Wip1、PCT和IL-6对未足月胎膜早破合并绒毛膜羊膜炎的临床价值研究  

The Clinical Value of Wip1,PCT and IL-6 on Preterm Premature Rupture of Membranes with Chorioamnionitis

作　　者：刘艳华 赵玲 杨志芬 王胜普 张惠欣[1] LIU Yanhua;ZHAO Ling;YANG Zhifen(Department of Gynaecology and Obstetrics,The Fourth Hospital of Hebei Medical University,Shijiazhuang Hebei 050011,China)

机构地区：[1]河北医科大学第四医院妇产科,河北石家庄050011

出　　处：《实用妇产科杂志》2021年第2期127-132,共6页Journal of Practical Obstetrics and Gynecology

基　　金：河北省医学科学研究重点课题计划项目(编号:20190723)。

摘　　要：目的:探讨磷酸酶Wip1、降钙素原(PCT)和白细胞介素(IL)-6对未足月胎膜早破(PPROM)合并绒毛膜羊膜炎(CS)的诊断价值。方法:选取2017年1月至2019年12月河北医科大学第四医院东院产科PPROM患者58例作为PPROM组,PPROM合并CS患者43例作为PPROM/CS组,正常妊娠产妇60例作为对照组,实验室检查分析患者血液白细胞计数(WBC)、中性粒细胞百分比(NEU)、C反应蛋白(CRP)、PCT、IL-6、IL-8、IL-10水平;流式细胞术分析外周血单核细胞Wip1(PBMC Wip1)表达水平;PPROM/CS危险因素分析采用多因素Logistic回归分析;PBMC Wip1表达与临床指标的相关性分析采用Pearson法;ROC曲线分析检测指标的诊断价值。结果:3组血常规和血生化分析指标比较结果显示,与对照组、PPROM组比较,PPROM/CS组患者WBC、NEU、PCT、IL-6及IL-8均显著升高,差异有统计学意义(P<0.01);3组CRP和IL-10比较,差异无统计学意义(P>0.05)。对照组与PPROM组的PBMC Wip1表达水平比较差异无统计学意义(t=0.17,P>0.05),与PPROM/CS组比较显著降低(t=3.49,P<0.01);与PPROM组相比,PPROM/CS组PBMC Wip1表达水平显著降低(t=4.01,P<0.01)。多因素Logistic回归分析结果显示,PCT、IL-6升高和Wip1降低是影响PPROM/CS发生的独立危险因素(OR>1,P<0.05)。Wip1与IL-6(r=-0.3237,P=0.034)和PCT(r=-0.4249,P=0.005)呈负相关。Wip1、血清IL-6及血清PCT的曲线下面积(AUC)分别为0.8987、0.8551、0.8210(P<0.01);当PBMC Wip1、血清IL-6及血清PCT的阈值为6.68 MFI、8.56 ng/L、0.10μg/L时约登指数最大,为最佳检测临界点。Wip1、IL-6及PCT联合应用的AUC为0.9655,灵敏度为90.70%,特异度94.83%,高于Wip1、IL-6和PCT的单项指标(P<0.001)。结论:Wip1可能是PPROM/CS早期诊断的重要指标,Wip1、PCT、IL-6与PPROM合并CS有关,而Wip1的表达与负性调控PCT和IL-6水平相关,三者均对PPROM合并CS具有一定的早期诊断价值,而三者联合检测对PPROM/CS具有更高的诊断价值。Objective:To explore the value of Wip1,PCT and IL-6 in the diagnosis of preterm premature rupture of membranes with chorioamnionitis.Methods:58 patients with preterm premature rupture of membranes(PPROM)from the obstetrics department of the Eastern Hospital of The Fourth Hospital of Hebei Medical University from January 2017 to December 2019 were selected as the PPROM group,and 43 patients with PPROM combined with chorioamnionitis(CS)were enrolled as PPROM/CS group.60 normal parturients served as a control group.Laboratory analysis of serum WBC,NEU,CRP,PCT,IL-6,IL-8,IL-10 levels were performed.Flow cytometry analysis was used to detect peripheral blood mononuclear cells Wip1(PBMC Wip1)expression level.Multi-factor Logistic regression was used to analyze the PPROM/CS risk factor.The correlation analysis of PBMC Wip1 expression and clinical indicators were analyzed by the Person method.The diagnostic value of detection index was demonstrated by ROC curve analysis.Results:Compared with those in the PPROM group and the control group,the blood WBC,NEU,serum PCT,IL-6 and IL-8 of the PPROM/CS group were significantly increased(P<0.01).There was no significant difference of CRP or IL-10 between the three groups(P>0.05).There was no significant difference of PBMC Wip1 in control and PPROM/CS group(t=0.17,P>0.05).The level of PBMC Wip1 in PPROM/CS group significantly decreased compared with that in the control group(t=3.49,P<0.01)and PPROM group(t=4.01,P<0.01).Multi-factor Logistic regression showed that increase of PCT andIL-6 and decrease of Wip1 are independent risk factors of PPROM/CS(OR>1,P<0.05).PBMC Wip1 was moderately negatively correlated with IL-6(r=-0.3237,P=0.034)and PCT(r=-0.4249,P=0.005).The areas under the curve(AVC)of PBMC Wip1,serum IL-6,and serum PCT were 0.8987,0.8551 and 0.8210,respectively(P<0.01).When PBMC Wip1,serum IL-6 and serum PCT were 6.68(MFI),8.56(ng/L),and 0.10(μg/L),the Youden index was the largest,which was the best detection critical point.The area under the ROC curve of the Wip1,IL-6 and

关 键 词：磷酸酶Wip1 未足月胎膜早破 绒毛膜羊膜炎 白介素-6 降钙素原 

分 类 号：R714.2[医药卫生—妇产科学]