未足月胎膜早破发生组织学绒毛膜羊膜炎的临床预测研究

目的 通过对未足月胎膜早破(preterm premature rupture of membrane,PPROM)病例进行临床资料分析,研究能否通过患者的临床指标进行组织学绒毛膜羊膜炎(histologic chorioamnionitis,HCA)的预测.方法 回顾性分析2010年1月至2016年12月在北京大学第...

Clinical prediction of histological chorioamnionitis in preterm premature rupture of membranes

Objective By analyzing the clinical data of preterm premature rupture of membrane(PPROM) cases, it was investigated whether histologic chorioamnionitis(HCA) could be predicted by the clinical indicators of patients.Methods A retrospective analysis of 388 pregnant women with singleton PPROM who gave birth in Peking University First Hospital from January 2010 to December 2016 and obtained postpartum placental pathology results were divided into HCA group and non-HCA group according to postpartum placental pathology results.There were 168 cases in the HCA group and 220 cases in the non-HCA group.The clinical data were collected;The white blood(WBC) count, neutrophil(NE) count, percentage of neutrophils(neutrophil%,NE%),lymphocyte count, C-reactive protein(C-reactive protein, CRP) results, calculate the neutrophil to lymphocyte ratio(neutrophil to lymphocyte ratio, NLR).The ROC curve was drawn to further explore the predictive value of different indicators for HCA,and combined with the scoring system of clinical indicators to predict the occurrence of HCA in PPROM less than 34 weeks of gestation.Results(1) The proportion of HCA group was 43.3%(168/388).The average gestational age of PPROM(33;weeks) and gestational age of delivery(33;weeks) in the HCA group were significantly lower than those in the non-HCA group(35;weeks, 35;weeks)(P<0.05);(2) The study of medical history data showed that the history of in vitro fertilization embryo transfer + uterine cavity operation in HCA group(11.9%) was significantly higher than that in non-HCA group(5.5%);(3) Prenatal pregnant women in HCA group fever(17.3%) and puerperal infection(6.0%) were significantly higher than those in the non-HCA group(9.1%,0)(P<0.05);(4) Compared with the non-HCA group, the prenatal blood CRP of the HCA group(11 mg/L vs 5 mg/L),WBC(13.1×10⁹/L vs 10.6×10⁹/L),NE(10.7×10⁹/L vs 8.4×10⁹/L),NE%(80.9% vs 78.4%),NLR(6.9 vs 5.3),there was a significant difference(P<0.05);(5) The area under the ROC curve of CRP in blood before delivery at PPROM <34 weeks was 0.806,and its sensitivity for predicting HCA was 65.6%;(6) PPROM <34 weeks, the sensitivity of clinical score ≥3 for predicting HCA was 87.0%,the specificity was 93.8%,the positive predictive value was 95.2%,and the negative predictive value was 83.3%.Conclusion Maternal blood CRP before delivery is the best serological factor for predicting the occurrence of histological chorioamnionitis in preterm premature rupture of membranes <34 weeks.Scoring system combined with clinical indicators has high sensitivity and specificity for HCA in pregnant women with PPROM<34 weeks.