促肾上腺皮质激素释放激素联合胎儿纤维连接蛋白检测对早产的预测价值

目的 探讨孕妇血浆促肾上腺皮质激素释放激素(CRH)及阴道分泌物中胎儿纤维连接蛋白(fFN)检测联合宫颈长度测量对预测早产的临床价值.方法 采集2009年12月至2010年12月来我院查体孕妇的血浆及阴道分泌物,应用ELISA方法检测CRH和fFN,观察其在妊娠不同时间的变化,并结合不同妊娠结局(早产与足月产)进行分析.结果 112例孕妇早产54例,足月产58例.早产组妊娠24周时宫颈管长度为(2.8±0.4) cm,足月产组为(3.3±0.5) cm,差异有统计学意义(t=3.254,P=0.021).早产组与足月产组妊娠28～ 30周、31 ～32周、33 ～34周、35 ～36周血浆CRH分别为(162.33±16.49)、(60.01±14.56) ng/L,( 352.12±61.01)、(118.04±53.74) ng/L,(364.55±56.71)、(122.95±71.41) ng/L,(372.78±149.89)、(124.00±19.05)ng/L,差异均有统计学意义(t值分别为3.687、6.875、8.652、8.524,P均＜0.05).CRH、fFN联合宫颈长度测定预测早产均有较好的灵敏度(97.92％)、特异度(90.00％)、阳性预测值(95.92％)和阴性预测值(94.73％).结论 检测孕妇CRH、ffN联合宫颈长度测量可以提高对早产的预测性,为早产的早期诊断与治疗提供良好、可靠的临床依据.

The value of corticotropin-releasing hormone and fetal fibronectin in predicting premature delivery

Objective To study the value of plasma corticotropin-releasing hormone (CRH) and the fetal fibronectin (fFN) in vaginal secretions and cervical length in predicting preterm labor.Methods The plasma CRH levels and fFN levels in vaginal secretions from 24 -37 weeks pregnant woman checked up in our hospital from Dec.2009 to Dec.2010 were detected by ELLISA method.The changes of these three indexes were observed with the pregnant time and were analyzed according to different pregnancy outcomes.Results Among the 112 cases of pregnant women,premature delivery in 54 cases,full-term birth 58 cases.At the 24 week of pregnancy,there were significant difference on the cervical length( 2.8 ±0.4]cm vs 3.3 ±0.5]cm,t =3.254,P =0.021 ) between premature delivery group and full-term birth group.At the 28 - 30 week,31 -32 week,33 - 34 week,35 - 36 week,the CRH were ( 162.33 ± 16.49 ) ng/L,(60.01:±: 14.56) ng/L;(352.12 ±61.01 )ng/L,( 118.04 ±53.74)ng/L; (364.55 ±56.71 )ng/L,( 122.95 ±71.41 )ng/L; (372.78 ±149.89)ng/L,(124.00 ± 19.05 )ng/L respectively in premature delivery group and full-term birth group,and there were significant differences on CRH at the four different pregnant time(t =3.687,6.875,8.652,8.524,respectively,P ＜ 0.05 ).It shows better sensitivity ( 97.92％ ),specificity ( 90.00％ ),positive predictive value(95.92％ ) and negative predictive value(94.73％ ) in predicting premature delivery by detection of CRH,fFN combined with cervical length.Conclusion Detection of plasma CRH,fFN combined with cervix length measurement can improve the predictability of premature and provide a good,reliable clinical basis for the early diagnosis and treatment for preterm premature.