IGFBP-1的测定及宫颈结构的变化在早产预测中的价值

目的探讨宫颈结构变化及IGFBP-1的测定在早产预测中的价值。方法阴超检测先兆早产者宫颈长度、内口形态及宫颈指数,并结合IGFBP-1的测定,来作为预测早产的指标。设立随机和自身对照研究。结果①先兆早产组宫颈长度（2.56±0.62）cm,明显短于对照组正常孕妇宫颈长度（3.74±0.71）cm,差异有高度统计学意义（t=4.659,P〈0.001）。其中9例早产的宫颈长度（1.61±0.22）cm,明显短于未发生早产的53例宫颈长度（2.69±0.51）cm,差异有高度统计学意义（t=6.221,P〈0.001）。先兆早产组宫颈指数（0.68±0.21）,明显高于正常孕妇宫颈指数（0.35±0.23）,差异有高度统计学意义（t=8.762,P〈0.001）。9例早产的宫颈指数（0.85±0.26）明显高于未发生早产的53例宫颈指数（0.63±0.24）,差异有统计学意义（t=2.513,P〈0.05）;②宫颈内口形态：62例先兆早产中宫颈内口漏斗型11例,其中发生早产9例（占81.82%）。正常组宫颈内口均成“T”型;③IGFBP-1：62例先兆早产中IGFBP-1阳性27例（占43.55%）,经保胎治疗后先兆早产症状消失。有9例于入院后1-3 d内发生早产（占14.52%）。正常组78例IGFBP-1均为阴性;④疗效：先兆早产IGFBP-1阳性27例;经治疗症状消失,2周后复查IGFBP-1有18例转为阴性（占66.67%）。另外先兆早产治疗后宫颈长度有所增长,平均增长0.56 cm。结论宫颈结构及IGFBP-1的测定与早产密切相关;可以作为预测早产的客观可靠的指标;也可作为早产疗效判断的可靠指标。宫颈长度≤2.5 cm,宫颈指数≥0.5,宫颈内口有漏斗形成,宫颈阴道分泌物IGFBP-1阳性,则发生早产的特异性为100%。值得临床医生重视。

Evaluation of cervicovanginal insulin growth factor binding protein-1 and cervical sonography in the prediction of preterm labor

Objective To evaluate cervicovanginal insulin growth factor binding protein-1（IGFBP-1） and cervical sonography in the prediction of preterm labor.Methods Transvaginal sonography was performed in women with threatened preterm labor to measure the length of uterine cervix,width of cervical internal os and cervical index and IGFBP-1 was measured as a predictive indicator.Random and self-control study was conducted.Results ① In the threatened preterm labor group,the cervical length was shorter（2.56±0.62）cm vs.（3.74±0.71）cm,t=4.659,P〈0.001]and the cervical index was higher（0.68±0.21）vs.（0.35±0.23）,t=8.762,P〈0.001）]than normal pregnancy women.The cervical length was significantly shorter （1.61±0.22）cm vs.（2.69±0.51）cm,t=6.221,P〈0.001]and the cervical index was higher（0.85±0.26）vs.（0.63±0.24）,t=2.513,P〈0.05）]in the 9 cases with preterm labor than the other 53 women without preterm labor.② Nine out of 11 women（81.82%） with funnel-shaped cervical internal os in the threatened preterm labor group resulted in preterm labor.All of the normal pregnant women presented T-shaped cervical internal os.③ Twenty-seven out of 63（43.55%） women with threatened preterm labor were IGFBP-1 positive,whose symptoms disappeared after treatment.Nine women with threatened preterm labor and positive IGFBP-1 were admitted in the hospital and turned out preterm labor within 1-3 days.All of the normal pregnant women（78 cases） were IGFBP-1 negative.④ After treatment,the symptoms of threatened preterm labor disappeared in the 27 cases of IGFBP-1 positive and 18（66.67%） became negative in 2 weeks.The cervical length increased after treatment in the threatened preterm labor group at the average growth of 0.56 cm.Conclusions The cervicovanginal IGFBP-1 and the cervical sonography are reliable and objective indicators of preterm labor,which are helpful in predicting the prognosis and follow up after management.The cervical length≤2.5 cm,the cervical index ≥0.5,funnel