宫颈长度胎儿纤维连接蛋白和可溶性细胞间黏附分子-1预测早产的价值

摘要

Objective To analyze the values of cervical length ,soluble intercellular adhesion molecule-1(sI-CAM-1) and fetal fibronectin (fFN) in prediction of premature labor .Method One Hundred pregnant women with threatened premature labor treated in our hospital from March 2013 to May 2014 were selected ,and divided into premature labor group(57 cases) and term labor group(43 cases) according to the outcome of labor .Sixty health pregnant women at the same period were selected as the normal control group .The positive rates of cervical length ,sICAM-1 and fFN in different groups were observed ,and the efficacy of three indexes in prediction of pre-mature labor were analyzed .Results ①The positive rates of cervical length ,sICAM-1 and fFN in premature la-bor group were higher than those in term labor group and normal control group(P<0 .01) .②When the index pre-dicted premature labor alone ,the sensitivity(Sen) was fFN>sICAM-1>cervical length ,the specificity(Spe) was cervical length>sICAM-1>fFN ,the sequence of Youden's index(γ) approach to 1 was fFN ,sICAM-1 and cervical length .③When two indexes were combined ,the Sen ,diagnostic index(DI) and positive likelihood ratio(LR+ ) of the combination of fFN with sICAM-1 was the highest ,the positive predictive value(PV+ ) ,negative predictive value(PV -) and γapproached to 1 the most .When three indexes were combined ,the Sen ,DI and LR+ were higher than those of the combination of any other two indexes ,and PV+ ,PV - andγmuch more approached to 1 , the negative likelihood ratio(LR+ ) was only 0 .02 .Conclusion The value of the combination of cervical length , sICAM-1 and fFN in prediction of premature labor is relatively high .%目的 分析宫颈长度、可溶性细胞黏附分子-1(sICAM-1)及胎儿纤维连接蛋白(fFN )预测早产的价值.方法 选取我院2013年3月至2014年5月先兆早产并入院治疗的孕妇100例 ,根据分娩结局分为早产组57例 ,足月产组43例 ;选取同期60例健康孕妇作为健康对照组.观察宫颈长度、sICAM-1及fFN在不同组别检出的阳性率 ,并分析3个指标预测早产的效能.结果 ①早产组中宫颈长度、fFN和sICAM-1 3个指标阳性率均明显高于健康组和足月产组(P<0 .01). ②各指标单独预测早产时 ,敏感性依次为fFN>sICAM-1>宫颈长度 ,特异性分别是宫颈长度>sICAM-1>fFN ,Youden指数接近1的顺序依次fFN、sICAM-1和宫颈长度. ③两两指标联合时 ,fFN联合sICAM-1时的灵敏度、诊断指数和阳性似然比最高 ,阳性预测值、阴性预测值和Youden指数最接近1.3个指标联合时 ,灵敏度、诊断指数和阳性似然比较任2个指标联合时更高 ,阳性预测值、阴性预测值和Youden指数更接近1 ,阴性似然比仅为0 .02.结论 宫颈长度、sICAM-1以及fFN联合检测对早产预测有较高的价值.