【doc】胎儿纤维连接蛋白对先兆早产孕妇发生早产的预测价值.doc

胎儿纤维连接蛋白对先兆早产孕妇发生早产的预测价值 ?2?生堡旦匡堂盘查堡月第9卷第1期ChinJPerinatMed.Jan.2006,Vo1.9,No.1 胎儿纤维连接蛋白对先兆早产孕妇 发生早产的预测价值 时眷艳杨慧霞金燕志杨孜郭艳军谢毅徐先明董悦 【摘要】目的研究胎儿纤维连接蛋白(fetalfibronectin,fFN)对先兆早产孕妇发生早产的预 测价值,及与宫颈长度联合应用时对早产的预测意义.方法联合国内三家医院对有先兆早产症 状的孕妇进行阴道后穹窿分泌物中fFN的测定及宫颈的超声检测,追踪这些孕妇的妊娠结局.结 果(1)共检测122例先兆早产孕妇,75例IFN阳性,阳性率为61.5.(2)阳性孕妇中7d内,14d 内,37周前分娩率分别为22.7(17/75),41.3(31/75),65.3(49/75);阴性孕妇则分别为0(0/ 47),0(0/47),12.8(6/47).对于7d内,14d内和37周内分娩的阴性预测值分别为100, 100和87.2.(3)50例孕妇同时进行了宫颈长度的测量.以宫颈长度≤26ram为异常5O例中 fFN(+)和宫颈长度同时异常者7d内,14d内,37周前分娩率分别为13.3(2/15),40.0(6/15), 93.3(14/15),均显着高于fFN(+)而宫颈长度正常的孕妇.宫颈长度异常而fFN阴性者中无一例 14d内分娩.二者同时异常预测先兆早产孕妇发生早产的敏感性为7O,特异性为97.2,阳性预 测值为93.3,阴性预测值为85.4.结论(1)在先兆早产孕妇中阴道后穹窿分泌物fFN阳性 对先兆早产孕妇发生早产有一定的预测意义,阴性预测短期内不发生早产的价值较大.(2)fFN测定 与宫颈长度联合应用可以提高37周前早产阳性预测结果,但对短期内发生早产的预测意义不大. 【关键词】纤维连接蛋白类;超声检查,产前;子宫颈}分娩,早产;预测 Pretermbirthpredictionwithfetalfibronectininpregnantwomenwithpretermlabor YANGHui—xia,JlNYah—zhi,eta1.DepartmentofObstetricsandGynecology, FirstHospital,Beijing100034,China SHIChun—yah, PekingUniversity 【Abstract]0bjectlveTodeterminethepredictivevalueoffetalfibronectin(fFN)aloneorcom binedwithcervicallength(CL)forpretermbirthinpregnantwomenwithpretermlabor.Methods Pregnantwomenwerecollectedfromthreehospitals.fFNlevelindischargesfromtheposteriorfornix andtheCLundervaginalultrasoundscanweremeasuredforallsubjectswhopresentedwithpreterm laborbetween24～34gestationalweekswithintactmembranes,eervicaldilationlt;3cmandwithout previoustoeolysis.Pregnantoutcomeswererecorded.Results(1)Among122subjects,positive fFNwasdetectedin61.5(75cases).Theoverallpretermbirthratewas45.1(55/122).The prevalenceofspontaneouspretermdeliveryamongthosewomenwithfFN(+)within7days.14days, andlt;37weekswere22.7(17/75),41.3(31/75)and65.3(49/75),respectively,whichwere significantlyhigherthanthosewomenwithfFN(一)Eo(0/47),0(0/47)and12.7(6/47)-I.The negativepredictivevalues(PPV)were100,100and87.2.(3)CLwasmeasuredin5Ocases, 2OofwhichwithCLlt;26ram.TherateofpretermbirthinthosewomenwithbothshorterCLandfFN (十)within7da