母体血内脂素、降钙素原和超敏C-反应蛋白联合预测胎膜早破并发宫内感染的价值  

Prediction of intrauterine infection with premature rupture of membranes by maternal serum visfatin,hs-CRP and PCT

作　　者：李娟[1] 沈晓亚 Li Juan;Shen Xiaoya(Department of Obstetrics and Gynecology,Nanjing Jiangbei Hospital Affiliated to Nantong University,China)

机构地区：[1]南通大学附属南京江北医院妇产科,江苏南京210048

出　　处：《发育医学电子杂志》2021年第6期427-431,共5页Journal of Developmental Medicine (Electronic Version)

基　　金：南京市科技项目(Ykk13183)。

摘　　要：目的探讨母体血内脂素、降钙素原(procalcitonin,PCT)、超敏-C反应蛋白(hypersensitive C-reactive protein,hs-CRP)水平联合预测胎膜早破并发宫内感染的价值。方法2018年5月至2019年3月,在南通大学附属南京江北医院收治的明确诊断为胎膜早破的孕妇中,纳入192例孕妇,检测母体血内脂素、hs-CRP、PCT水平,并根据是否并发宫内感染分为感染组和未感染组。统计胎膜早破的宫内感染发生率。比较未感染组与感染组的基本情况和母体血内脂素、hs-CRP、PCT水平。分析母体血内脂素、hs-CRP联合PCT对宫内感染的预测作用。采用t检验、受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)进行统计分析。结果192例胎膜早破孕妇中,宫内感染发生率为17.7%(34/192)。感染组与未感染组的年龄、孕周、体重指数、孕次比较,差异均无统计学意义(P>0.05)。未感染组与感染组的内脂素水平[(4.26±0.82)与(8.89±1.74)μg/L,t=23.550]、hs-CRP水平[(2.61±0.53)与(8.72±1.73)mg/L,t=37.271]、PCT水平[(2.34±0.45)与(9.19±1.83)μg/L,t=41.867]比较,感染组均高于未感染组,差异有统计学意义(P<0.05)。根据ROC曲线,内脂素、hs-CRP、PCT的最佳截断值分别为8.10μg/L、8.62 mg/L、9.09μg/L;内脂素、hs-CRP、PCT及3项指标联合预测胎膜早破宫内感染的AUC分别为0.795、0.820、0.803及0.911,其灵敏度分别为79.41%、85.29%、88.24%、94.18%,特异度分别为88.61%、86.08%、82.91%、94.94%。3项指标联合预测的AUC、灵敏度、特异度均高于单项。结论胎膜早破并发宫内感染的风险高,并发宫内感染者母血内脂素、hs-CRP、PCT均高于未发生感染者,且3项指标联合对胎膜早破并发宫内感染有良好的预测作用。Objective To explore the value of maternal serum visfatin,procalcitonin(PCT)and highsensitivity C-reactive protein(hs-CRP)in the prediction of premature rupture of membranes(PROM)with intrauterine infection.Methods 192 pregnant women diagnosed as PROM from May 2018 to March 2019 in the Department of Obstetrics and Gynecology of Nanjing Jiangbei Hospital Affiliated to Nantong University were enrolled.The maternal serum visfatin,hs-CRP and PCT levels were detected.The patients were divided into infected group and uninfected group according to whether intrauterine infection occurred.The incidence of intrauterine infection in PROM cases was counted.The levels of serum visfatin,hs-CRP and PCT of prenatal mothers in the two groups were compared.The t-test and area under curve(AUC)of receiver operating characteristic(ROC)were used for statistical analysis.Results The incidence of intrauterine infection in PROM cases was 17.71%(34/192).There was no significant difference in age,gestational age,body mass index and gravidity between infected group and non-infected group(P>0.05).The levels of lipopolysin,hs-CRP and PCT in the infected group were significantly higher than those in the non-infected group[lipopolysin(8.89±1.74)vs(4.26±0.82)μg/L,t=23.550;hs-CRP(8.72±1.73)vs(2.61±0.53)mg/L,t=37.271;PCT(9.19±1.83)vs(2.34±0.45)μg/L,t=41.867;all P<0.05].The optimal cut-off value of visfatin was 8.10μg/L,hs-CRP 8.62 mg/L,and PCT 9.09μg/L.The AUC predicted intrauterine infection of PROM by visfatin,hs-CRP,PCT and the three indicators combined was 0.795,0.820,0.803 and 0.911,with the sensitivity of 79.41%,85.29%,88.24%and 94.18%,and the specificity of 88.61%,86.08%,82.91%and 94.94%,respectively.The AUC,sensitivity and specificity of the three indicators combine d were higher than single ind icator.Conclusions PROM has the risk of intrauterine infection.In PROM cases with intrauterine infection,maternal serum levels of visfatin,hs-CRP and PCT increase.The three indicators combined have good predictive effects on intrauterine

关 键 词：内脂素 超敏C-反应蛋白 降钙素原 胎膜早破 宫内感染 预测作用 

分 类 号：R714.433[医药卫生—妇产科学]