血清降钙素原、基质金属蛋白酶-9和可溶性细胞间黏附分子-1联合检测对绒毛膜羊膜炎的诊断价值

doi:10.3877/cma.j.issn.1674-1358.2023.03.008

中华实验和临床感染病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 194 -199. doi: 10.3877/cma.j.issn.1674-1358.2023.03.008

论著

血清降钙素原、基质金属蛋白酶-9和可溶性细胞间黏附分子-1联合检测对绒毛膜羊膜炎的诊断价值

任琼^†(

), 吴东燕, 李中花, 石晶, 张静, 耿丽伟

050000　石家庄市，河北省优抚医院妇产科
050011　石家庄市，石家庄市第四医院妇产科
050000　石家庄市，长安区胜北社区卫生服务中心妇产科
050057　石家庄市，栾城人民医院妇产科

收稿日期:2022-06-16 出版日期:2023-06-15
通信作者: 任琼
基金资助:
河北省卫健委重点课题(No. 20171023)

Diagnostic value of combined detection of serum pro-calcitonin, matrix metalloproteinase-9 and soluble intercellular adhesion molecule 1 in chorioamnionitis

Qiong Ren^†(), Dongyan Wu, Zhonghua Li, Jing Shi, Jing Zhang, Liwei Geng

Department of Gynaecology and Obstetrics, Shijiazhuang Youfu Hospital, Shijiazhuang 050000, China
Department of Gynaecology and Obstetrics, Shijiazhuang the Fourth Hospital, Shijiazhuang 050011, China
Department of Gynaecology and Obstetrics, Shengbei Community Health Service Center, Chang'an District, Shijiazhuang 050000, China
Department of Gynaecology and Obstetrics, Luancheng People's Hospital, Shijiazhuang 050057, China

Received:2022-06-16 Published:2023-06-15
Corresponding author: Qiong Ren

全文 ( ) 下载PDF ( ) 导出引用

引用本文：

任琼, 吴东燕, 李中花, 石晶, 张静, 耿丽伟. 血清降钙素原、基质金属蛋白酶-9和可溶性细胞间黏附分子-1联合检测对绒毛膜羊膜炎的诊断价值[J/OL]. 中华实验和临床感染病杂志(电子版), 2023, 17(03): 194-199.

Qiong Ren, Dongyan Wu, Zhonghua Li, Jing Shi, Jing Zhang, Liwei Geng. Diagnostic value of combined detection of serum pro-calcitonin, matrix metalloproteinase-9 and soluble intercellular adhesion molecule 1 in chorioamnionitis[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2023, 17(03): 194-199.

目的

探讨血清降钙素原（PCT）、基质金属蛋白酶-9（MMP-9）和可溶性细胞间黏附分子-1（sICAM-1）联合检测对诊断绒毛膜羊膜炎的价值。

方法

选取2019年3月至2021年12月于河北省优抚医院就诊的83例单胎妊娠发生胎膜早破的产妇进行回顾性研究；根据胎盘病理及患者有无绒毛膜羊膜炎临床表现将患者分为4组，即临床表现和病理诊断均符合绒毛膜羊膜炎19例患者为临床+病理组；无明显临床表现但胎盘病理诊断为绒毛膜羊膜炎患者为病理组（17例）；具有一定临床表现但病理诊断为阴性的患者为临床组（20例）；其余27例患者临床表现和病理诊断均为阴性，为对照组。比较各组产妇血清PCT、MMP-9和ICAM-1水平，应用Spearman相关性分析绒毛膜羊膜炎产妇血清PCT、MMP-9和ICAM-1间的相关性；应用受试者工作特征曲线（ROC）分析3种指标单独使用和联合检测对绒毛膜羊膜炎的诊断价值。

结果

各组产妇血清PCT、MMP-9和sICAM-1水平差异有统计学意义（F = 35.907、75.807、44.363，P均< 0.001）。临床+病理组产妇PCT、MMP-9和sICAM-1水平均显著高于其他3组（P均< 0.001）。但病理组和临床组产妇PCT、MMP-9和sICAM-1水平差异无统计学意义（t = 0.328、P = 0.671，t = 0.449、P = 0.551，t = 0.173、P = 0.826）。Spearman相关性分析结果显示，绒毛膜羊膜炎产妇血清PCT与MMP-9、sICAM-1均呈正相关（r = 0.420、P = 0.001，r = 0.343、P = 0.010），血清MMP-9与sICAM-1呈显著正相关（r = 0.424、P = 0.001）。以胎盘病理诊断为金标准，评估血清PCT、MMP-9和sICAM-1水平对绒毛膜羊膜炎的诊断价值。PCT阈值设为61.020 pg/ml时，其特异度和灵敏度分别为87.2%和83.3%，ROC曲线下面积（AUC）为0.917（95%CI：0.825~0.955）；MMP-9阈值为111.412 ng/ml时，特异度和灵敏度分别为72.3%和97.2%，AUC为0.927（95%CI：0.837~0.962）；sICAM-1阈值为1 149.635 ng/ml时，特异度和灵敏度分别为83.0%和86.1%，AUC为0.879（95%CI：0.798~0.902）；联合检测特异度和灵敏度分别为93.1%和93.4%，AUC为0.951（95%CI：0.874~0.969），联合检测AUC较PCT、MMP-9和sICAM-1单独检测AUC差异无统计学意义（Z = 0.500、P = 0.617，Z = 0.901、P = 0.368），联合检测AUC显著高于sICAM-1单独检测AUC，差异具有统计学意义（Z = 3.158、P = 0.018）。

结论

血清PCT、MMP-9和sICAM-1联合检测辅助诊断绒毛膜羊膜炎有较好的灵敏度和特异性。

关键词: 绒毛膜羊膜炎, 降钙素原, 基质金属蛋白酶-9, 细胞间黏附分子-1

Objective

To investigate the value of combined detection of serum calcitonin (PCT), matrix metalloproteinase-9 (MMP-9) and soluble intercellular adhesion molecule 1 (sICAM-1) in the diagnosis of chorioamnionitis.

Methods

From March 2019 to December 2021, a total of 83 women with premature rupture of membranes (PROM) in single pregnancy in Hebei Youfu Hospital were selected, retrospectively. According to the placental pathology and clinical manifestations of chorioamnionitis, patients were divided into four groups; 19 patients with clinical and pathological findings consistent with chorioamnionitis were classified as clinical + pathological group, 17 patients without obvious clinical manifestations but with placental pathology diagnosed as chorioamnionitis were classified as pathological group, 20 patients with certain clinical manifestations but negative pathological diagnosis were classified as clinical group. The clinical manifestations and pathological diagnosis of the remaining 27 patients were negative, and they were enrolled in control group. The levels of serum PCT, MMP-9 and ICAM-1 among different groups of postpartum women were compared, and Spearman correlation analysis was used to analyze the correlations between serum PCT, MMP-9 and ICAM-1 among postpartum women with chorioamnionitis. The diagnostic value of chorioamnionitis of the three indicators alone and combination were analyzed by receiver operating characteristic curve (ROC).

Results

There were significant differences in the levels of serum PCT, MMP-9 and sICAM-1 in each group of postpartum women (F = 35.907, 75.807, 44.363, all P < 0.001). The levels of PCT, MMP-9 and sICAM-1 in the clinical + pathological group were significantly higher than those of the other three groups (all P < 0.001). However, there was no significant difference in the levels of PCT, MMP-9 and sICAM-1 between pathological group and clinical group (t = 0.328, P = 0.671; t = 0.449, P = 0.551; t = 0.173, P = 0.826). Spearman correlation analysis showed that serum PCT of cases with chorioamnionitis was positively correlated with MMP-9 and sICAM-1 (r = 0.420, P = 0.001; r = 0.343, P = 0.010), while serum MMP-9 was positively correlated with sICAM-1 (r = 0.424, P = 0.001), both with significant differences. The diagnostic values of serum PCT, MMP-9 and sICAM-1 levels for chorioamnionitis were analyzed by diagnosing placental pathology as the gold standard. When the PCT threshold was 61.020 pg/ml, its specificity and sensitivity were 87.2% and 83.3%, respectively, and the AUC was 0.917 (95%CI: 0.825-0.955); When the MMP-9 threshold was 111.412 ng/ml, the specificity and sensitivity were 72.3% and 97.2%, respectively, and the AUC was 0.927 (95%CI: 0.837-0.962); When the sICAM-1 threshold was 1 149.635 ng/ml, the specificity and sensitivity were 83.0% and 86.1%, respectively, and the AUC was 0.879 (95%CI: 0.798-0.902). The specificity and sensitivity of the combined detection of the above three indicators were 93.1% and 93.4%, respectively, with the AUC of 0.951 (95%CI: 0.874-0.969). The combined detection of AUC showed no significant difference compared with PCT and MMP-9 alone (Z = 0.500, P = 0.617; Z = 0.901, P = 0.368). The combined detection of AUC was significantly higher than that of sICAM-1 alone (Z = 3.158, P = 0.018).

Conclusions

Combined detection of serum PCT, MMP-9 and sICAM-1 has good sensitivity and specificity in assisting in diagnosis of chorioamnionitis.

Key words: Chorioamnionitis, Procalcitonin, Matrix metalloproteinase 9, Intercellular adhesion molecule -1

表1 各组产妇的一般资料

组别	例数	年龄（ ± s，岁）	孕次（ ± s，次）	产次（ ± s，次）	剖宫产[例（%）]	顺产[例（%）]	胎儿出生体重（ ± s，kg）
临床+病理组	19	33.02 ± 4.98	2.14 ± 0.46	1.56 ± 0.84	19（100.00）	0（0.00）	2.10 ± 0.32
病理组	17	32.57 ± 5.01	2.31 ± 0.59	1.49 ± 0.76	8（47.06）	9（52.94）	1.98 ± 0.23
临床组	20	32.05 ± 4.76	2.21 ± 0.48	1.51 ± 0.69	8（40.00）	12（60.00）	2.05 ± 0.33
对照组	27	32.87 ± 4.17	2.19 ± 0.51	1.53 ± 0.75	11（40.74）	16（59.26）	2.20 ± 0.28
统计量		F = 0.171	F = 0.351	F = 0.028	χ² = 20.045^a		F = 2.18
P值		0.916	0.789	0.994	< 0.001		0.097

表1 各组产妇的一般资料

组别	例数	年龄（ ± s，岁）	孕次（ ± s，次）	产次（ ± s，次）	剖宫产[例（%）]	顺产[例（%）]	胎儿出生体重（ ± s，kg）
临床+病理组	19	33.02 ± 4.98	2.14 ± 0.46	1.56 ± 0.84	19（100.00）	0（0.00）	2.10 ± 0.32
病理组	17	32.57 ± 5.01	2.31 ± 0.59	1.49 ± 0.76	8（47.06）	9（52.94）	1.98 ± 0.23
临床组	20	32.05 ± 4.76	2.21 ± 0.48	1.51 ± 0.69	8（40.00）	12（60.00）	2.05 ± 0.33
对照组	27	32.87 ± 4.17	2.19 ± 0.51	1.53 ± 0.75	11（40.74）	16（59.26）	2.20 ± 0.28
统计量		F = 0.171	F = 0.351	F = 0.028	χ² = 20.045^a		F = 2.18
P值		0.916	0.789	0.994	< 0.001		0.097

表2 各组产妇血清PCT、MMP-9和sICAM-1水平（ ± s）

组别	例数	PCT（pg/ml）	MMP-9（ng/mL）	sICAM-1（ng/ml）
临床+病理组	19	88.26 ± 15.20	178.59 ± 30.89	1468.38 ± 273.46
病理组	17	68.58 ± 19.56	125.41 ± 19.09	1176.32 ± 279.76
临床组	20	67.12 ± 10.58	120.84 ± 21.27	1042.73 ± 283.17
对照组	27	28.71 ± 9.07	84.38 ± 10.94	698.28 ± 31.28
F值		116.850	75.807	44.363
P值		< 0.001	< 0.001	< 0.001
t₁值		3.390	6.124	3.165
P₁值		0.002	< 0.001	0.003
t₂值		5.063	6.504	4.771
P₂值		< 0.001	< 0.001	< 0.001
t₃值		16.623	16.652	14.567
P₃值		< 0.001	< 0.001	< 0.001
t₄值		0.288	0.682	1.438
P₄值		0.775	0.500	0.159
t₅值		9.182	9.082	8.852
P₅值		< 0.001	< 0.001	< 0.001
t₆值		13.372	7.662	6.293
P₆值		< 0.001	< 0.001	< 0.001

表2 各组产妇血清PCT、MMP-9和sICAM-1水平（ ± s）

组别	例数	PCT（pg/ml）	MMP-9（ng/mL）	sICAM-1（ng/ml）
临床+病理组	19	88.26 ± 15.20	178.59 ± 30.89	1468.38 ± 273.46
病理组	17	68.58 ± 19.56	125.41 ± 19.09	1176.32 ± 279.76
临床组	20	67.12 ± 10.58	120.84 ± 21.27	1042.73 ± 283.17
对照组	27	28.71 ± 9.07	84.38 ± 10.94	698.28 ± 31.28
F值		116.850	75.807	44.363
P值		< 0.001	< 0.001	< 0.001
t₁值		3.390	6.124	3.165
P₁值		0.002	< 0.001	0.003
t₂值		5.063	6.504	4.771
P₂值		< 0.001	< 0.001	< 0.001
t₃值		16.623	16.652	14.567
P₃值		< 0.001	< 0.001	< 0.001
t₄值		0.288	0.682	1.438
P₄值		0.775	0.500	0.159
t₅值		9.182	9.082	8.852
P₅值		< 0.001	< 0.001	< 0.001
t₆值		13.372	7.662	6.293
P₆值		< 0.001	< 0.001	< 0.001

图1 绒毛膜羊膜炎产妇血清PCT、MMP-9、sICAM-1之间相关性注：A：PCT与MMP-9相关性；B：PCT与sICAM-1相关性；C：MMP-9与sICAM-1相关性

图2 PCT、MMP-9和sICAM-1诊断绒毛膜羊膜炎的ROC曲线

表3 血清PCT、MMP-9和sICAM-1水平对绒毛膜羊膜炎的诊断价值

检测指标	AUC	最佳阈值（pg/ml）	特异性（%）	灵敏度（%）	95%CI
PCT	0.917	61.020	87.2	83.3	0.825~0.955
MMP-9	0.927	111.412	72.3	97.2	0.837~0.962
sICAM-1	0.879	1149.635	83.0	86.1	0.798~0.902
联合检测	0.951	—	93.1	94.5	0.874~0.969

表3 血清PCT、MMP-9和sICAM-1水平对绒毛膜羊膜炎的诊断价值

检测指标	AUC	最佳阈值（pg/ml）	特异性（%）	灵敏度（%）	95%CI
PCT	0.917	61.020	87.2	83.3	0.825~0.955
MMP-9	0.927	111.412	72.3	97.2	0.837~0.962
sICAM-1	0.879	1149.635	83.0	86.1	0.798~0.902
联合检测	0.951	—	93.1	94.5	0.874~0.969

[1]	Jain VG, Willis KA, Jobe A, et al. Chorioamnionitis and neonatal outcomes[J]. Pediatr Res,2022,91(2):289-296.
[2]	Xu HG, Tian M, Pan SY. Clinical utility of procalcitonin and its association with pathogenic microorganisms[J]. Crit Rev Clin Lab Sci,2022,59(2):93-111.
[3]	Feduniw S, Pruc M, Ciebiera M, et al. Biomarkers for pregnancy latency prediction after preterm premature rupture of membranes-asystematic review[J]. Int J Mol Sci,2023,24(9):8027.
[4]	孔振兴, 马恺, 韩娜, 等. 血清MMP-9, TIMP-1, TNF-α及IL-10在未足月胎膜早破而早产产妇中的表达及临床意义[J]. 现代生物医学进展,2020,20(21):4168-4171.
[5]	曹泽毅主编. 中华妇产科学(临床版)[M]. 北京: 人民卫生出版社,2010:229.
[6]	孟凡橹, 李玉芬, 王伟灿, 等. 绒毛膜羊膜炎与新生儿呼吸系统疾病关系的研究进展[J]. 中国当代医药,2020,27(5):27-29.
[7]	Bermick J, Schaller M. Chorioamnionitis exposure dampens the preterm monocyte response to subsequent challenges[J]. Immunol Cell Biol,2018,96(8):789-791.
[8]	Strunk T, Campbell C, Burgner D, et al. Histological chorioamnionitis and development outcomes in very preterm infants[J]. J Perinatol, 2019,39(2):321-330.
[9]	何远敏, 肖云山, 郭孝君, 等. 未足月胎膜早破合并组织型绒毛膜羊膜炎的危险因素及预测模型的建立[J]. 中国实用妇科与产科杂志,2020,36(10):971-975
[10]	Wang J, Wu X, Tian Y, et al. Dynamic changes and diagnostic and prognostic significance of serum PCT, hs-CRP and s-100 protein in central nervous system infection[J]. ExpTher Med,2018,16(6):5156-5160.
[11]	冯云霞, 张学鹏, 陈硕, 等. 蜂蜇伤患者血清降钙素原水平及其预测急性肾损伤的价值[J]. 中国急救医学,2020,40(7):610-613.
[12]	丁燕燕, 潘小姣, 薛苗苗, 等. 血清降钙素原联合超敏C反应蛋白在脓毒症患者中的表达及诊断效能[J]. 中国医师杂志,2020,22(5):775-777.
[13]	Bakar RZ, Köroğlu N, Turkgeldi LS, et al. Maternal serum procalcitonin levels in prediction of chorioamnionitis in women with preterm premature rupture of membranes[J]. Arch Med Sci,2019,17(3):694-699.
[14]	Zuo G, Dong JX, Zhao FF, et al. Expression of matrix metalloproteinase-9 and its substrate level in patients with premature rupture of membranes[J]. J Obstet Gynaecol,2017,37(4):441-445.
[15]	Brien ME, Gaudreault V, Hughes K, et al. A systematic review of the safety of blocking the IL-1 system in human pregnancy[J]. J Clin Med,2021,11(1):225.
[16]	Hong S, Park Y, Kim YM, et al. Antibody microarray analysis of amniotic fluid proteins associated with subsequent ruptured membranes in women with threatened preterm labor[J]. Am J Reprod Immunol,2021,85(5):e13371.
[17]	蔡树梅, 王亚敏, 陈辉, 等. 胎膜早破患者绒毛膜羊膜炎的发生情况及NLRP3炎症小体表达与炎症因子,蛋白酶的相关性[J]. 中国医药导报,2020,17(6):107-110.
[18]	Lee SM, Park KH, Joo E, et al. High-throughput analysis of amniotic fluid proteins associated with histological chorioamnionitis in preterm premature rupture of membranes using an antibody-based microarray[J]. Am J Reprod Immunol,2022,88(3):13595.
[19]	杨帆, 安晓霞, 程亚华. 血清β-hCG, ICAM-1, MMP-9在足月胎膜早破宫内感染及预后中的临床评价意义[J]. 临床输血与检验,2020,22(1):96-99.
[20]	宋春红, 马倩, 甄娟, 等. NOD2, TNF-α, MMP-9及Caspase-3在胎膜早破发病中的作用及意义[J]. 天津医药,2019,47(4):417-420.
[21]	刘会雪, 尹红亚, 童重新, 等. 胎膜早破并发绒毛膜羊膜炎患者与IL-6, TNF-α, sICAM-1的相关性研究[J]. 医学理论与实践,2020,33(16):2722-2723.
[22]	唐翠兰, 吴言英. sICAM-1及hs-CRP在疑似胎膜早破及绒毛膜羊膜炎孕妇中的检测价值探究[J]. 中国妇幼保健,2019,34(13):2935-2937.
[23]	Ren J, Qiang Z, Li YY, et al. Biomarkers for a histological chorioamnionitis diagnosis in pregnant women with or without group B Streptococcus infection: a case-control study[J]. BMC Pregnancy Childbirth,2021,21(1):250.
[24]	傅潮琅. sICAM-1与suPAR联合检测对胎膜早破新生儿败血症的预测价值[J]. 浙江医学,2018,40(18):2020-2023.
[25]	包翠梅, 杨梅. 产妇血清IL-6, sICAM-1, CRP水平与未足月胎膜早破的相关性研究[J]. 标记免疫分析与临床,2018,25(12):1857-1859, 1880.

[1]	贾亚娟, 蒙钰铭, 高志伟, 高素敏, 张劲松, 孙虹. 血小板与淋巴细胞比值、降钙素原和白细胞介素6联合检测对脓毒症患者预后价值的研究[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(02): 118-123.
[2]	黄蓉, 梁自毓, 祁文瑾. NLRP3炎症小体在胎膜早破孕妇血清中的表达及其意义[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 540-548.
[3]	涂家金, 廖武强, 刘金晶, 涂志鹏, 毛远桂. 严重烧伤患者鲍曼不动杆菌血流感染的危险因素及预后分析[J/OL]. 中华损伤与修复杂志(电子版), 2023, 18(06): 491-497.
[4]	张升荣, 李晓东, 王伟. B族链球菌感染分型对孕产妇未足月胎膜早破的预测价值及其与绒毛膜羊膜炎的关系[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(03): 170-175.
[5]	董大红, 周明虎, 李芝朋, 许正峰. 碳青霉烯类抗生素联合呼吸机治疗肺部感染的临床疗效分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 793-796.
[6]	甘志新, 胡雍军, 肖晶, 胡明冬. 降钙素原在脓毒血症与肺部感染中的研究进展[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 663-666.
[7]	燕红玲, 王岩岩, 陈树斌. PCT、NLR联合LUBS预测ICU CRKP致呼吸机相关肺炎撤机及预后分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 617-620.
[8]	何俊, 易淑华, 陈婷婷, 杨玉, 李红雨, 谢飞, 何健. 妊娠并发社区获得性肺炎临床特征及降钙素原和炎症指数对其诊断意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(03): 421-425.
[9]	魏丁, 乔艳艳, 顾兴, 张燕, 李艳燕, 钱卫生, 潘蕾, 高永恒, 金发光. 体外膜肺氧合救治急性呼吸窘迫综合征不良预后危险因素分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(03): 363-367.
[10]	徐辉, 杨勇琼, 刘健, 许剑, 江佳莲, 邓正波. s-ChE、PCT、CRP在肺结核中的表达及继发肺部感染的预测意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(02): 292-295.
[11]	赵月, 田坤, 张宗明, 郭震天, 刘立民, 张翀, 刘卓. 降钙素原对老年急性重度胆囊炎发生的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 801-806.
[12]	刘蕊, 李乐, 陈金明, 李鑫. 急性胆管炎严重程度与血清标志物相关性的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(02): 176-181.
[13]	沈炎, 张俊峰, 唐春芳. 预后营养指数结合血清降钙素原、胱抑素C及视黄醇结合蛋白对急性胰腺炎并发急性肾损伤的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 536-540.
[14]	卓少宏, 林秀玲, 周翠梅, 熊卫莲, 马兴灶. CD64指数、SAA/CRP、PCT联合检测在小儿消化道感染性疾病鉴别诊断中的应用[J/OL]. 中华消化病与影像杂志(电子版), 2023, 13(06): 505-509.
[15]	闫诺, 邓伟, 张英霞, 贺丹阳, 樊宁. 泌尿系超声检查联合降钙素原对儿童高级别膀胱输尿管反流的诊断价值[J/OL]. 中华诊断学电子杂志, 2024, 12(03): 149-154.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Diagnostic value of combined detection of serum pro-calcitonin, matrix metalloproteinase-9 and soluble intercellular adhesion molecule 1 in chorioamnionitis

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Diagnostic value of combined detection of serum pro-calcitonin, matrix metalloproteinase-9 and soluble intercellular adhesion molecule 1 in chorioamnionitis