母血及羊水中TIM-3、GATA-3水平对胎膜早破合并宫内感染的诊断价值

doi:10.11958/20221201

天津医药 ›› 2023, Vol. 51 ›› Issue (3): 315-319.doi: 10.11958/20221201

母血及羊水中TIM-3、GATA-3水平对胎膜早破合并宫内感染的诊断价值

王思思(), 谢双双, 孟玥秀, 张翔云, 刘云春

河北北方学院附属第一医院妇产科（邮编075000）

收稿日期:2022-08-01 修回日期:2022-10-11 出版日期:2023-03-15 发布日期:2023-03-02
作者简介:王思思（1985），女，硕士，主治医师，主要从事妇产科临床方面研究。E-mail：wangsisi927@163.com
基金资助:
河北省医学科学研究重点课题计划项目(20180851);张家口市重点研发计划项目(2121153D)

The diagnostic value of TIM-3 and GATA-3 levels in maternal blood and amniotic fluid for premature rupture of membranes complicated with intrauterine infection

WANG Sisi(), XIE Shuangshuang, MENG Yuexiu, ZHANG Xiangyun, LIU Yunchun

Department of Obstetrics and Gynecology, the First Hospital Affiliated to Hebei North University, Zhangjiakou 075000, China

Received:2022-08-01 Revised:2022-10-11 Published:2023-03-15 Online:2023-03-02

王思思, 谢双双, 孟玥秀, 张翔云, 刘云春. 母血及羊水中TIM-3、GATA-3水平对胎膜早破合并宫内感染的诊断价值[J]. 天津医药, 2023, 51(3): 315-319.

WANG Sisi, XIE Shuangshuang, MENG Yuexiu, ZHANG Xiangyun, LIU Yunchun. The diagnostic value of TIM-3 and GATA-3 levels in maternal blood and amniotic fluid for premature rupture of membranes complicated with intrauterine infection[J]. Tianjin Medical Journal, 2023, 51(3): 315-319.

摘要/Abstract

摘要： 目的分析母血及羊水中T细胞免疫球蛋白黏蛋白分子-3（TIM-3）、GATA结合蛋白3（GATA-3）水平对胎膜早破（PROM）合并宫内感染的诊断价值。方法选择PROM患者89例作为研究对象，发生宫内感染者42例作为感染组，未发生宫内感染者47例作为未感染组，并选择同期正常足月孕妇45例作为对照组。根据宫内感染严重程度将PROM合并宫内感染患者分成轻度组16例、中度组17例、重度组9例。检测血、羊水中TIM-3、GATA-3 mRNA及蛋白水平，比较对照组、未感染组、感染组和不同感染程度孕妇血、羊水中TIM-3、GATA-3 mRNA及蛋白水平，受试者工作特征曲线分析血清及羊水中TIM-3、GATA-3蛋白单独及联合诊断PROM孕妇发生宫内感染的效能。结果对照组、未感染组、感染组血及羊水中TIM-3 mRNA、蛋白水平依次升高（P<0.05），GATA-3 mRNA、蛋白水平依次降低（P<0.05）；轻度组、中度组、重度组血及羊水中TIM-3 mRNA、蛋白水平依次升高（P<0.05），GATA-3 mRNA、蛋白水平依次降低（P<0.05）；血清TIM-3、GATA-3蛋白单独及联合，羊水TIM-3、GATA-3蛋白单独及联合诊断PROM孕妇发生宫内感染的曲线下面积分别为0.854、0.813、0.937，0.834、0.850、0.922。结论 PROM合并宫内感染患者母血及羊水中TIM-3呈高表达，GATA-3呈低表达，两者均对PROM孕妇发生宫内感染有一定的诊断价值，联合诊断效能更高。

关键词: 胎膜早破, 羊水, 甲型肝炎病毒细胞受体2, 母血, T细胞免疫球蛋白黏蛋白分子-3, GATA结合蛋白3, 宫内感染

Abstract: Objective To analyze the diagnostic value of T cell immunoglobulin mucin molecule-3 (TIM-3) and GATA binding protein-3 (GATA-3) in maternal blood and amniotic fluid in the diagnosis of premature rupture of membranes (PROM) complicated with intrauterine infection. Methods Eighty-nine patients with PROM were regarded as the research subjects. Among them, 42 patients with intrauterine infection were regarded as the infection group, and 47 patients without intrauterine infection were regarded as the uninfected group. Meantime, 45 normal full-term pregnant women were used as the control group. According to the severity of intrauterine infection, PROM complicated with intrauterine infection patients were divided into the mild group (16 cases), the moderate group (17 cases) and the severe group (9 cases). The mRNA and protein levels of TIM-3, GATA-3 in whole blood and amniotic fluid were detected. The mRNA and protein levels of TIM-3, GATA-3 in whole blood and amniotic fluid were compared between the control group, the uninfected group, the infection group and pregnant women with different degrees of infection. The efficacy of TIM-3 and GATA-3 proteins in serum and amniotic fluid alone and in combination in the diagnosis of intrauterine infection in pregnant women with PROM were analyzed by receiver operating characteristic curve. Results The TIM-3 mRNA and protein levels in whole blood and amniotic fluid of the control group, the uninfected group and the infection group were increased in turn (P<0.05), and GATA-3 mRNA and protein levels decreased in turn (P<0.05). The TIM-3 mRNA and protein levels in whole blood and amniotic fluid of the mild group, the moderate group and the severe group increased in turn (P<0.05), and GATA-3 mRNA and protein levels decreased in turn (P<0.05). The area under curve of serum TIM-3 and GATA-3 protein alone and in combination, and amniotic fluid TIM-3 and GATA-3 protein alone and in combination to diagnose intrauterine infection in pregnant women with PROM were 0.854, 0.813, 0.937, 0.834, 0.850 and 0.922, respectively. Conclusion The maternal blood and amniotic fluid of patients with PROM complicated with intrauterine infection have high expression of TIM-3 and low expression of GATA-3, both of them have certain diagnostic value for intrauterine infection in pregnant women with PROM, and the combined diagnostic efficiency is higher.

Key words: fetal membranes, premature rupture, amniotic fluid, hepatitis A virus cellular receptor 2, maternal blood, T cell immunoglobulin mucin molecule-3, GATA binding protein-3, intrauterine infection

中图分类号:

R714

图/表 8

参考文献 20

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基因名称	引物序列（5′→3′）	产物大小（bp）
TIM-3	上游：ACCTGAAGTTGGTCATCAAACCA	227
	下游：CCTTGGAAAGGCTGCAGTGA	227
GATA-3	上游：AGGGAGTGTGTGAACTGTGGG	284
	下游：CTTCGCTTGGGCTTAATGAGG	284
GAPDH	上游：GAGTCAACGGATTTGGTCGTT	213
	下游：TTGATTTTGGAGGGATCTCG	213

基因名称	引物序列（5′→3′）	产物大小（bp）
TIM-3	上游：ACCTGAAGTTGGTCATCAAACCA	227
	下游：CCTTGGAAAGGCTGCAGTGA	227
GATA-3	上游：AGGGAGTGTGTGAACTGTGGG	284
	下游：CTTCGCTTGGGCTTAATGAGG	284
GAPDH	上游：GAGTCAACGGATTTGGTCGTT	213
	下游：TTGATTTTGGAGGGATCTCG	213

组别	n	血浆		羊水
组别	n	TIM-3	GATA-3	TIM-3	GATA-3
对照组	45	1.03±0.14	1.05±0.13	1.01±0.10	0.99±0.12
未感染组	47	1.42±0.25^a	0.83±0.15^a	1.47±0.22^a	0.78±0.14^a
感染组	42	1.83±0.31^ab	0.62±0.12^ab	1.86±0.29^ab	0.59±0.13^ab
F		118.620^＊＊	111.190^＊＊	168.942^＊＊	102.437^＊＊

组别	n	血浆		羊水
组别	n	TIM-3	GATA-3	TIM-3	GATA-3
对照组	45	1.03±0.14	1.05±0.13	1.01±0.10	0.99±0.12
未感染组	47	1.42±0.25^a	0.83±0.15^a	1.47±0.22^a	0.78±0.14^a
感染组	42	1.83±0.31^ab	0.62±0.12^ab	1.86±0.29^ab	0.59±0.13^ab
F		118.620^＊＊	111.190^＊＊	168.942^＊＊	102.437^＊＊

组别	n		血清
组别	n		TIM-3蛋白（ng/L）		GATA-3蛋白（μg/L）
对照组	45		214.39±33.76		362.49±37.25
未感染组	47		285.32±38.51^a		298.62±32.21^a
感染组	42		342.77±40.82^ab		258.46±29.04^ab
F			126.482^＊＊		110.019^＊＊
组别		羊水
组别		TIM-3蛋白（ng/L）		GATA-3蛋白（μg/L）
对照组		227.83±35.12		346.72±36.09
未感染组		305.14±39.23^a		287.41±32.85^a
感染组		360.57±42.58^ab		239.53±27.68^ab
F		127.491^＊＊		118.987^＊＊

母血及羊水中TIM-3、GATA-3水平对胎膜早破合并宫内感染的诊断价值

The diagnostic value of TIM-3 and GATA-3 levels in maternal blood and amniotic fluid for premature rupture of membranes complicated with intrauterine infection

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指标	AUC（95%CI）	敏感度（%）	特异度（%）	截断值
血清TIM-3蛋白	0.854（0.777~0.931）	81.0	78.7	309.74 ng/L
血清GATA-3蛋白	0.813（0.721~0.904）	78.6	85.1	279.46 μg/L
血清TIM-3联合 GATA-3蛋白	0.937（0.886~0.988）	90.5	83.0	-
羊水TIM-3蛋白	0.834（0.749~0.919）	83.3	78.7	328.33 ng/L
羊水GATA-3蛋白	0.850（0.771~0.929）	78.6	78.7	252.63 μg/L
羊水TIM-3联合 GATA-3蛋白	0.922（0.869~0.976）	92.9	76.6	-

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组别	n	血浆		羊水
组别	n	TIM-3	GATA-3	TIM-3	GATA-3
轻度组	16	1.62±0.28	0.75±0.14	1.63±0.25	0.72±0.15
中度组	17	1.87±0.32^a	0.60±0.12^a	1.90±0.30^a	0.58±0.12^a
重度组	9	2.14±0.35^ab	0.45±0.09^ab	2.23±0.32^ab	0.40±0.11^ab
F		8.209^＊＊	17.748^＊＊	12.829^＊＊	17.486^＊＊

组别	n	血浆		羊水
组别	n	TIM-3	GATA-3	TIM-3	GATA-3
轻度组	16	1.62±0.28	0.75±0.14	1.63±0.25	0.72±0.15
中度组	17	1.87±0.32^a	0.60±0.12^a	1.90±0.30^a	0.58±0.12^a
重度组	9	2.14±0.35^ab	0.45±0.09^ab	2.23±0.32^ab	0.40±0.11^ab
F		8.209^＊＊	17.748^＊＊	12.829^＊＊	17.486^＊＊

组别	n		血清
组别	n		TIM-3蛋白（ng/L）		GATA-3蛋白（μg/L）
轻度组	16		297.40±39.27		288.31±30.42
中度组	17		351.65±41.38^a		254.01±29.16^a
重度组	9		406.71±43.25^ab		204.47±26.49^ab
F			21.319^＊＊		23.921^＊＊
组别		羊水
组别		TIM-3蛋白（ng/L）		GATA-3蛋白（μg/L）
轻度组		317.49±40.17		273.13±29.72
中度组		366.82±43.64^a		234.54±27.05^a
重度组		425.27±44.85^ab		189.24±25.23^ab
F		18.746^＊＊		26.768^＊＊

组别	n		血清
组别	n		TIM-3蛋白（ng/L）		GATA-3蛋白（μg/L）
轻度组	16		297.40±39.27		288.31±30.42
中度组	17		351.65±41.38^a		254.01±29.16^a
重度组	9		406.71±43.25^ab		204.47±26.49^ab
F			21.319^＊＊		23.921^＊＊
组别		羊水
组别		TIM-3蛋白（ng/L）		GATA-3蛋白（μg/L）
轻度组		317.49±40.17		273.13±29.72
中度组		366.82±43.64^a		234.54±27.05^a
重度组		425.27±44.85^ab		189.24±25.23^ab
F		18.746^＊＊		26.768^＊＊