胎儿纤维连结蛋白和宫颈长度联合测量预测早产的临床应用

目的探讨胎儿纤维连结蛋白(fFN)和宫颈长度联合测量预测早产的临床应用价值。方法收集我院妇产科2010年10月-2012年6月收治的先兆早产的孕妇124例,根据其结局分为早产组(n=44)和足月组(n=80)。彩色多普勒超声诊断仪测量宫颈长度,双抗体夹心免疫层析法检测fFN的表达。结果早产组和足月组中fFN的阳性率分别为72.7%和22.5%,早产组显著高于足月组(P0.05)。fFN预测早产的敏感性为72.7%(32/44),特异性为77.5%(62/80),漏诊率为27.3%(12/44),误诊率为22.5%(18/80),阳性预测值为64.0%(32/50),阴性预测值为83.8%(62/74)。早产组和足月组中宫颈平均长度分别为(21.34±5.08)mm和(29.59±5.46)mm,早产组显著短于足月组(P0.05)。宫颈长度预测早产的敏感性为68.2%(30/44),特异性为76.2%(61/80),漏诊率为31.8%(14/44),误诊率为23.8%(19/80),阳性预测值为61.2%(30/49),阴性预测值为81.3%(61/75)。fFN联合宫颈长度预测早产的敏感性为90.9%(40/44),特异性为88.8%(71/80),漏诊率为9.1%(4/44),误诊率为11.2%(9/80),阳性预测值为81.6%(40/49),阴性预测值为94.7%(71/75)。联合检测预测早产的敏感性、特异性、漏诊率、误诊率、阳性预测值以及阴性预测值显著优于fFN或宫颈长度的单独预测(P0.05)。结论 fFN联合宫颈长度测量预测早产效果显著,值得临床推广应用。

Prediction of preterm birth by fetal fibronectin combined with cervical length measurement

Objective To explore the predictive value 6f fetal fibronectin（fFN） combined with cervical length measurement for preterm birth. Methods A total of 124 pregnant women with threatened preterm birth were enrolled in this study. All eases were assigned into two groups ：preterm group （n = 44） and full-term group （n = 80 ）. The cervical length was measured by ultrasonography. The fFN expression was detected by double-antibody sandwich immunosorbent assay. Results The positive rates of fFN in preterm group and full-term group were 72.7% and 22.5% , respectively, which was higher in pretenn group than that in full-term group（ P 〈 0.05 ）. The preterm delivery was predicted by fFN with sensitivity 72.7% （32/44） ,specificity 77.5% （62/80） ,missed diagnosis rate 27.3% （12/44） ,misdiagnosis rate 22.5% （ 18/80 ）, positive predictivevalue of 64.0% （ 32/50 ）, and negative predictive value 83.8% （ 62/74 ）. The average cervical length in preterm group and full-term group were （21.34 ± 5.08 ）mm and （ 29.59 ±5.46 ） mm, respectively, which was shorter in preterm group than that in full-term group（ P 〈 0.05 ）. The preterm delivery was predicted by cervical length measurement with sensitivity 68.2% （30/44）, specificity 76.2% （ 61/80）, missed diagnosis rate 31.8% （ 14/44）, misdiagnosis rate 23.8 % （ 19/80）, positive predic-tive value 61.2% （30/49）, and negative predictive value 81.3% （61/75）. The preterm delivery was predicted by fFN combined with cervical length measurement with sensitivity 90.9% （40/44） ,specificity 88.8% （71/80） ,missed diagnosis rate 9.1% （4/44） ,misdiagnosis rate 11.2% （9/80）, positive predictive value 81.6% （40/49）, and negative predictive value 94.7% （ 71/75 ）, which was better than that predicted by fFN or cervical length （P 〈 0.05）. Conclusion The fFN combined with cervical length measurement showed effectively to predict preterm birth,which was worthy of clinical application.