宫颈IGFBP-1与Bishop评分及宫颈指数联合预测临产时间的临床研究

目的:探讨足月妊娠妇女宫颈分泌物中磷酸化胰岛素样生长因子结合蛋白-1(IGFBP-1)、宫颈Bishop评分和宫颈指数预测临产时间的价值。方法:选择49例初产妇,自妊娠38周开始测定宫颈分泌物中磷酸化IGFBP-1,同时行Bishop评分,再行会阴部B超测量并计算宫颈指数〔(漏斗长度+1)/宫颈长度〕。结果:①IGFBP-1测定阳性、弱阳性、阴性三者72h内临产率比较有显著性差异;阳性与弱阳性72h内临产率比较有显著性差异。②IGFBP-1阳性、弱阳性二者平均宫颈Bishop评分比较有显著性差异;弱阳性与阴性平均宫颈Bishop评分比较有显著性差异。③IGFBP-1测定阳性、弱阳性平均宫颈指数二者比较有显著性差异;阴性与弱阳性比较有显著性差异。④临产时间与宫颈Bishop评分有直线相关关系。⑤ROC曲线显示IGFBP-1阳性预测72h内临产的效果好;IGFBP-1阴性预测1周内不临产的效果好;IGFBP-1弱阳性预测72h内临产的效果差,但结合Bishop评分和宫颈指数,可提高预测效果。结论:宫颈分泌物中IGFBP-1阳性对于72h内临产预测效果好,阴性预测1周内不临产效果好,二者可单独作为预测指标。IGFBP-1弱阳性预测临产时间敏感性、特异性差,当结合宫颈指数≥0.40、Bishop评分≥7.5分则72h内临产可能性大;当宫颈指数≤0.33、Bishop评分≤5.5分则1周内不临产可能性大。

Study of IGFBP-1 in cervical secretion,bishop score and cervical index in prediction of labor

Objective:To study the efficacy of phosphorylated isoforms of insulin-like growth factor binding protein-1 (IGFBP-1 ) in cervical secretion, cervical Bishop Score and cervical index in prediction of labor.Methods:Successive measurement of phosphorylated IGFBP-1 in cervical secretion and cervical Bishop Score was carried out since 38 weeks of gestation in 49 pregnant women. Cervical parameters of the trans-perineal sonography were evaluated includiog endocervical length, the presence of funneling, funnel length and cervical index.Results:①The comparison of natural delivery within 72h among the positive,weak positive and negative test had markedly difference.②The comparison of the cervical Bishop Score between positive and weak positive subjects had markedly difference. The comparison of the cervical Bishop Score between weak positive and negative had markedly difference.③The comparison of cervical index between positive and weak positive subjects had markedly difference. The comparison of cervical index between weak positive and negative subjects had markedly difference. ④The starting time of labour had linear correlation with cervical Bishop Score. ⑤The rapid positive phlGFBP-1 test for natural delivery within 72 h was satisfied. The rapid negative phlGFBP-1 test for non-delivery within one week was satisfied. The rapid weak positive phlGFBP-1 test for natural delivery within 72h and one week was not satisfied.Conclusion:Positive IGFBP-1 can predict the starting time within 72h alone.Negative IGFBP-1 can predict non-delivery within one week alone.But the capacity of weak positive IGFBP-1 to predict the starting time is not satisfied. In weak positive a cervical index of 0.40 and Bishop Score of 7.5 are the best cut off point to predict the starting time of labor within 72h, and a cervical index of 0.33 and cervical Bishop Score of 5.5 are the best cut off point to predict non-delivery within one week.