urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.25.1.42FNXCGCurmj-2088Research ArticleОригинальные статьи | Original articlesOriginal articlesМаркеры деградации внеклеточного матрикса при преждевременном разрыве плодных оболочекMarkers of Extracellular Matrix Degradation in Premature Rupture of Fetal Membraneshttps://orcid.org/0009-0007-5029-7278ДубовойА. А.DubovoyA. A.

Александр Александрович Дубовой — кандидат медицинских наук, доцент кафедры акушерства и гинекологии с курсом дополнительного профессионального образования; акушер-гинеколог родового отделения с операционными 

Ставрополь 

Aleksandr A. Dubovoy — Candidate of Sciences (Medicine), Associate Professor of the Department of Obstetrics and Gynecology with a Continuing Professional Education Program; Obstetrician-Gynecologist of Maternity Ward with Operating Rooms 

Stavropol 

alexander@dubovoj.ruhttps://orcid.org/0009-0008-8458-7473ТюльпиновВ. А.TyulpinovV. A.

Владимир Алексеевич Тюльпинов — ординатор кафедры акушерства и гинекологии с курсом дополнительного профессионального образования; врач-стажер акушерского физиологического отделения с совместным пребыванием матери и ребенка

Ставрополь 

Vladimir A. Tyulpinov — Resident of the Department of Obstetrics and Gynecology with a Continuing Professional Education Program; Trainee Physician of the Obstetric Physiology Department with a Joint Stay of Mother and Child

Stavropol 

look_down@list.ruhttps://orcid.org/0000-0001-5209-6524АксененкоВ. А.AksenenkoV. A.

Виктор Алексеевич Аксененко — доктор медицинских наук, профессор, заведующий кафедрой акушерства и гинекологии с курсом дополнительного профессионального образования

Ставрополь 

Viktor A. Aksenenko — Doctor of Sciences (Medicine), Professor, Head of the Department of Obstetrics and Gynecology with a Continuing Professional Education Program 

Stavropol 

aksenenko_va@mail.ruhttps://orcid.org/0009-0005-7050-8891ХомутоваЛ. В.KhomutovaL. V.

Лилия Вячеславовна Хомутова — ассистент кафедры акушерства и гинекологии с курсом дополнительного профессионального образования; акушер-гинеколог акушерского отделения патологии беременности 

Ставрополь 

Liliya V. Khomutova — Assistant of the Department of Obstetrics and Gynecology with a Continuing Professional Education Program; Obstetrician-Gynecologist of the Obstetric Department of Pregnancy Pathology 

Stavropol 

lvh165@gmail.comСтавропольский государственный медицинский университет; Ставропольский краевой клинический перинатальный центр № 1РоссияStavropol State Medical University; Stavropol Regional Clinical Perinatal Center No. 1Russian FederationСтавропольский государственный медицинский университетРоссияStavropol State Medical UniversityRussian FederationСтавропольский государственный медицинский университет; Ставропольский краевой клинический перинатальный центрРоссияStavropol State Medical University; Stavropol Regional Clinical Perinatal CenterRussian Federation20262702202625142–52Copyright © Дубовой А.А., Тюльпинов В.А., Аксененко В.А., Хомутова Л.В., 20262026Дубовой А.А., Тюльпинов В.А., Аксененко В.А., Хомутова Л.В.Dubovoy A.A., Tyulpinov V.A., Aksenenko V.A., Khomutova L.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/2088

Цель — комплексное изучение сывороточных и гомогенатных уровней матриксной металлопротеиназы 9-го типа (MMP-9), ее тканевого ингибитора (TIMP-1) и пропептида проколлагена 1-го типа (PICP) у пациенток с преждевременным разрывом плодных оболочек (ПРПО) для оценки их диагностической и патогенетической значимости, а также их корреляции с клиническими и морфологическими параметрами.

Материалы и методы

Материалы и методы. Проведено проспективное исследование «случай — контроль». В основную группу вошло 25 пациенток с ПРПО и преждевременными родами в сроке 22–336 недель; группу контроля — 50 женщин со срочными родами в сроке 37–416 недель. Методом иммуноферментного анализа определены уровни MMP-9, TIMP-1 и PICP в сыворотке крови и супернатанте гомогената. Результаты. У пациенток с ПРПО выявлен статистически значимый дисбаланс в системе MMP-9/ TIMP-1 по сравнению с контрольной группой. Медианный уровень MMP-9 выше в основной группе (50,52 нг/ мл против 43,67 нг/мл; p < 0,050), TIMP-1 ниже — (44,74 нг/мл против 51,15 нг/мл; p < 0,050). Индекс MMP-9/ TIMP-1 значимо выше в группе ПРПО (1,13 против 0,85; p < 0,010). Уровень PICP демонстрировал разнонаправленную динамику. Выявлена прямая связь между индексом MMP-9/TIMP-1 и наличием гистологического хориоамнионита (r = 0,670; p < 0,050).

Заключение

Заключение. Полученные данные указывают на системный дисбаланс протеолиза при ПРПО, коррелирующий с локальным воспалением. Комбинированный анализ MMP-9, TIMP-1 и PICP в сыворотке крови и гомогенате плодных оболочек представляет собой перспективный инструмент для оценки риска и понимания патогенеза ПРПО. 

Objective is to comprehensively study serum and homogenate levels of matrix metalloproteinase 9 (MMP-9), its tissue inhibitor (TIMP-1), and type I procollagen propeptide (PICP) in patients with premature rupture of membranes (PROM) to assess their diagnostic and pathogenetic significance, as well as their correlation with clinical and morphological parameters.

Materials and methods

Materials and methods. A prospective case-control study was conducted. The main group consisted of 25 patients with PROM and preterm birth at 22–33 6 weeks. The control group consisted of 50 women with term births at 37–41 6 weeks. MMP-9, TIMP-1, and PICP levels were determined in blood serum and homogenate supernatant with ELISA.

Results

Results. Patients with PROM showed a statistically significant imbalance in the MMP-9/TIMP-1 system compared to the control group. The median MMP-9 level was higher in the main group — 50.52 ng/mL versus 43.67 ng/ mL (p < 0.050), while the TIMP-1 level was lower — 44.74 ng/mL versus 51.15 ng/mL (p < 0.050). The MMP-9/TIMP-1 index was significantly higher in the PROM group (1.13 vs. 0.85; p < 0.010). The PICP level showed mixed dynamics. A direct relationship was found between the MMP-9/TIMP-1 index and the presence of histological chorioamnionitis (r = 0.670; p < 0.050).

Conclusion

Conclusion. The obtained data indicate a systemic imbalance in proteolysis in PROM, correlating with local inflammation. Combined analysis of MMP-9, TIMP-1, and PICP in serum and membranes represents a promising tool for assessing the risk and understanding the pathogenesis of PROM. 

преждевременный разрыв плодных оболочекпреждевременные родыматриксные металлопротеиназытканевые ингибиторы металлопротеиназхориоамнионитбиомаркерыMMP-9TIMP-1PICPpremature rupture of membranespreterm labormatrix metalloproteinasestissue inhibitors of metalloproteinaseschorioamnionitisbiomarkersMMP-9TIMP-1PICPИсследование выполнено при финансовой поддержке внутреннего гранта Ставропольского государственного медицинского университета по договору от 31 января 2025 г.This research was supported by an internal grant from Stavropol State Medical University, under contract dated 31 January 2025.ReferencesGorczyca K, Kozioł MM, Kimber-Trojnar Ż, Kępa J, Satora M, Rekowska AK, et al. Premature rupture of membranes and changes in the vaginal microbiome — Probiotics. Reproductive Biology. 2024;24(3):100899. DOI: https://doi.org/10.1016/j.repbio.2024.100899.Gorczyca K, Kozioł MM, Kimber-Trojnar Ż, Kępa J, Satora M, Rekowska AK, et al. 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The authors declare that there are no conflicts of interest present.