感染性指标在胎膜早破患者组织学绒毛膜羊膜炎诊断中的价值研究  

Value of infectious index in diagnosis of histological chorioamnionitis in patients with premature rupture of membranes

作　　者：黄岭[1] 陈小斌 乔宠[1] HUANG Ling;CHEN Xiao-bin;QIAO Chong(Department of Obstetrics and Gynecology,Shengjing Hospital,China Medical University,Shenyang 110004,China)

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》2020年第9期855-858,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家重点研发计划(2016YFC1000404);国家自然科学基金面上项目(81771610);辽宁省特聘教授(2017)。

摘　　要：目的探讨感染性指标在胎膜早破(PROM)患者组织学绒毛膜羊膜炎(HCA)诊断中的临床价值。方法选取2015年12月至2017年12月于中国医科大学附属盛京医院住院分娩的PROM患者370例,根据是否并发HCA分为对照组194例(未并发HCA)、病例组176例(并发HCA)。检测患者入院时及临产前白细胞(WBC)计数、中性粒细胞比例(NE比例)、C-反应蛋白(CRP)、降钙素原(PCT)及入院时铁蛋白水平,采用受试者工作特征曲线(ROC曲线)用于寻找关于HCA诊断实验室指标的界值,以病理诊断为标准评估各指标的诊断相关灵敏度和特异度。结果(1)在PROM并发HCA患者中,WBC界值入院时为11.65×10~9/L,分娩前为11.43×10~9/L(P<0.001);NE比例界值入院时为0.7945,分娩前为0.7855(P<0.001);CRP水平界值在入院时和分娩前均为109.0mg/L(P<0.01);PCT水平界值入院时和分娩前分别为33ng/L、32ng/L(P>0.05);铁蛋白水平界值入院时为22.8μg/L(P>0.05)。(2)入院时联合检测WBC计数、NE比例、CRP水平中2项及3项指标阳性诊断的灵敏度分别为18.8%、17.6%,特异度为89.2%、96.4%。分娩前联合检测中2项指标及3项指标阳性诊断的灵敏度分别为20.5%、21.6%,特异度为87.6%;95.4%。结论入院时和待产过程中对WBC计数、NE比例及CRP水平联合检测及动态监测有助于对PROM并发HCA患者进行早期诊断评估。Objective To investigate the clinical value of infectious indicators in the diagnosis of histological chorioamnionitis(HCA)in patients with premature rupture of membranes(PROM).Methods Three hundreds and seventy patients with PROM who were hospitalized for delivery at Shengjing Hospital,China Medical University,from December 2015 to December 2017,were divided into control group(194 cases,without HCA)and case group(176 cases,with HCA).Laboratory indexes such as white blood cell count,neutrophil percentage,C-reactive protein level,procalcitonin level and ferritin level on admission to hospital and before delivery were detected,and the receiver operating characteristic curve(ROC curve)was used to search for the diagnostic cut-off values of laboratory indexes,and the relative sensitivity and specificity of these indexes were assessed based on pathological diagnosis.Results(1)Among the patients with premature rupture of membranes combined with histological chorioamnionitis,the cut-off values of WBC count at admission and before delivery were 11.65×10~9/L and 11.43×10~9/L(P<0.001).The cut-off values of NE count at admission and before delivery were 0.7945 and 0.7855(P<0.001).The CRP levels at admission and before delivery were all 109.0 mg/L(P<0.01).The PCT levels at admission and before delivery were 33 ng/L and 32 ng/L(P>0.05).The level of ferritin in hospital was 22.8μg/L,but without statistical significance(P>0.05).(2)The sensitivity and specificity of combining any two of the WBC count,NE count rate and CRP level at admission were 18.8%and 89.2%respectively.The sensitivity and specificity of combining three of WBC count,NE count rate and CRP level were 17.6%and 96.4%.The sensitivity and specificity of the combining any two of WBC count,NE count rate and CRP level were 20.5%and 87.6%respectively.The sensitivity and specificity of combining three of WBC count,NE count rate and CRP level were 21.6%and 95.4%.Conclusion The combined detection of WBC count,NE percentage and CRP level on admission to hospital and befo

关 键 词：胎膜早破 组织学绒毛膜羊膜炎 白细胞 C-反应蛋白 降钙素原 铁蛋白 

分 类 号：R714.43+3[医药卫生—妇产科学]