经阴道超声测量宫颈长度联合实验室指标fFN、PAPP-A、IGFBP-1、hCG、MMP-8预测先兆早产的价值  

The value of transvaginal ultrasound measurement of cervical length combined with laboratory indicators of fFN, PAPP-A, IGFBP-1, hCG and MMP-8 in the prediction of threatened preterm delivery

作　　者：曹蕾[1] 范荣[1] 薛美[1] CAO Lei;FAN Rong;XUE Mei(Department of Obstetrics,The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京医科大学第一附属医院产科,江苏南京210029

出　　处：《中国优生与遗传杂志》2021年第1期64-68,共5页Chinese Journal of Birth Health & Heredity

摘　　要：目的探讨经阴道超声测量宫颈长度(CL)联合实验室指标胎儿纤维连接蛋白(f FN)、妊娠相关蛋白-A(PAPP-A)、胰岛素样生长因子结合蛋白-1(IGFBP-1)、人绒毛膜促性腺激素(h CG)、基质金属蛋白酶-8(MMP-8)预测先兆早产的价值,为先兆早产的防治提供参考,促进优生优育。方法选取2018年1月至2019年12月我院收治的148例先兆早产孕妇作为研究组,同期52例正常产检孕妇作为对照组。采用经阴道超声测量两组孕妇宫颈长度,采用胶体金法或酶联免疫吸附法(ELISA)检测两组孕妇宫颈分泌物f FN、IGFBP-1、MMP-8和血清PAPP-A、hCG水平。采用受试者工作特征(ROC)曲线分析CL和上述实验室指标预测先兆早产的价值。结果研究组CL及PAPP-A、IGFBP-1水平均低于对照组,而f FN、hCG、MMP-8水平均高于对照组,差异有统计学意义(P<0.05)。ROC曲线分析显示:CL、f FN、PAPP-A、IGFBP-1、h CG、MMP-8对先兆早产均具有一定预测价值(AUC分别为0.823、0.820、0.821、0.808、0.818、0.843,P<0.01)。进一步Logistic回归分析显示:联合检测预测先兆早产的AUC、敏感度、特异度分别为0.980、92.6%、94.2%,均高于CL、f FN、PAPP-A、IGFBP-1、h CG、MMP-8单项检测(P<0.01)。结论经阴道超声测量CL和实验室指标f FN、PAPP-A、IGFBP-1、h CG、MMP-8均可作为先兆早产的预测指标,且联合检测可提高先兆早产的预测效能。Objective To investigate the value of transvaginal ultrasound measurement of cervical length(CL) combined with laboratory indicators of fetal fibronectin(fFN), pregnancy associated plasma protein-a(PAPP-A), insulin-like growth factor binding protein-1(IGFBP-1), human chorionic gonadotropin(hCG), matrix metalloproteinase-8(MMP-8) in the prediction of threatened preterm delivery. Methods 148 cases of threatened preterm delivery in our hospital from January 2018 to December 2019 were selected as the study group, and 52 cases of normal pregnant women in the same period were selected as the control group. The cervical length was measured by transvaginal ultrasound. The levels of fFN, IGFBP-1, MMP-8 in cervical secretion and PAPP-A and hCG in serum were detected. ROC curve was used to analyze the value of CL and the above laboratory indicators in the prediction of threatened preterm delivery. Results The levels of CL, PAPP-A and IGFBP-1 in the study group were lower than those of control group, the levels of fFN, hCG and MMP-8 in the study group were higher than those in the control group(P<0.05). ROC curve analysis showed that: The CL, fFN, PAPP-A, IGFBP-1, hCG and MMP-8 had certain predictive value for threatened preterm delivery(AUC=0.823, 0.820, 0.821, 0.808, 0.818, 0.843, respectively;P<0.01). Further logistic regression analysis showed that: The AUC, sensitivity and specificity of combined detection in the prediction of threatened preterm delivery were 0.980, 92.6% and 94.2% respectively, which were higher than those of CL, fFN, PAPP-A, IGFBP-1, hCG and MMP-8(P<0.01). Conclusion Transvaginal ultrasound measurement of CL and laboratory indicators of fFN, PAPP-A, IGFBP-1, hCG, MMP-8 were can be used as predictors of threatened preterm delivery, and the combined detection can improve the predictive efficiency of threatened preterm delivery.

关 键 词：先兆早产 宫颈长度 胎儿纤维连接蛋白 妊娠相关蛋白-A 胰岛素样生长因子结合蛋白-1 人绒毛膜促性腺激素 基质金属蛋白酶-8 

分 类 号：R714.21[医药卫生—妇产科学] R445.1[医药卫生—临床医学]