阴道分泌物胎儿纤维连接蛋白与宫颈长度联合预测早产的多中心前瞻性研究  

Prospective study on the prediction of preterm birth with fFN and cervical length

作　　者：马京梅[1] 杨慧霞[1] 郭战坤[1] 时春艳[1] 张运平[2] 马仲秋[2] 范玲[3] 周士平[3] 杨孜[4] 王珈略[4] 

机构地区：[1]北京大学第一医院妇产科,100034 [2]北京海淀妇幼保健院 [3]北京妇产医院 [4]北京大学第三医院妇产科

出　　处：《中华围产医学杂志》2009年第3期190-193,共4页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨阴道分泌物胎儿纤维连接蛋白（fFN）与宫颈长度测量联合应用在早产预测中的价值。方法选择2006年12月至2007年12月在北京大学第一医院等四家医院就诊的孕22～35周，有不规律宫缩，或有早产高危因素的511例孕妇为研究对象，检测其宫颈阴道分泌物中fFN，同时B超测量宫颈长度，比较其临产的时间及孕周情况。结果fFN阳性对7d内分娩预测的敏感度为77．4％，特异度69．4％，阴性预测值97．9％，对34周内分娩预测的敏感度、特异度和阴性预测值分别为70．5％，70．0％，96．2％。宫颈缩短（≤3cm）者7d内分娩的敏感度、特异度、阴性预测值分别为54．8％、66．3％、95．8％；对34周内分娩预测的敏感度、特异度和阴性预测值分别为59．1％、67．2％、和94．6％，二者联合7d内分娩预测敏感度、特异度、阳性预测值和阴性预测值分别为51．6％、87．1％和96．5％；预测34周内分娩的敏感度45．5％，特异度87．6％，阴性预测值94．5％。结论阴道分泌物fFN比宫颈长度对预测7d及34周内分娩有较高的阴性预测值及特异度，与超声宫颈长度测量联合应用可进一步提高其阳性预测值和特异度，提高对早产的预测。Objective To discuss the clinical value of fetal fibroneetin （fFN） and cervical length in predicting preterm birth. Methods Totally, 511 pregnant women at 22-35 weeks of gestations were enrolled from Dec. 2006 to Dee. 2007 at 4 tertiary hospitals in Beijing, and all with either symptoms or high risk factors of preterm birth, but without preterm premature rupture of membrane or vaginal bleeding. Cervical fFN were determined and cervical length of each subjects were measured by ultrasound. The pregnancy outcomes were compared. Results The sensitivity, specificity and negative predictive value （NPV） of fFN in predicting preterm birth within 7 d were 77. 4%, 69.4% and 97.90/00, respectively; and 70.5%, 70.0% and 96.2% for deliveries within 34 weeks. The above figures changed to 54.8%, 66.3%, 95.8% for deliveries within 7 d and 59.1%, 67.2%, 94.6% for those within 34 weeks, respectively, when cervical length ≤3 cm was applied to predict preterm birth. When fFN and cervical length were combined, the sensitivity, specificity and NPV were 51.6%, 87.1%, 96.5% for deliveries within 7 d, and 45.5%, 87.6%, 94.5% for those within 34 weeks, respectively. Conclusions FFN has higher NPV and specificity than cervical length in predicting preterm birth within 7 d and 34 weeks, be improved when combined with cervical length.

关 键 词：早产 预测 纤连蛋白类 子宫颈 人体测量术 

分 类 号：R714[医药卫生—妇产科学]