Şevki Çelen, Yavuz Şimşek, Nida Erol, Oya Şengezer, Cuma Taşın, Ümran Büyükkağnıcı

İkinci Trimester Amniyotik Sıvı TNF-alfa ve IL-6 Düzeylerinin Preterm Doğumu ve Yenidoğan Yoğun Bakım İhtiyacını Tahmin Etmede

Amaç: Prematür doğum neonatal morbidite ve mortalite ile ilişkili en sık rastlanan perinatal komplikasyondur. Bu olguların önceden belirlenmesi ve zamanında müdahale ile preterm doğum ve bunula ilişkili komplikasyonlar azaltılabilir. Bu çalışmada ikinci trimesterde genetik amniyosentez yapılan hastalarda amniyotik sıvı TNF-a ve IL-6 düzeyleri ölçülerek, preterm doğum riski ile ilişkisi değerlendirildi. Materyal-metod: Çalışmaya çeşitli endikasyonlarla genetik amniyosentez yapılan 88 hasta dahil edildi. İşlem sırasında alınan 3 cc'lik amniyotik sıvıda TNF-a ve IL-6 düzeyleri çalışıldı. Hastalar 33 hafta ve altında (Grup 1), 34-36 hafta arasında (Grup 2) ve 37 hafta ve üzerinde (Grup 3) doğum yapanlar olmak üzere 3 gruba ayrılarak ikinci trimester TNF-a ve IL-6 düzeyleri karşılaştırıldı. Bulgular: Grupların obstetrik karakteristikleri arasında anlamlı farklılık saptanmadı. Grup 1,2 ve 3'ün TNF alfa değerleri sırasıyla 39,8±4,8 pg/ml (33,5-48,0); 31,9±4,5 pg/ml (23,9-42,2); 28,0±6,1 pg/ml (11,6-39,3) saptandı (P<0,001). Grup 1,2 ve 3'ün IL-6 değerleri sırasıyla 815,4±216,5 pg/ml (483-1000); 394,9±130,3 pg/ml (234-752); 290,1±200,8 pg/ml (59-1000) saptandı (P<0,001). Grup 1'deki tüm yenidoğanlar yoğun bakımda takip edildi. Grup 2'deki yenidoğanların %15,7'si; Grup 3'deki yenidoğanların %1,69'u yoğun bakım takibi gerektirdi. Sonuç: Preterm doğum yapan hastaların etiyolojisinde amniyotik sıvıda artmış inflamasyon erken gebelik haftalarından itibaren saptanabilir. Erken ikinci trimesterde amniyotik sıvıda ölçülen TNF-alfa ve IL-6 düzeylerindeki artış hastaların preterm doğum riski ve yeni doğan yoğun bakım ihtiyacı ile ilişkilidir. Anahtar kelimeler: Preterm Doğum; Yenidoğan Yoğun Bakımı; TNF a; IL-6.

Anahtar Kelimeler:

Preterm Doğum; Yenidoğan Yoğun Bakımı; TNF a; IL-6.

Midtrimester Amniotic Fluid TNF-alpha and IL-6 Levels in the Prediction of Premature Delivery and Admission to Neonatal Intensive Care Unit

Objective: The most common perinatal complication associated with neonatal morbidity and mortality is premature delivery. Prediction of these cases and timely intervention can prevent premature delivery and its complications. In this study, amniotic fluid TNF-a and IL-6 levels were measured at second trimester of pregnancy in order to investigate their correlation with premature delivery. Material and methods: 88 patients underwent to a genetic amniocentesis were included to the sutdy. TNF-a and IL-6 levels were measured in 3 cc sample of amniotic fluid taken during amniocentesis. Patients were divided into three groups according to their delivery time: patients those were delivered at or before 33th week of gestation were assigned as Group 1; patients delivered between 34-36th week of gestation were assigned Group 2; patients those delivered at or after 37th week of gestation were assigned as Group 3. TNF-a and IL-6 levels of the groups were compared. Results: The main obstetric characteristic of the groups were not significantly different. TNF-a levels of the groups were 39,8±4,8 pg/ml (33,5-48,0); 31,9±4,5 pg/ml (23,9-42,2) and 28,0±6,1 pg/ml (11,6-39,3), respectively (P<0,001). IL-6 levels of the groups were 815,4±216,5 pg/ml (483-1000); 394,9±130,3 pg/ml (234-752); 290,1±200,8 pg/ml (59-1000), respectively (P<0,001). The all newborns of Group 1, 15,7% of the newborns in Group 2 and 1,69% of the newborns in Group 3 were admitted to the neonatal intensive care unit. Conclusion: The increased inflammation in the amniotic fluid in patients with premature delivery can be detected from the earlier gestational weeks. The increase in the amniotic fluid levels of TNF-a and IL-6 at early midtrimester of pregnancy is associated with premature delivery and increased admission rate to neonatal intensive care unit. Key words: Premature Delivery; Neonatal Intesive Care; TNF-a; IL-6.

Keywords:

Premature Delivery; Neonatal Intesive Care; TNF-a; IL-6.,

PDF

___

Lang CT, Iams JD. Goals and strategies for prevention of preterm birth: an obstetric perspective. Pediatr Clin North Am 2009; 56(3): 537-63.
Mally PV, Bailey S, Hendricks-Muñoz KD. Clinical issues in the management of late preterm infants. Curr Probl Pediatr Adolesc Health Care 2010; 40(9): 218-33.
Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C; GAPPS Review Group. Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data. BMC Pregnancy Childbirth 2010; 23;10 Suppl 1:S1.
McCormick MC, Litt JS, Smith VC, Zupancic JA. Prematurity: an overview and public health implications. Annu Rev Public Health 2011; 21(32): 367-79.
Simmons LE, Rubens CE, Darmstadt GL, Gravett MG. Preventing preterm birth and neonatal mortality: exploring the epidemiology, causes, and interventions. Semin Perinatol 2010; 34(6): 408-15.
Yoon BH, Romero R, Moon JB, Shim SS, Kim M, Kim G, Jun JK. Clinical significance of intra-amniotic inflammation in patients with preterm labor and intact membranes. Am J Obstet Gynecol 2001;185(5): 1130-6.
Puchner K, Iavazzo C, Gourgiotis D, et al. Mid-trimester amniotic fluid interleukins (IL-1β, IL-10 and IL-18) as possible predictors of preterm delivery. In Vivo 2011; 25(1): 141-8.
Vedovato S, Zanardo V. Chorioamnionitis and inflammatory disease in the premature newborn infant. Minerva Pediatr. 2010; 62(3 Suppl 1): 155-6.
El-Bastawisi AY, Williams MA, Riley DE, Hitti J, Krieger JN. Amniotic fluid interleukin-6 and preterm delivery: A review. Obstet Gynecol 2000; 95(6 Pt2): 1056-64.
Thomakos N, Daskalakis G, Papapanagiotou A, Papantoniou N, Mesogitis S, Antsaklis A. Amniotic fluid interleukin-6 and tumor necrosis factor-alpha at mid-trimester genetic amniocentesis: relationship to intra-amniotic microbial invasion and preterm delivery. Eur J Obstet Gynecol Reprod Biol 2010; 148(2): 147-51.
Ghezzi F, Franchi M, Raio L, et al. P. Elevated amniotic fluid C- reactive protein at the time of genetic amniocentesis is a marker for preterm delivery. Am J Obstet Gynecol 2002; 186(2): 268-73.
Kara M, Ozden S, Arioglu P, Cetin A. The significance of amniotic fluid interleukin-6 levels in preterm labour. Aust N Z J Obstet Gyneacol 1998; 38: 403-6.
Bamberg C, Fotopoulou C, Thiem D, Roehr CC, Dudenhausen JW, Kalache KD. Correlation of midtrimester amniotic fluid cytokine concentrations with adverse pregnancy outcome in terms of spontaneous Abortion, preterm birth, and preeclampsia. J Matern Fetal Neonatal Med 2011.
Romero R, Yoon BH, Mazor M, et al. The diagnostic and prognostic value of amniotic fluid white blood cell count, glucose, interleukin-6, and gram stain in patients with preterm labor and intact membranes. Am J Obstet Gynecol 1993; 169(4): 805-16.
Hasson D, Spong CY, Ghidini A. Levels of interleukin-6 in second-trimester amniotic fluid are not predictive of adverse neonatal outcome. J Matern Fetal Med 2001; 10(1): 35-9.
Wu HC, Shen CM, Wu YY, Yuh YS, Kua KE. Subclinical histologic chorioamnionitis and related clinical and laboratory parameters in preterm deliveries. Pediatr Neonatol 2009; 50(5): 217-21.
Baud O, Emilie D, Pelletier E, et al. Amniotic fluid concentrations of interleukin-1beta, interleukin-6 and TNF-alpha in chorioamnionitis before 32 weeks of gestation: histological associations and neonatal outcome. Br J Obstet Gynaecol 1999; 106(1):72-7.