胎儿纤维连接蛋白联合宫颈长度检测在早产预测中的价值探讨  

Value of fetal fibronectin testing and sonographic measurement of cervical length in women with threatened preterm labor for predicting of preterm birth

作　　者：徐元春[1] 康程[1] 王细先[1] 费明红 方亚平[2] 孙晓妹[2] 宋玉喧 刘颖丽[1] 曹霞[1] 王秀英[2] 张雪艳[2] 侯素梅[2] 

机构地区：[1]北京航天总医院妇产科,北京100076 [2]北京航天总医院超声科,北京100076

出　　处：《中国优生与遗传杂志》2012年第12期71-73,共3页Chinese Journal of Birth Health & Heredity

摘　　要：目的探讨胎儿纤连蛋白(FFN)联合B超宫颈长度(CL)测量对先兆早产孕妇发生早产的预测是否比单独使用两者时更具有价值。方法 385例先兆早产孕妇行阴道后弯窿分泌物FFN的测定,同时对其中338例采用阴道B超测量CL,并追踪妊娠结局。结果 1.385例孕妇中,120例FFN阳性,其中33例早产,FFN阳性的孕妇在7d,14d和37周内分娩例数和发生率分别为15例(12.5%)、26例(21.7%)、33例(27.5%);超声测量CL 338例中,88例CL≤30mm,其中34例早产,CL≤30mm组在7d,14d,37周内分娩例数和发生率分别为15例(17%)、28例(31.8%)、34例(38.6%);FFN阳性并CL≤30mm的37例孕妇中22例早产,其在7d,14d,37周内分娩的例数及分娩率分别为12(32.4%),22(59.5%),22(59.5%)。2.FFN预测<37周早产的敏感性、特异性、PPV和NPV分别为62.3%,73.8%,27.5%,92.5%;而CL预测上述指标分别为73.9%,81.5%,38.6%,95.2%;二者联合预测上述指标为78.6%、92.2%、59.5%、96.7%,明显高于单独测定FFN或CL。采取多因素logistic回归分析:CL是预测<37周分娩的危险因素(P=0.000,OR=3.8)。结论 FFN阳性及CL≤30mm对预测早产均有一定价值,且有很好的一致性,NPV的预测价值更高,两者联合应用,可以明显提高先兆早产孕妇预测<37周早产的敏感性、特异性、PPV及NPV。Objective： The purpose of this study was to determine whether the combination of fetal fibronectin（FFN） test result and cervical length（CL） provides a better prediction than the individual tests alone in women presenting with threatened preterm labor for predicting preterm birth.Methods： 385 women with threatened preterm labor performed FFN in vaginal posterior fornix secretions,Among them,338 women measured transvaginal sonographic measurement of CL.the outcomes of pregnancies were followed up.Results： 1.Among 385 cases,positive FFN was detected in 120 cases.33 cases of which were delivered within 37 weeks.The prevalence of spontaneous preterm delivery among those women with FFN（＋） within 7days,14 days and less than 37 weeks were 5（12.5%）,26（21.7%）,33（27.5%）.In 338 pregnant women measured CL,88 cases′CL≤30mm,and 34 cases of which were delivered within 37 weeks.The prevalence of preterm delivery among those women with CL≤30mm within 7days,14 days and less than 37 weeks were 15（17%）,28（31.8%）,34（38.6%）;37 cases were found FFN（＋） combine with CL≤30mm,22 cases were delivered within 37 weeks,the prevalence of preterm delivery within 7days,14 days and less than 37 weeks were12（32.4%）,22（59.5%）,22（59.5%）.2.The sensitivity,specificity,PPV and NPV of FFN for preterm birth less than 37 weeks were 62.3%,73.8%,27.5%,92.5%,and for short CL,they were 73.9%,81.5%,38.6% and 95.2%.For their combination,they were78.6%,92.2%,59.5%,96.7%,respectively.Logistic regression analysis demonstrated that the only significantly higher risk to the prediction of delivery less than 37 weeks was cervical length（P=0.000,OR=3.8） Conclusion： positive FFN and CL≤30mm are valuable in predicting preterm birth in women with threatened preterm labor,especially significant for NPV,FFN combined with CL can improve the sensitivity,specificity,PPV and NPV of preterm delivery less than 37weeks.

关 键 词：先兆早产 纤连蛋白 宫颈长度 早产预测 

分 类 号：R714.21[医药卫生—妇产科学]