宫颈分泌物中性粒细胞弹性蛋白酶预测早产临床研究

Prospective study on the prediction of preterm delivery with increased level of neutrophil elastase in cervical secretion

目的:探讨宫颈分泌物中性粒细胞弹性蛋白酶(NE)预测早产的临床价值。方法:选择2008年1月～2009年4月在我院住院保胎并分娩的孕28～36周单胎妊娠符合条件的78例为研究对象。检测宫颈分泌物NE水平,同时观察宫颈分泌物中性粒细胞百分率,比较不同保胎时间,不同分娩孕周,不同孕周胎膜早破(PPROM)NE水平及中性粒细胞百分率,并分析NE水平与中性粒细胞百分率的相关性。结果:保胎时间<7天宫颈分泌物NE水平及中性粒细胞百分率明显高于保胎时间7～14天和>14天(P<0.01);分娩孕周<32周宫颈分泌物NE水平和中性粒细胞百分率明显高于分娩孕周≥32周(P<0.01,P<0.05);孕周<32周发生PPROM明显高于孕周≥32周(P<0.01);孕周<32周的PPROM宫颈分泌物NE水平和中性粒细胞百分率明显高于孕周≥32周的PPROM(P<0.01);保胎时间<7天、分娩孕周<32周和≥32周及孕周<32周的PPROM宫颈分泌物NE水平与中性粒细胞百分率均呈正相关(P<0.05)。结论:保胎时间<7天、分娩孕周<32周以及孕周<32周的PPROM宫颈分泌物NE水平明显升高,宫颈分泌物NE可能成为早产预测指标,尤其对较早期的早产更有意义。

Objective：To discuss the clinical value of neutrophil elastase（NE） in cervical secretion in predicting preterm delivery.Methods：78 pregnant women with symptoms or signs of preterm delivery at 28~36 weeks of gestation were enrolled prospectively from Jan.2008 to Apr.2009 at our hospital.The levels of NE in cervical secretions were measured by immunocapture assay,meanwhile,cervical secretions were collected for the microscopic evaluation of Wright＇s-stained smears to count the neutrophil percentage.Results：The level of NE in cervical secretions was significantly higher within 7 days after test than at 7~14 days and at 14 days（P0.01）.The similar results were obtained for neutrophil percentage in cervical secretions;The level of NE and neutrophil percentage in cervical secretions were significantly higher at 32 gestational weeks delivery and PPROM than at≥32 gestational weeks delivery and PPROM（P0.01 or P0.05）;the level of NE and neutrophil percentage in cervical secretions was positive correlation not only at within 7 days,but also at 32 gestational weeks delivery and at≥32 gestational weeks delivery and at 32 gestational weeks PPROM.Conclusion：The present study demonstrates that the risk of spontaneous preterm delivery whin 7 days and before 32 weeks of gestation is increased in the women with preterm labor who are found to have an increased level of NE in cervical secretions.