胎儿纤维连接蛋白检测在早产预测中临床价值的研究  

Clinical values of fetal fibronectin in the prediction of preterm delivery

作　　者：郭仲杰[1] 董涛威 陈慧[1] 付帅[1] 刘颖琳[1] 张建平[1] 

机构地区：[1]中山大学孙逸仙纪念医院产科,广东广州510120 [2]广州市妇女儿童医疗中心妇产科,广东广州510120

出　　处：《热带医学杂志》2011年第9期1029-1031,共3页Journal of Tropical Medicine

基　　金：广东省科技计划项目(2010B060900034);广东省卫生厅医学科研立项(A2010171);国家科技攻关计划(2004BA720A06-01)

摘　　要：目的研究胎儿纤维连接蛋白(fFN)在广州地区孕妇早产预测中的应用价值。方法随机选择2008年2月至2009年1月于中山大学孙逸仙纪念医院门诊产检或住院的中晚期妊娠孕妇124例为研究对象。取阴道后穹窿分泌物,应用胎儿纤维连接蛋白快速测试条进行检测,同时取样检测白带常规和细菌性阴道病、支原体、衣原体。记录7d、14d、34周、37周内分娩的情况,追踪妊娠结局。分析敏感性、特异性、阳性预测值、阴性预测值。结果 124例患者中,7d、14d、34周、37周内分娩分别为2、4、10、18例,其对应敏感性、特异性、阳性预测价值、阴性预测价值分别为(7d)100%、77.8%、6.9%、100%,(14d)75%、78.3%、10.3%、98.9%,(34周)50%、78.9%、17.2%、94.7%,(37周)33.3%、78.3%、20.7%、87.4%。排除18例早产后,fFN阳性者23例,其中下生殖道感染者17例,占73.9%;fFN阴性83例,其中下生殖道感染者18例,占21.7%,两者比较差异具有统计学意义(P<0.05)。对出现fFN阳性、有先兆早产症状的患者给予宫缩抑制剂及促胎肺成熟的治疗,取得良好效果。实际发生早产的孕妇18例,约占全部分娩孕妇的14.5%,其中34周内分娩的孕妇10例,占8%,除2例由于分娩时孕周不足28周外,其余分娩的患儿全部存活。结论中晚孕行fFN检测可预测早产,预测早产的阴性预测价值和近期预测价值均较高,但其阳性预测价值和远期预测价值低,其原因与生殖道感染的干扰有关,对fFN检测阴性者避免过度处理,fFN检测阳性者结合临床及时处理。在整个妊娠期间,需连续监测fFN的变化,及早发现异常,对早产进行早诊断,早治疗,减少围产儿的致病率和死亡率。Objective To evaluate the clinical value of fetal fibronectin（fFN） in the prediction of preterm delivery in pregnant women in the Guangzhou area.Methods 124 pregnant women living in Guangzhou area were randomly selected.Vaginal samples were collected and tested for fFN.Microbiological examination was performed to test for the presence of mycoplasma and chlamydia.Statistical analysis,including the sensitivity,specificity,positive predictive value and negative predictive value were performed.Results The number of pregnant women delivered at 7 days,14 days,34 weeks and 37 weeks was 2,4,10 and 18,respectively.The sensitivity,specificity,positive and negative predictive values at 7 days were 100%,77.8%,6.9% and 100%;at 14 days were 75%,78.3%,10.3% and 98.9%;at 34weeks were 50%,78.9%,17.2% and 94.7%;and at 37 weeks were 33.3%,78.3%,20.7% and 87.4%.Except 18 cases of early delivery,17 out of 23 cases of fFN-positive cases had lower genital tract infection（73.9%）.18 out of 83 fFN-negative cases had lower genital tract infection（21.7%） and the difference was significance（P〈0.05）.We got good result by using uterine contraction inhibitor and promoting fetal lung maturity in the fFN-positive pregnant women having the symptoms of early delivery.There were 18 cases（14.5%） of early delivery.10 cases（8%） of delivery were within 34 weeks of pregnancy.Except 2 newborns with gestational age of 28 weeks,all other newborns were survive.Conclusion fFN in mid-to late-pregnancy could be used to predict early delivery.Both the negative and positive predictive values were high.But the positive predictive value and long-term predictive value were low.fFN-negative patients should not be over treated.fFN-positive women should be treated according to the clinical symptoms.During the whole period of pregnancy,we should continuously monitor fFN and provide early treatment so as to reduce the perinatal morbidity and mortality.

关 键 词：早产预测 胎儿纤维连接蛋白 阴性预测值 

分 类 号：R714.21[医药卫生—妇产科学]