阴道分泌物胎儿纤维连接蛋白与宫颈长度联合预测早产的多中心前瞻性研究

摘要

目的 探讨阴道分泌物胎儿纤维连接蛋白(fFN)与宫颈长度测量联合应用在早产预测中的价值.方法 选择2012年1月～2012年12月就诊的孕22～35周,有不规律宫缩,或有早产高危因素的121例孕妇为研究对象,检测其宫颈阴道分泌物中fFN,同时B超测量宫颈长度,比较其临产的时间及孕周情况.结果 同时行宫颈长度超声测量与fFN检测的121例先兆早产孕妇中,82例孕妇的宫颈长度≤3.0 cm,其中57例fFN呈阳性,25例呈阴性；39例宫颈长度＞3.0 cm的孕妇中,4例fFN呈阳性,35例呈阴性.fFN阳性对7d内分娩预测的敏感度为75.44％,特异度为100.00％,阴性预测值为100.00％.宫颈缩短(≤3 cm)者7d内分娩的敏感度、特异度、阴性预测值分别为52.44％、100.00％、100.00％；二者联合7、14d内分娩预测敏感度明显高于fFN检测和宫颈长度测量(P＜0.05).结论 阴道分泌物fFN比宫颈长度对预测7d及14d内分娩有较高的阴性预测值及特异度,超声宫颈长度测量联合可进一步提高其阳性预测值和特异度,提高对早产的预测.%Objective To investigate the effect of vaginal secretions fetal fibronectin (fFN) and the value of combined application of cervical length measurement in the prediction of premature labor.Methods From 2012 January to 2012 December, 121 cases of pregnant women who were at 22 to 35 weeks, no regular uterine contraction, or at high risk of preterm birth were chosed as the research object, the cervix and vagina in the secretion of fFN were detected, at the same time, B ultrasound measurement of cervical length, the labor time and gestational weeks were compared.Results 121 cases of pregnant women with preterm labor who detected the cervical length measurement and fFN ultrasound at the same time, cervical length was smaller than 3.0 cm in 82 cases, including 57 cases of fFN positive, 25 cases were negative; 39 cases of cervical length > 3.0 cm, 4 cases were fFN positive, 35 cases were negative.FFN positive on the prediction of delivery within 7 d sensitivity was 75.44%, specificity was 100.00%, the negative predictive value of 100.00%.Cervical shortening (≤3 cm) 7 d delivery within the sensitivity, specificity, negative predictive value were 52.44%, 100.00%, 100.00% respectively; 7, 14 d two combined delivery within prediction sensitivity significantly higher than that of fFN detection and measurement of cervical length (P < 0.05).Conclusion The vaginal secretion of fFN than negative cervical length have higher forecast for 7 d and 14 d delivery prediction value and specificity, ultrasound cervical length measurement in combination can further improve the positive predictive value and specificity, improve the prediction of preterm birth.