho K.I., da Silva M.G. Gene expression and protein localization of TLR-1, -2, -4 and -6 in amniochorion membranes of pregnancies complicated by histologic chorioamnionitis. Eur J. Obstet Gynecol Reprod Biol. 2013; 171(1): 12-7. doi: 10.1016/j.ejogrb.2013.07.036.
  8. Cappelletti M., Lawson M.J., Chan C.C., Wilburn A.N., Divanovic S. Differential outcomes of TLR2 engagement in inflammation-induced preterm birth. J. Leukoc Biol. 2018; 103(3): 535-43. doi: 10.1002/JLB.3MA0717-274RR.
  9. Abrahams V.M., Potter J.A., Bhat G., Peltier M.R., Saade G., et al. Bacterial modulation of human fetal membrane Toll-like receptor expression. Am J. Reprod Immunol. 2016; 69: 33-40. doi: 10.1111/aji.12016
  10. Blencowe H., Cousens S., Chou D., Oestergaard M., Say L., Moller A.B., Kinney M., Lawn J.; Born Too Soon Preterm Birth Action Group. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health. 2013; 10 Suppl 1: S2. doi: 10.1186/1742-4755-10-S1-S2.
  11. Okamura Y., Watari M., Jerud E.S., Young D.W., Ishizaka S.T., Rose J., Chow J.C., Strauss J.F. 3rd. The extra domain A of fibronectin activates Toll-like receptor 4. J. Biol Chem. 2001; 276(13): 10229-33. PMID: 11150311 Free Article
  12. Yu L., Wang L., Chen S. Endogenous toll-like receptor ligands and their biological significance. J. Cell Mol Med. 2010; 14(11): 2592-603. doi: 10.1111/j.1582-4934.2010.01127.x.
  13. Chin P.Y., Dorian C.L., et al. Novel Toll-like receptor-4 antagonist (+)-naloxone protects mice from inflammation-induced preterm birth. Sci Rep. 2016; 6: 36112. doi: 10.1038/srep36112

Қосымша файлдар

Қосымша файлдар
Әрекет
1. JATS XML
Жүктеу

© Bionika Media, 2020

Осы сайт cookie-файлдарды пайдаланады

Біздің сайтты пайдалануды жалғастыра отырып, сіз сайттың дұрыс жұмыс істеуін қамтамасыз ететін cookie файлдарын өңдеуге келісім бересіз.< / br>< / br>cookie файлдары туралы< / a>