探讨母血、羊水、脐血中三种细胞因子白细胞介素–6，–8(interleukin–6，–8，IL–6，–8)和血管细胞黏附分子–1(vascular cell adhesion molecule, VCAM–1)对胎膜早破(premature rupture of membrance, PROM)、绒毛膜羊膜炎和新生儿预后判断的临床意义。

采用双抗体夹心酶联免疫吸附法，检测58例胎膜早破(PROM组，n＝58)及38例正常孕妇(对照组，n＝38) 母血、羊水、脐血中白细胞介素–6，–8和血管细胞黏附分子–1水平的动态变化，并进行胎膜病理学检查。同时，PROM组按破膜时间分为三组。A1组(n＝29)破膜时间为16 h，A2组(n＝19)破膜时间为(16～24) h，A3组(n＝10)破膜时间为>24 h。另外，PROM组与对照组孕妇按病理学检查结果，分为绒毛膜羊膜炎组(n＝15)，非绒毛膜羊膜炎组(n＝81)。按照PROM组孕妇所产新生儿的Apgar评分，将PROM组分为B1组(n＝7，Apgar评分≤7分)和B2组(n＝51，Apgar评分≥8分)(分组遵循程序符合扬州大学临床医学院负责人体试验委员会所制定的伦理学标准，并得到该委员会批准，分组征得受试对象的知情同意)。所有个体均无母体疾病、其他产科并发症及胎儿、胎位异常。

PROM组母血、羊水、脐血中白细胞介素–6，–8和血管细胞黏附分子–1的含量均高于对照组，且含量随破膜时间的延长而升高，尤其破膜时间超过24 h(A3组)时，升高更为明显。绒毛膜羊膜炎组患者母血、羊水、脐血中白细胞介素–6，–8和血管细胞黏附分子–1水平明显高于非绒毛膜羊膜炎组患者，两组比较，差异有显著意义(P<0.05，P<0.01)。PROM组产妇所生新生儿的Apgar评分≤7分组，其母血、羊水、脐血中白细胞介素–6，–8和血管细胞黏附分子–1含量显著高于Apgar≥8分组(P<0.05，P<0.01)。

白细胞介素–6，–8和血管细胞黏附分子–1三种细胞因子联合检测，可用于对胎膜早破、绒毛膜羊膜炎进行早期诊断，对新生儿预后判断也具有一定的临床价值。

To evaluate cytokines levels (interleukin-6, -8 and vascular cell adhesion molecule-1)in maternal serum, amniotic fluid and umbilical cord serum in women with premature rupture of membranes (PROM).

The levels of interleukin-6, -8 and vascular cell adhesion molecule-1 in maternal serum, amniotic fluid, and umbilical cord serum were detected by enzyme linked immunosorbent assay in 58 pregnant women with premature rupture of membranes (PROM group) and 38 normal pregnant women (control group). Informed consent was obtained from all participants. Chorioamnionitis was histopathologically confirmed after the delivery. The PROM group were divided into 3 groups. They were group A1 (n=29, 16 hours of the duration of the rupture of membrance), group A2 (n=19, 16 h~24 h of the duration of rupture of membrance), group A3(n=10, >24 hours of the duration of the rupture of membrance). The PROM group and the control group were divided into chorioamnionitis group (n=15) and non-chorioamnionitis group (n=81). The PROM group were divided into 2 groups. They were group B1(n=7, Apgar score≤7) and group B2(n=81, Apgar score≥8).

The levels of interleukin-6, -8 and vascular cell adhesion molecule-1 were significantly higher in the PROM group than those in the control group(P<0.05, P<0.01). The longer the duration of the rupture of membrance to delivery was, the more serious chorioamnionitis was, and the higher the levels of interleukin-6, -8 and vascular cell adhesion molecule-1. The levels of interleukin-6, -8 and vascular cell adhesion molecule-1 were significantly higher in maternal serum, amniotic fluid, and umbilical cord serum in patients with chorioamnionitis than those of non-chorioamnionitis(P<0.05, P<0.01). In the PROM group, the levels of interleukin-6, -8 and vascular cell adhesion molecule-1 were significantly higher in neonates whose Apgar score≤7 than those of neonates whose Apgar score≥8.

Cytokines may implicate the pathophysiologic mechanisms of preterm and term labor. The measurement of interleukin-6, -8 and vascular cell adhesion molecule-1 concentrations in maternal serum, amniotic fluid, and umbilical cord serum is a useful biomarker for identifying the chorioamnionitis and predicting premature rupture of membrance.