羊水炎症因子与紧急子宫颈环扎术孕妇妊娠结局的关系  

Relationship between amniotic fluid inflammatory factors and pregnancy outcomes after emergency cervical cerclage

作　　者：吴琳祥 包琳[1] 祝丽琼[1] 郭颖琛 刘勇[2] 谭剑平[1] 陈慧[1] 张建平[1] 刘颖琳[1] Wu Linxiang;Bao Lin;Zhu Liqiong;Guo Yingchen;Liu Yong;Tan Jianping;Chen Hui;Zhang Jianping;Liu Yinglin(Department of Obstetrics and Gynecology,Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou 510120,China;Department of Pediatrics,Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院妇产科,广州510120 [2]中山大学孙逸仙纪念医院儿科,广州510120

出　　处：《中华妇产科杂志》2024年第7期522-529,共8页Chinese Journal of Obstetrics and Gynecology

基　　金：国家重点研发计划(2019YFA0801403)。

摘　　要：目的探讨羊水和外周血中炎症因子水平与紧急子宫颈环扎术孕妇妊娠结局的关系,寻找预测术后不良妊娠结局的指标。方法采用病例对照研究,收集2013年1月1日至2019年7月31日于中山大学孙逸仙纪念医院住院,妊娠16~28周因子宫颈外口扩张行紧急子宫颈环扎术的孕妇,选取其中围术期行羊膜腔穿刺术并检测羊水中炎症因子的孕妇共85例。根据是否抱婴回家,分为不良结局组(28例)与活产组(57例)。采用单因素logistic回归分析寻找不良妊娠结局的相关危险因素,进一步行多因素logistic回归分析建立预测不良妊娠结局的列线图。结果(1)与活产组比较,不良结局组孕妇行紧急子宫颈环扎术的孕周较早[分别为(23.7±1.8)、(22.9±1.9)周],宫口扩张程度较大(中位数分别为2.0、3.0 cm),分娩孕周较早[分别为(32.8±4.0)、(25.2±2.0)周]、延长孕周时间较短(中位数分别为65.0、13.5 d),分别比较,差异均有统计学意义(P均<0.05)。(2)不良结局组紧急子宫颈环扎术围术期羊水中肿瘤坏死因子α(TNF-α)、白细胞介素(IL)1β、IL-6、IL-8、IL-10及术后外周血C反应蛋白(CRP)水平显著高于活产组(P均<0.05);而环扎术前及术后孕妇外周血白细胞计数(WBC)、中性粒细胞百分比,以及术前CRP水平的差异均无统计学意义(P均>0.05)。(2)单因素logistic回归分析显示,羊水WBC、TNF-α、IL-1β、IL-2受体(IL-2R)、IL-6、IL-8、IL-10、术后外周血CRP、环扎术孕周及宫口扩张程度与不良结局相关(P均<0.05),多因素logistic回归分析显示,仅羊水WBC、TNF-α为不良结局的独立危险因素。(3)结合临床实践,综合羊水TNF-α、WBC、环扎术孕周及宫口扩张程度构建多因素logistic回归模型,绘制列线图及校准曲线,提示该多因素logistic回归模型对不良结局的预测价值良好,曲线下面积为0.811(95%CI:0.697~0.926),预测不良结局的敏感度为0.792,特异度为0.852,阳性预测值为0.679,�Objective To explore the relationship between amniotic fluid and peripheral blood inflammatory factors and the pregnancy outcomes after emergency cervical cerclage,and to identify effective indicators for predicting adverse pregnancy outcomes after the procedure.Methods A case-control study was conducted,including pregnant women who were hospitalized at Sun Yat-sen Memorial Hospital,from January 1,2013,to July 31,2019,and underwent emergency cervical cerclage due to cervical dilatation at gestational age between 16 and 28 weeks.A total of 85 pregnant women who underwent amniocentesis for the detection of amniotic fluid inflammatory factors during the perioperative period were included.Based on whether their baby was perinatal death,the participants were divided into the case group(28 cases with perinatal death)and the control group(57 cases with live births).Univariate logistic regression analysis was performed to identify risk factors associated with adverse pregnancy outcomes,followed by multivariate logistic regression analysis to establish a regression model and nomogram.Results(1)The levels of tumor necrosis factor α(TNF-α),interleukin(IL)-1β,IL-6,IL-8,IL-10 in the amniotic fluid during the perioperative period and postoperative serum C-reactive protein(CRP)were significantly higher in the case group compared to the control group(all P<0.05).The case group underwent emergency cervical cerclage at an earlier gestational age compared to the control group,and their cervical dilation was greater than that of the control group(all P<0.05).However,there were no significant differences in the white blood cell counts,neutrophil percentage,and the level of preoperative CRP in the peripheral blood of pregnant women during the perioperative period(all P>0.05).(2)Univariate logistic regression analysis showed that the levels of amniotic fluid WBC,TNF-α,IL-1β,IL-2 receptor(IL-2R),IL-6,IL-8,IL-10,postoperative CRP in the peripheral blood,gestational age at cerclage and cervical dilation were associated with adverse p

关 键 词：宫颈功能不全 羊水 细胞因子类 环扎术 宫颈 妊娠结局 

分 类 号：R714[医药卫生—妇产科学]