胰岛素样生长因子结合蛋白-1检测胎膜早破及预测早产临床价值  

The role of insulin-like growth factor binding protein-1 in the diagnosis of premature rupture of membranes and prediction of preterm delivery

作　　者：郑东明[1] 崔红[1] 张志涛[1] 张丽娟[1] 陈静[1] 尹少尉[1] 邱辉[1] 蔡本硕[1] 刘彩霞[1] 

机构地区：[1]中国医科大学附属盛京医院妇产科,辽宁沈阳110004

出　　处：《中国实用妇科与产科杂志》2012年第11期865-867,共3页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：中华国际医学交流基金会基金(CIMF-F-007)

摘　　要：目的探讨宫颈阴道分泌物中胰岛素样生长因子结合蛋白-1(IGFBP-1)检测胎膜早破及预测早产的临床价值。方法选择2011年9月至2012年3月在中国医科大学附属盛京医院住院并临床确诊的胎膜早破孕妇87例,临床确诊无胎膜早破孕妇88例,临床疑似胎膜早破孕妇25例,对宫颈分泌物分别进行IGFBP-1(胶体金法)检测及pH检测,并对其预测早产情况进行研究。结果 IGFBP-1(胶体金法)检测胎膜早破的灵敏度98.85%(86/87),特异度98.86%(87/88),阳性预测值98.85%,阴性预测值98.86%,优于目前临床上应用最多的pH试纸法[灵敏度68.97%(60/87)]。患者发生胎膜早破时,IGFBP-1(胶体金法)预测72h早产发生的阳性预测值为97.44%,而未发生胎膜早破,其阳性预测值仅为6.67%。疑似胎膜早破组的25例中,IGFBP-1(胶体金法)阳性有16例,72h内临床确诊胎膜早破或分娩的有13例(包括3例死产),其中早产9例,早产的阳性预测值为56.25%。结论阴道分泌物中检测IGFBP-1(胶体金法)可作为快速检测胎膜早破的有效方法,同样也可用于预测早产的发生。Objective The aim of this study was to determine the role of insulin-like growth factor binding protein-1（IGFBP-1） in the cervical-vaginal secretion in the diagnosis of premature rupture of membranes and prediction of preterm delivery.Methods Based on the clinical diagnosis,patients were grouped as clinically confirmed premature rupture of membranes（PROM,n=87）,clinically suspected PROM（n=25） and women with intact fetal membranes（n=88）.Detection of IGFBP-1 in the cervical-vaginal secretions and pH paper was done in all the cases.Results For the IGFBP-1 test（colloidal gold method）,the sensitivity was 98.85%（86/87 in clinically confirmed PROM）,the specificity was 98.86%（87/88 with intact membranes）,the positive predictive value was 98.85%,and the negative predictive value was 98.86%.It＇s better than pH paper.Among women with PROM,the negative predictive value was 97.44%,which was used to predict the preterm delivery in the next 72 hours.However,the negative predictive value was only 6.67% for women without PROM.Among 25 women with clinically suspected PROM,16（64%） tested positive for IGFBP-1.In this group,there were 13 cases which were diagnosed premature rupture of membranes or giving delivery within 72 hours,which included 3 stillbirths.Among the 13 cases,9 cases were preterm delivery.The positive predictive value of preterm delivery is 56.25%.Conclusion The screening test of IGFBP-1 in the cervical-vaginal secretions is effective to detect PROM,which is helpful for the early diagnosis of premature rupture of membranes.It is also helpful to predict preterm delivery.

关 键 词：胰岛素样生长因子结合蛋白-1 胎膜早破 早产 

分 类 号：R714.4[医药卫生—妇产科学]