未足月胎膜早破孕妇胎盘组织TLR4和IL-6及分泌物涂片联合预测绒毛膜羊膜炎的诊断价值  

Diagnostic value of placenta tissues TLR4 and IL-6 combined with secretion smears in predicting chorioamnionitis in pregnant women with preterm premature rupture of membranes

作　　者：张坚贞 吴燕 沈华祥 朱小玉 艾玲 薛丽丽 ZHANG Jian-zhen;WU Yan;SHEN Hua-xiang;ZHU Xiao-yu;AILing;XUE Li-li(Jiaxing Maternal and Child Health Hospital(Women and Children Hospital Affiliatedto Jiaxing University),Jiaxing,Zhejiang 314000,China)

机构地区：[1]嘉兴市妇幼保健院(嘉兴学院附属妇儿医院)产科,浙江嘉兴314000

出　　处：《中华医院感染学杂志》2022年第20期3156-3160,共5页Chinese Journal of Nosocomiology

基　　金：嘉兴市科技计划公益性应用技术研究计划基金资助项目(2018AD32106)。

摘　　要：目的分析未足月胎膜早破(pPROM)孕妇胎盘组织Toll样受体(TLR4)、白细胞介素-6(IL-6)及分泌物涂片联合预测绒毛膜羊膜炎(HCA)的价值。方法选取2019年2月-2020年11月嘉兴市妇幼保健院收治的80例pPROM产妇,依据产后胎盘组织学检测结果分为HCA组34例和非HCA组46例,另选同期体检正常产妇30名设为对照组,比较三组的TLR4、IL-6和宫颈分泌物涂片情况,采用受试者工作特征(ROC)曲线分析TLR4、IL-6联合宫颈分泌物涂片对HCA及不同程度HCA的诊断价值,采用Logistic回归模型分析发生HCA的影响因素。结果HCA组的TLR4、IL-6及分泌物涂片评分均高于非HCA组和对照组(P<0.05);非HCA组的TLR4、IL-6及分泌物涂片评分均高于对照组(P<0.05);重度组的TLR4、IL-6水平及分泌物涂片评分均高于轻中度组(P<0.05);TLR4、IL-6、分泌物涂片指标联合应用诊断HCA及轻中、重度HCA的曲线下面积(AUC)为0.938、0.915,灵敏度、特异度分别为84.62%、72.86%和80.00%、75.45%;AUC、灵敏度、特异度均高于单一检测(P<0.05);TLR4水平是影响HCA发生的影响因素(OR=1.694,P=0.009)。结论pPROM产妇胎盘组织的TLR4、IL-6水平联合分泌物涂片可有效预测HCA的发生,同时也具有较好预测HCA发展的价值。OBJECTIVE To analyze the diagnositic value of placenta tissues Toll-like receptor 4(TLR4)and interleukin-6(IL-6)combined with secretion smears in predicting histological chorioamnionitis(HCA)in pregnant women with preterm premature rupture of membranes(pPROM).METHODS A total of 80 pregnant women with pPROM admitted to Jiaxing Maternal and Child Health Hospital from Feb.2019 to Nov.2020 were selected and divided into HCA group(34 cases)and non-HCA group(46 cases)according to the results of postpartum placental histological examination,and 30 normal pregnant women who underwent physical examination during the same period were selected as the control group.The levels of TLR4 and IL-6,and smears of cervical secretions among the three groups were compared.The diagnostic value of TLR4 and IL-6 combined with cervical secretion smears in predicting HCA and its different severity was analyzed by receiver operating characteristic(ROC)curves.The influencing factors of HCA were analyzed by Logistic regression model.RESULTS The levels of TLR4 and IL-6,and scores of secretion smears in HCA group were higher than those of the non-HCA group and the control group,and the TLR4,IL-6 and secretion smear scores of the non-HCA group were higher than those of the control group(P<0.05).The levels of TLR4 and IL-6,and scores of secretion smears in severe group were higher than those in mild-to-moderate group(P<0.05).The area under the curve(AUC)of TLR4 and IL-6 combined with secretion smear in the diagnosis of HCA and mild-to-moderate and severe HCA were 0.938 and 0.915,respectively,and the sensitivity and specificity were 84.62%and 72.86%,80.00%and 75.45%,respectively.The AUC,sensitivity and specificity of the combined detection were all higher than those of single detection(P<0.05).TLR4 was the influencing factor for the occurrence of HCA(OR=1.694,P=0.009).CONCLUSION The TLR4 and IL-6 combined with secretion smears of placental tissues in pPROM pregnant women could effectively predict the occurrence of HCA,which also had good value in

关 键 词：未足月胎膜早破 绒毛膜羊膜炎 TOLL样受体4 白细胞介素-6 分泌物涂片 

分 类 号：R714.433[医药卫生—妇产科学]