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

Öz

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

Abstract

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.

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