羊水板层小体计数预测胎儿肺成熟度的评价

The Evaluation of Amniotic Fluid Lamellar Body Count to Predict Fetal Lung Maturity

目的:检测羊水中板层小体计数(LBC),并对胎儿肺成熟度进行评价。方法:选取82例孕28～40周的单胎孕妇(妊娠合并糖尿病27例,妊娠期高血压疾病20例,妊娠期肝内胆汁淤积症16例,正常妊娠孕妇19例)检测其羊水标本中LBC,其中14例测定经过地塞米松促胎肺成熟治疗前后两次羊水,并随访其新生儿是否发生呼吸窘迫综合征(RDS)。根据羊水LBC与新生儿是否发生RDS的关系,建立本实验室羊水LBC预测胎儿肺不成熟与胎儿肺成熟的临界值,并计算相应的灵敏度、特异度、阳性预测值、阴性预测值。结果:随孕妇孕周增加,羊水LBC增加,新生儿RDS的发生率降低;有妊娠合并症的孕妇使用地塞米松促胎肺成熟治疗后,羊水LBC明显增加,可达到同孕周正常孕妇羊水LBC水平;82例新生儿中11例(13.4%)发生了RDS,其中8例LBC<15×109/L,另外3例LBC介于15×109/L～50×109/L。以LBC<15×109/L预测胎儿肺不成熟,灵敏度为72.7%,特异度为100%,阳性预测值为100%,阴性预测值为95.9%。以LBC>50×109/L预测胎儿肺成熟,灵敏度为81.7%,特异度为100%,阳性预测值为100%,阴性预测值为45.8%。结论:羊水LBC检测因其简便、快速、准确、经济、易于标准化,适于临床开展,可作为预测胎儿肺成熟度的筛查实验。

Objective：This prospective study was designed to perform lamellar body count（LBC） of amniotic fluid to evaluate fetal lung maturity.Methods：LBC in 82 amniotic fluid samples from 82 pregnant women（28～40 gestational weeks） were evaluated,in which 14 cases were checked two times before and after administration of dexamethasone to accelerate fetal pulmonary maturation.After delivery,each infant was evaluated for any evidence of respiratory distress syndrome（RDS）.SPSS sofeware was used to define the cutoff value of LBC to predict fetal lung immaturity and fetal lung maturity,and the sensitivity,specificity,positive predictive value and negative predictive value were calculated.Results：The LBC increased and the incidence of RDS decreased along with the increased gestational weeks.The LBC increased significantly after the use of dexamethasone to accelerate fetal lung maturation.11（13.4%） infants developed RDS,8 of them with LBC15×109/L,the other three LBC were between 15×109/L and 50×109/L.If cutoff value of LBC15×109/L was defined to predict fetal lung immaturity,the sensitivity was 72.7%,specificity was 100%,the positive predictive value was 100%,negative predictive value was 95.9%.If cutoff value of LBC50×109/L was defined to predict fetal lung maturity,the sensitivity was 81.7%,specificity was 100%,the positive predictive value was 100%,negative predictive value was 45.8%. Conclusions：LBC can be used as a favorable predictor and reliable screening test for fetal lung maturity because the method is simple,quick,inexpensive,standardization and available.