Inflamatorni odgovor prevremeno porođenih žena sa inflamatornim bolestima parodoncijuma

Abstract

Prevremeni porođaj je onaj porođaj koji se dogodi pre navršene 37. nedelje trudnoće. Prevalenca prevremenog porođaja u svetu se kreće od 5% do 13.3%. Prevremeni porođaj može biti uzrokovan mnogobrojnim patološkim procesima kao i bolestima majke ili fetusa. Jedan od prepoznatih uzroka prevremenog porođaja je intraamnionska infekcija. Intraamnionska infekcija indukuje produkciju proinflamatornih citokina karakterističnih za terminski porođaj uključujući factor nekroze tumora alfa (TNF)-α, IL-8, IL-6, IL-1β i PGE2. U nekim slučajevima prevremenog porođaja u amnionskoj tečnosti se ne mogu detektovati mikrobiološki agensi ni gajenjem u kulturi ni drugim osetljivijim mikrobiološkim tehnikama uprkos povećanim nivoima citokina u amnionskoj tečnosti. Literaturni podaci ukazuju da se, u slučajevima prevremenog porođaja sa sterilnom antramnionskom inflamacijom, citokini produkuju u procesu infekcije ili inflamacije na udaljenom mestu u organizmu. Na taj način stvoreni citokini cirkulacijom dospevaju do feto-placentarne jedinice, prolaze placentarnu barijeru i u momentu kada dostižu kritičnu koncentraciju stimulišu porođaj. Ova zapažanja su u skladu sa Miller-ovom (Miller) teorijom žarišta iz 1891. Godine. Mikrobiološka i imunološka istraživanja kao i studije na animalnom modelu ukazuju da periodontalni procesi mogu uticati na fetoplacentarnu jedinicu I indukovati prevremeni porođaj. Perodontalna oboljenja su infektivna oboljenja čiji je ishod inflamacija specifičnih tkiva koja okružuju zub i predstavljaju njegovu potporu. Postoje dve glavne kategorije periodalnog oboljenja: a) gingivitis-nedestruktivna i reverzibilna inflamacija gingival i b) periodontitis-destruktivna inflamacija potpornog tkiva zuba. Gingivitis je reverzibilna i nedestruktivna inflamacija gingiva prouzrokovana nespecifičnim bakterijama. Ako gingivitis perzistira kasnije može dovesti do periodontitisa...

Preterm birth (PTB) is defined as a delivery prior to the completed 37th week of gestation. The global prevalence rate of preterm birth is ranging from 5% to 13.3%. PTB is associated with multiple pathological processes such as medical conditions of the mother or fetus.Intra-amniotic infection has been causally linked to PTB. Intra-amniotic infection induces the production of pro-inflammatory cytokines, involved in term delivery, including tumor necrosis factor (TNF)-α, IL-8, IL-6, IL-1β, and PGE2. In some cases of PTB microorganisms cannot be detected by cultivation and other microbiology techniques despite high levels of cytokines in amniotic fluid. Literature data suggest that in cases of PTB with sterile intra-amniotic inflammation, cytokines are produced in distant part of the body due to infection and inflammation, cross the placental barrier, and when they reach appropriate quantities stimulate labor. This statement is in accordance with Miller’s focal infection theory published in 1891. Microbiological, immunological and animal model studies suggested that periodontal processes may influence to the feto-placental unit and induce preterm delivery. Periodontal diseases are infectious diseases that result in the inflammation of the specialized tissues that both surround and support the teeth. There are two major categories of periodontal diseases: a) Gingivitis – non-destructive and reversible gingival inflammation and b) Periodontitis – destructive inflammation of teeth supporting tissues. Gingivitis is a mainly reversible and nondestructive gingival inflammation related to a non-specific bacterial challenge. When gingivitis is persistent, it can further lead to periodontitis. Periodontitis is a destructive inflammatory disease of the supporting tissues of the teeth. Pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) and prostaglandins (PGE1 and PGE2) are produced in response to infection. Vascular permeability is also increased – allowing the diffusion of cytokines into the blood flow which may have systemic effects on the host. During the second and third trimester of pregnancy, the gingival/periodontal inflammation often becomes more severe. Analysis of amniotic fluid obtained at the time of preterm birth without chorio- amnionitis shows elevated levels of inflammatory cytokines...