胎儿纤维连接蛋白及宫颈长度测量在早产预测中的评价

Preterm Birth Prediction With Fetal Fibronectin and Cervical Length in Pregnant Women With Preterm Labor.

目的研究胎儿纤维连接蛋白(fetal fibronectin,fFN)和宫颈长度测量单独及二者联合对先兆早产孕妇最终发生早产的预测价值。方法对2007年1月至5月,在北京市海淀妇幼保健院门诊定期产检的有先兆早产症状的孕妇176例,测定其阴道分泌物中fFN及超声测量子宫颈长度,追踪其妊娠结局,统计学分析,采用单独及联合使用两种方法预测早产的敏感性、特异性、阳性预测值和阴性预测值等指标。结果1进行fFN检测的176例先兆早产孕妇中,24例fFN呈阳性,152例呈阴性。24例fFN检测呈阳性的孕妇在从阴道分泌物中取出标本后的7 d,14 d和37周内分娩,分娩率分别为20.8%(5/24),29.2%(7/24),33.3%(8/24);152例呈阴性的孕妇在7 d,14 d和37周内无1例分娩。2同时超声测量宫颈长度的124例先兆早产孕妇中,9例孕妇的宫颈长度≤2.6 cm,其中6例在7 d,14 d,37周内分娩,分娩率分别为55.6%(5/9),11.1%(1/9),0;115例宫颈长度>2.6 cm的孕妇,无1例发生早产。3本研究结果显示,fFN预测孕37周前发生早产的敏感性、特异性、阳性预测值和阴性预测值分别为100%,90.5%,33.3%,100%;而宫颈长度预测孕37周前发生早产的敏感性、特异性、阳性预测率、阴性预测率分别为100%,97.5%,66.7%,100%;二者联合预测,则上述指标均为100%。结论1fFN呈阳性对预测早产有一定价值,而呈阴性的预测价值更高,并有积极意义。2宫颈长度超声测量也是一种有价值的早产预测手段,它和fFN联合使用,可以提高先兆早产孕妇的阳性预测率。

Objective To investigate the predictive value of fetal fibronectin （fFN） and cervical length alone and combination for preterm birth in pregnant women with preterm labor. Methods fFN level in discharges from the posterior fornix and cervical length under vaginal ultrasound scan were measured for the subjects who presented with preterm labor between 22-35 gestational weeks with intact membranes, cervical dilation 〈3 cm and without previous tocolysis. All subjects outcomes were recorded and the sensitivity, specificity, positive （PPV） and negative predictive value （NPV） of fFN, cervical length and their combination were analyzed statistically. Results ①Among 176 cases, positive fFN was detected in 24 cases. The prevalence of spontaneous preterm delivery among those women with fFN （＋） within 7 days, 14 days and less than 37 weeks were 20.8%, 29.2%, 33.3%. No pretermbirth occurred among those 152 women with fFN（-）. ② In 124 pregnant women with preterm labor, 9 cases＇ cervical length was less than 2. 6 cm, and 6 cases of which were delivered within 14 days. No preterm birth occurred among the 115 cases with cervical length longer than 2.6 cm. ③The sensitivity, specificity, PPV and NPV of fFN for preterm birth were 100%, 90.5%, 33.3% and 100M, and for cervical length, they were 100%, 97.5% 66.7% and 100%. For their combination the sensitivity, specificity, PPV and NPV were 100%, respectively. Conclusion fFN is valuable in predicting preterm birth in women with preterm labor, especially significant for NPV. cervical length is also an important means for predicting the preterm birth, and fFN combined with cervical length can improve the PPV of preterm delivery less than 37 weeks.