摘要
目的研究胎儿纤维连接蛋白(fetal fibronectin,fFN)对先兆早产孕妇发生早产的预测价值,及与官颈长度联合应用时对早产的预测意义。方法联合国内三家医院对有先兆早产症状的孕妇进行阴道后穹窿分泌物中fFN的测定及宫颈的超声检测,追踪这些孕妇的妊娠结局。结果 (1)共检测122例先兆早产孕妇,75例fFN阳性,阳性率为61．5％。(2)阳性孕妇中7 d内、14 d 内、37周前分娩率分别为22．7％(17／75)、41.3％(31／75)、65．3％(49／75);阴性孕妇则分别为0％(0／ 47)、0％(0／47)、12.8％(6／47)。对于7 d内、14 d内和37周内分娩的阴性预测值分别为100％、 100％和87．2％。(3)50例孕妇同时进行了宫颈长度的测量。以宫颈长度≤26mm为异常。50例中 fFN(+)和宫颈长度同时异常者7 d内、14 d内、37周前分娩率分别为13．3％(2／15)、40．0％(6／15)、 93．3％(14／15),均显著高于fFN(+)而宫颈长度正常的孕妇。宫颈长度异常而fFN阴性者中无一例 14 d内分娩。二者同时异常预测先兆早产孕妇发生早产的敏感性为70％,特异性为97．2％,阳性预测值为93．3％,阴性预测值为85．4％。结论 (1)在先兆早产孕妇中阴道后穹窿分泌物fFN阳性对先兆早产孕妇发生早产有一定的预测意义,阴性预测短期内不发生早产的价值较大。(2)fFN测定与宫颈长度联合应用可以提高37周前早产阳性预测结果,但对短期内发生早产的预测意义不大。
Objective To determine the predictive value of fetal fibronectin （fFN） alone or com bined with cervical length （CL） for preterm birth in pregnant women with preterm labor. Methods Pregnant women were collected from three hospitals, fFN level in discharges from the posterior fornix and the CL under vaginal ultrasound scan were measured for all subjects who presented with preterm labor between 24-34^＋6 gestational weeks with intact membranes, cervical dilation 〈3 cm and without previous tocolysis. Pregnant outcomes were recorded. Results （1） Among 122 subjects, positive fFN was detected in 61.5% （75 cases）. The overall preterm birth rate was 45.1% （55/122）. The prevalence of spontaneous preterm delivery among those women with fFN（＋） within 7 days, 14 days, and 〈37 weeks were 22.7%（17/75）,41.3%（31/75） and 65.3% （49/75）, respectively, which were significantly higher than those women with fFN（ - ） [0 % （0/47） ,0 % （0/47） and 12.7 % （6/47）-]. The negative predictive values （PPV） were 100% ,100% and 87.2%. （3） CL was measured in 50 cases, 20 of which with CL〈26mm. The rate of preterm birth in those women with both shorter CL and fFN （＋） within7 days, 14 days, 〈37weeks were 13.3%（2/15）,40.0%（6/15）,93.3%（14/15）, and were significantly higher than those with normal CL and fFN（＋）. No preterm birth occurred among the women with shorter CL and fFN（-）. The sensitivity, specificity, PPV and negative predictive value（NPV） of shorter CL and fFN（＋） for preterm birth were 70%, 97.2%, 93.3% and 85.4%, respectively. Conclusions Vaginal fFN is valuable in predicting preterm birth in women with pre term labor, especially significant for NPV. Vaginal fFN determination combined with CL measurement can improve the PPV of preterm delivery 〈37 weeks, but not of preterm delivery for short period.
出处
《中华围产医学杂志》
CAS
2006年第1期2-5,共4页
Chinese Journal of Perinatal Medicine
关键词
纤维连接蛋白类
超声检查
产前
子宫颈
分娩
早产
预测
Fibronectins
Ultrasonography, prenatal
Cervix uteri
Labor, premature
Forecasting
