CIC孕妇宫颈环扎术后宫颈长度联合血清IL-6、TNF-α、hs-CRP预测自发性早产的价值  

Value of cervical length combined with serum IL-6,TNF-αand hs-CRP in predicting spontaneous preterm birth in pregnant women with CIC after cervical cerclage

作　　者：何静媛[1] 辛艳芬[2] 米辰 HE Jingyuan;XIN Yanfen;MI Chen(Department of Gynecology and Obstetrics,Deyang People’s Hospital,Deyang,Sichuan 618000,China;Ultrasound Department,Deyang People’s Hospital,Deyang,Sichuan 618000,China)

机构地区：[1]四川省德阳市人民医院妇产科,四川德阳618000 [2]四川省德阳市人民医院超声科,四川德阳618000

出　　处：《检验医学与临床》2025年第6期790-795,共6页Laboratory Medicine and Clinic

基　　金：四川省德阳市科技计划课题(2022SCZ135)。

摘　　要：目的探讨子宫颈功能不全(CIC)孕妇宫颈环扎术后宫颈长度(CL)联合血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)预测自发性早产(SPB)的价值。方法选取2021年1月至2024年3月行宫颈环扎术后于该院产检的185例CIC孕妇作为研究对象。通过医院电子病历系统收集所有孕妇的基线资料,包括是否支原体阳性、是否细菌阳性等。所有孕妇均于宫颈环扎术后3周内行阴道超声检查,测量CL。检测血清IL-6、TNF-α、hs-CRP水平。随访至妊娠结束,根据是否发生SPB,将孕妇分为SPB组和非SPB组,比较2组基线资料、CL及血清IL-6、TNF-α、hs-CRP水平;采用多因素Logistic回归分析发生SPB的影响因素。根据孕周临床分期,将SPB组孕周在28~31^(+6)周孕妇纳入早期SPB,>31^(+6)~33^(+6)周孕妇纳入中期SPB,>33^(+6)~36^(+6)周纳入晚期SPB,对比不同早产时间孕妇CL及血清IL-6、TNF-α、hs-CRP水平。采用Spearman相关分析SPB组CL及血清IL-6、TNF-α、hs-CRP水平与早产时间的相关性。绘制受试者工作特征(ROC)曲线分析CL及血清IL-6、TNF-α、hs-CRP诊断SPB的价值。结果研究期间失访3例,剔除因其他原因导致的早产4例,最终有178例孕妇纳入结果分析,其中40例发生SPB(SPB组),发生率为22.47%(40/178),未发生SPB的138例孕妇作为非SPB组。SPB组支原体阳性占比、细菌阳性占比及血清IL-6、TNF-α、hs-CRP水平高于非SPB组,CL短于非SPB组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,支原体阳性、细菌阳性及血清IL-6、TNF-α、hs-CRP水平升高均为CIC孕妇行宫颈环扎术后发生SPB的危险因素(P<0.05),CL变长是CIC孕妇行宫颈环扎术后发生SPB的保护因素(P<0.05)。孕周临床分期结果显示,16例为晚期SPB,13例为中期SPB,11例为早期SPB。晚期SPB孕妇CL长于中期SPB和早期SPB孕妇,血清IL-6、TNF-α、hs-CRP水平低于中期SPB和早期SPB孕妇,差异均有统计学�Objective To explore the value of cervical length(CL)combined with serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and high-sensitivity C-reactive protein(hs-CRP)in predicting spontaneous preterm birth(SPB)in pregnant women with cervical incompetence(CIC)after cervical cerclage.Methods A total of 185 pregnant women with CIC who underwent cervical cerclage and underwent prenatal care at the hospital from January 2021 to March 2024 were selected as the research objects.Baseline data of all pregnant women were collected through the hospital electronic medical record system,including whether they were mycoplasma-positive or not,and whether they were bacteria-positive or not.All pregnant women underwent vaginal ultrasound examination within 3 weeks after cervical cerclage,and CL was measured.Serum IL-6,TNF-α,and hs-CRP levels were detected.During the follow-up period until the end of pregnancy,the pregnant women were divided into SPB group and non-SPB group according to whether SPB occurred or not,baseline data,CL and serum levels of IL-6,TNF-α,and hs-CRP were compared between the two groups.Multivariate Logistic regression analysis was used to analyze the factors affecting the occurrence of SPB.According to the clinical staging of gestational weeks,the SPB group of pregnant women with 28-31^(+6)weeks were included in early stage SPB,pregnant women with>31^(+6)-33^(+6)weeks were included in intermediate stage SPB,and pregnant women with>33^(+6)-36^(+6)weeks were included in late stage SPB,and CL and serum IL-6,TNF-α,and hs-CRP levels of pregnant women with different preterm delivery stages were compared.Spearman correlation was applied to analyze the correlation of CL and serum IL-6,TNF-α,and hs-CRP levels with stages of preterm delivery in the SPB group.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of CL,serum IL-6,TNF-α,and hs-CRP for SPB.Results During the study period,3 cases were lost to follow-up,and 4 cases of premature delivery due to other reasons were exc

关 键 词：子宫颈功能不全 宫颈环扎术 早产 阴道超声 宫颈长度 炎症因子 

分 类 号：R446.11[医药卫生—诊断学] R713.4[医药卫生—临床医学]