母体血清可溶性细胞间黏附分子-1与早产关系的探讨

目的探讨可溶性细胞间黏附分子-1(sICAM-1)含量与孕妇妊娠结局的相关性,及其在先兆早产及晚期先兆流产诊治中的意义。方法 2011年4月至2012年3月在中山大学附属第一医院产科规律产检并分娩单胎妊娠共73例,分为正常对照组32例,晚期先兆流产及先兆早产41例,其中足月分娩组24例,早产组17例。采用酶联免疫吸附法测定血清sICAM-1,比较组间血清sICAM-1含量差异及其与孕妇早产的关系。结果 (1)早产组sICAM-1浓度高于正常对照组及足月分娩组,早产组宫颈长度小于足月分娩组。(2)sICAM-1浓度、宫颈长度分别达到388.65 ng/ml、21.5 mm时,预测先兆早产及晚期先兆流产孕妇早产的敏感性、特异性、阳性预测值、阴性预测值分别为52.9%、95.7%、90.0%、74.2%,58.8%、91.7%、83.3%、75.9%。(3)以sICAM-1=388.65 ng/ml及宫颈长度21.5 mm为临界点,联合预测晚期先兆流产及先兆早产孕妇早产的敏感性、特异性、阳性预测值、阴性预测值分别为35.3%、87.5%、100%及84%。结论 (1)sICAM-1达到388.65 ng/ml时可预测先兆早产及晚期先兆流产孕妇早产的发生。(2)以sICAM-1=388.65 ng/ml及宫颈长度21.5 mm为临界点,两者联合预测晚期先兆流产及先兆早产孕妇早产可提高阳性预测值及阴性预测值。

Relationship between maternal serum soluble intercellular adhesion molecule-1 and preterm labor

ObjectiveTo analyze the relationship between serum soluble intercellular adhesion molecule-1（sICAM-1） and preterm labor and to determine whether sICAM-1 can be an medical index for prediction and treatment.Methods73 nulliparous women, including 32 normal term delivery cases, 24 term labor cases with threatened labor in the second/third trimester and 17 preterm labor cases were recruited who received regular prenatal care and delivered at the first affiliated hospital of Sun yat-sen University. Serum sICAM-1 levels were assessed by enzyme-linked immunoassay（ELISA） to compare difference of sICAM-1 levels among groups and analyze the relevance between sICAM-1 and preterm delivery.Results In women with preterm delivery, serum sICAM-1 concentrations were significantly higher andcervical lengths were significantly shorter compared with women experiencing term labor and normal pregnancy, （345.56±33.93）ng/mlvs. （255.42±18.84）ng/ml,P=0.010; （345.56±33.93）ng/mlvs. （231.78±17.32）ng/ml,P=0.001; When cut-off of sICAM-1 was 388.65 ng/ml, cervical length was 21.5 mm or combined, the sensitivity, specificity, positive and negative predictive value to predict preterm delivery were 52.9%, 95.7%, 90.0%, 74.2%; 58.8%, 91.7%, 83.3%, 75.9% 35.3%, 87.5%, 100%, 84% respectively.ConclusionsWhen sICAM-1 is 388.65 ng/ml or cervical length is 21.5 mm, it can predict preterm delivery. Combinating sICAM-1 with cervical length to predict preterm delivery can improve positive and negative predictive value.