Indices of local immune status and content of neopterin and cortisol in various variants of premature birth
The problem of premature birth (PR) is one of the most urgent in modern obstetrics and requires a multifaceted study and an integrated approach to its solution. Currently, there is an active study of mechanisms for the realization of spontaneous preterm birth. In the literature there is more and more data on the role of innate immunity, neopterin in the implementation of PR. Many authors support the theory of the predominant fruit factor in the initiation of PR. The purpose of our study was to study the characteristics of the local immune status, neopterin and cortisol levels in various variants of preterm labor. Materials and methods. 77 patients were divided into two groups. The main group included 52 pregnant women with PR. The main group was divided into two subgroups. The first subgroup (1A) consisted of 28 pregnant women with premature rupture of membranes (PDO) in the absence of regular labor. The second subgroup (1B) was presented by 24 women with childbirth with the development of regular labor for the whole fetal bladder (true PR). In the control group were 25 women with timely delivery. The level of expression of mRNA genes of congenital immunity (IL1B, IL10, IL18, TNFa, TLR4, GATA3, CD 68, B2M) in the cervical canal was determined for all patients in the cervical canal by the ImmunoQvantex test system, as well as serum levels of neopterin and cortisol. The results obtained are analyzed by standard statistical methods. Results. There were no significant differences in the expression levels of most genes of innate immunity between study groups (p > 0.05). The study of expression of TLR4, GATA3 genes in different variants of PR revealed a significant decrease (p < 0.05) in patients with PDO (1A subgroup). In addition, it was in this subgroup that there was a higher inflammation index (Me = 99.5%, p < 0.01). There were no fundamental differences in the state of the local immune status between groups of true premature and timely births. Analysis of the neopterin content among the subjects showed a significant increase in the main group (PR) compared with the control (p = 0.0064). Comparison of the level of neopterin between different variants of PR showed that women with true PR had a higher index (p < 0.025). The concentration of cortisol in the study groups did not differ in principle from the basal (PR group) and control groups (p > 0.05). The maximum value of cortisol was found in subgroup 1B (true PR), which is significantly higher than in the subgroup 1A (with PDO), and in the control group (p < 0.01). Conclusion. The differences revealed by us in the state of local immune status in different variants of premature births indicate different mechanisms of initiation of preterm labor. It is likely that the ratio of genes of innate immunity and the index of inflammation determines the onset of PR. The level of neopterin can be used as a marker of PR development. The increase in cortisol determines the role of the fetus factor in the development of labor.