胎儿纤维连接蛋白和宫颈长度测定预测早产的价值

Preterm Birth Prediction with Fetal Fibronectin and Cervical Length in Pregnant Women

目的研究fFN和宫颈长度对预测先兆早产孕妇发生早产的价值。方法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,60例fFN阳性,阳性率为60.0%。(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100.0%、100.0%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≤26mm为异常。50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),均显著高于fFN(+)而宫颈长度正常的孕妇。宫颈长度异常而fFN阴性者中无1例14d内分娩。两者同时异常预测先兆早产孕妇发生早产的敏感性为70.0%,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。

Objective To determine the predictive value of fetal fibronectin alone or combined with cervical length for preterm birth in pregnant women with preterm delivery. Methods We measured the fFN level and the length of cervix uteri,and followed up the pregnant outcome. Resuits （1）Among 122 subjects,positive fFN was 60 cases（60.0%）.（2）The prevalence of spontaneous preterm delivery among those women with fFN （＋） within 7 days, 14 days, and 〈37 weeks were 22.7% （17/75）, 41.3 % （31/75） and 65.3 % （49/75）, respectively,which were significantly higher than those women with fFN（-）[0（0/47）,0（0/47）and 12.7%（6/47）].The negative predictive values（PPV） were 100.0%, 100.0%and 87.2%. （3）CL was measured in 50 cases,20 of which with CL〈26mm.The rate of preterm birth in those women with both shorter CL and fFN （＋） within 7 days, 14 days, 〈 37weeks were 13.3 % （2/15）, 40.0% （6/15）, 93.3 %（14/15）, and were significantly higher than those with normal CL and fFN（＋）. No preterm birth occurred among the women with shorter CL and fFN（-）. The sensitivity, specificity, PPV and negative predictive value of shorter C1 and fFN（＋） for preterm birth were 70.0%, 97.2%, 93.3 %and 85.4%, respectively.Conclusion Vaginal fFN is valuable in predicting preterm birth in women with prterm delivery, especially significant for NPV. Vaginal fFN determination combined with CL measurement can improve the PPV preterm dehvery〈 37weeks, but not of preterm delivery for short period.