孕中期羊水中生化物质与妊娠结局关系的探讨

Clinical study on association between second trimester amniotic fluid biochemical markers and adverse pregnancy outcomes

目的探讨孕中期羊水中生化物质与妊娠结局的关系。方法选择133例孕16～24周的单胎孕妇,常规羊膜腔穿刺抽取羊水3ml,测定其葡萄糖、C-反应蛋白、瘦素、甲胎蛋白与α1-抗胰蛋白酶的含量,并观察妊娠结局。结果孕中期羊水中葡萄糖含量与新生儿出生体重呈线性正相关(r=0.182,P=0.04),以羊水葡萄糖含量﹥2.7mmol/L为临界值,预测巨大儿发生的敏感性为53.8%,特异性为67.8%。早产组孕中期羊水α1-抗胰蛋白酶含量[(1901.36±914.87)μg/ml]明显高于足月分娩组[(1025.03±656.94)μg/ml](P=0.006)。ROC曲线分析表明以羊水α1-抗胰蛋白酶值﹥1245μg/ml为临界值,预测早产发生的敏感性为80%,特异性为72%,相关分析表明孕中期羊水α1-抗胰蛋白酶含量与新生儿出生体重呈线性负相关(r=-0.255,P=0.022)。结论孕中期羊水中葡萄糖、C-反应蛋白、瘦素和甲胎蛋白不能作为预测早产和胎膜早破的指标,孕中期羊水中葡萄糖、C-反应蛋白、瘦素不能作为预测糖代谢异常和妊娠高血压疾病的指标,孕中期羊水α1-抗胰蛋白酶可作为预测早产的特异性指标。

Objective To investigate the concentration of biochemical markers in amniotic fluid of middle age pregnant women and its influence on pregnancy outcome. Methods Glucose, c-reactive protein, leptin, alpha-fetoproteins and α1-antitrypsin in amniotic fluid of 133 women in 16～24 gestation weeks were measured. Outcome of pregnancy were observed. Results Amniotic fluid glucose level was positively related to neonatal birthweight（r=0.182, P=0.04）, and concentration of 〉2.7mmol/L had a sensitivity of 53.8% and a specificity of 67.8% in the prediction of high birth weight. α1-antitrypsin level was significantly different between women of premature labor and normal labor [（1901.36±914.87）μg/ml vs （1025.03±656.94）μg/ml, P=0.006], which was negaitively related to neonatal birthweight（r=-0.255, P=0.022）. Amniotic fluid αl-antitrypsin concentration of 〉1245μg/ml had a sensitivity of 80% and a specificity of 72% in the prediction of preterm delivery. Conclusions Clinical measurement of glucose, c-reactive protein, leptin, alpha-fetoproteins in amniotic fluid of middle age pregnant women may not serve as specific markers in predicting the occurrence of premature labor. Glucose, c-reactive protein, leptin in amniotic fluid may not serve as specific markers in predicting the occurrence of hypertension and glucose disorder. αl-antitrypsin can be a specific marker to predict premature labor.