阴道超声及细胞因子预测宫颈成熟度和临产时间的初步探讨

目的　探讨阴道超声、细胞因子———白细胞介素 (IL) 6、8及人绒毛膜促性腺激素 (hCG)对足月妊娠宫颈成熟度、临产时间的预测价值。方法　检测 79例足月初产妇宫颈阴道分泌液IL 6、IL 8及hCG水平 ;通过阴道超声测量孕妇宫颈长度、宫颈内口楔形区宽度、前羊膜囊长度 ;同时进行宫颈Bishop评分。结果　 (1)IL 6、IL 8、hCG临产后水平 [分别为 (782± 5 0 8)ng/L、(10 5 3 9± 8680 )ng/L、(114± 86)IU/L]较临产前 [分别为 (15 5± 75 )ng/L、(7113± 60 5 0 )ng/L、(3 5± 2 1)IU/L]显著升高 ,差异有极显著性 (P <0 0 5 )。 (2 )IL 6、IL 8、hCG、宫颈长度、前羊膜囊长度均与宫颈Bishop评分显著相关(r=0 42、0 2 4、0 44、- 0 5 6、0 3 5 ,P <0 0 5 )。 (3 )IL 6、IL 8、宫颈长度、前羊膜囊长度、宫颈Bishop评分均与临产时间显著相关 (r=- 0 42、- 0 46、0 64、- 0 5 2、- 0 41,P <0 0 1) ;且均能预测 1周内临产 ,其中宫颈长度的预测效果最好。宫颈长度≤ 3 0mm者 ,预测其在 1周内分娩的灵敏度、特异度、阳性预测值、阴性预测值分别为 0 83、0 89、0 91、0 81。 (4)多因素分析显示 :阴道超声测量宫颈长度 ,预测宫颈成熟度和临产时间的价值优于其他指标。结论　孕妇宫颈阴道分泌液IL 6、

Comparison study on transvaginal ultrasonographic measurement and cytokine in prediction of the cervical ripening and the onset time of term labor

OBJECTIVE: To compare the level of interleukin-6 (IL-6), interleukin-8 (IL-8), human chorionic gonadotropin (hCG) with transvaginal ultrasonographic measurement in prediction of the cervix ripening and the time of term labor. METHODS: The 79 cases of primiparous women of term pregnancy were chosen as the research subjects. The maternal level of IL-6, IL-8, hCG in cervicovaginal secretions were measured. The cervical length, internal cervical os wedge width and forebag length were measured by transvaginal ultrasonography. The cervical Bishop score was also determined. RESULTS: (1) The levels of IL-6, IL-8, hCG in cervicovaginal secretions were significantly higher in women they are in labor than that of women at term not in labor (782 +/- 508) ng/L, (10,539 +/- 8 680) ng/L, (114 +/- 86) IU/L, versus (155 +/- 75) ng/L, (7,113 +/- 6 050) ng/L, (35 +/- 21) IU/L, respectively. (2) The levels of cervicovaginal secretions IL-6, IL-8, hCG and the length of cervical, forebag were significant correlation with the cervical Bishop score (P < 0.05, r = 0.42, 0.24, 0.44, -0.56, 0.35) respectively. (3) The levels of cervicovaginal secretions IL-6, IL-8, the length of cervical, forebag measured by transvaginal ultrasonography and the cervical Bishop score were significant correlation to the onset time of term labor (P < 0.01, r = -0.42, -0.46, 0.64, -0.52, -0.41) respectively, and all these markers also could predict the onset of term labor in < or = 7 days, The predictive value on onset labor within < or = 7 days by cervical length < or = 30 mm: the sensitivity, specificity, positive values and negative value are 0.83, 0.89, 0.91 and 0.81 respectively. (4) Among the several markers in predicting cervix ripening and onset of labor, the best one was the transvaginal ultrasonographic measurement of cervical length. CONCLUSIONS: The levels of cervicovaginal secretions IL-6, IL-8, the length of cervical and forebag measured by transvaginal ultrasonography and the Bishop score are valuable in prediction of cervix ripening and onset of labor. The cervical length measured by transvaginal ultrasonography is the best one.