血清β-hCG与CRP水平在预测胎膜早破宫内感染及预后的应用比较

Levels of serum β-hCG and CRP in predicting intrauterine infections in premature rupture of membranes and prognosis:a comparative study

目的探讨血清β-绒毛膜促性腺激素(β-hCG)和C-反应蛋白(CRP)水平,在预测胎膜早破宫内感染和预后的应用比较。方法入选2009年3月-2011年5月在医院妇产科孕足月住院发生胎膜早破的孕妇146例,产前抽取静脉血5 ml,用免疫分析法分别检测血清β-hCG和CRP,产后留取胎膜组织和胎盘组织,检查是否存在组织绒毛膜炎,将146例胎膜早破孕妇分为感染组与非感染组,比较两组血清β-hCG和CRP,以评价β-hCG、CRP在预测胎膜早破宫内感染和预后中的临床价值。结果 146例胎膜早破孕妇中,血清β-hCG阳性者47例,发生感染33例,感染率为70.2%,阴性者99例,发生感染19例,感染率为19.2%;CRP阳性者63例,发生感染41例,感染率为65.1%;阴性者83例,发生感染11例,感染率为13.3%,差异均有统计学意义(P<0.05),血清β-hCG预测胎膜早破感染敏感度为63.5%,特异度为85.1%,二者与CRP检查差异无统计学意义,146例胎膜早破的孕妇分娩顺利,血清β-hCG和CRP阳性者预后较阴性者差,抗菌药物使用时间长,剂量大,住院时间延长,但是血清β-hCG和CRP在评价预后无差异。结论血清β-hCG和CRP均能较好地预测胎膜早破孕妇是否发生感染和评价预后,二者之间没有差异,临床上结合血清β-hCG和CRP能够更迅速、更准确地诊断胎膜早破并发感染,并能更好地评价预后。

OBJECTIVE To compare the value of serum β-hCG and C-reactive protein（CRP） levels in predicting intrauterine infections in premature rupture of membranes and prognosis.METHODS A total of 146 term-pregnancy patients with premature rupture of membranes in our hospital were enrolled for study,5ml venous blood were collected before the labor,serum β-hCG and CPR were determined with immunoassay method.The fetal tissue and placental tissues were examined if there had tissue chorioamnionitis,totally 146 pregnant women with premature rupture of membranes were divided into infection group and non-infection group,the serum β-hCG and CRP levels of the two groups were compared to evaluate the clinical value of β-hCG and CRP in predicting the premature rupture of membranes and prognosis.RESULTS Among the 146 pregnant women with premature rupture of membranes,there were 47 cases with positive serum β-hCG,infections occurred in 33 cases with the infection rate of 70.2%,99 cases with negative serum β-hCG,19 cases with nosocomial infections,the infection rate was 19.2%;there were 63 cases with positive CRP,infections occurred in 41 cases with the infection rate of 65.1%;there were 83 cases with negative serum β-hCG,infections occurred in 11 cases with the infection rate of 13.3%,the differences were statistically significant（P〈0.05）,the sensitivity of serum β-hCG for predicting premature rupture of membranes was 63.5%,the specificity was 85.1%,as compared with CRP,there was not statistical significance,all of 146 pregnant women with premature rupture of membranes delivered successfully,but those with positive serum β-hCG and CPR had the poor prognosis with long-term use of antibiotics,high dose,and prolonged hospital stay;there was no difference in evaluating prognosis between serum β-hCG and CRP. CONCLUSION Both serum β-hCG and CRP can successfully predict that if there are infections in pregnant women with premature rupture of membranes and evaluate the prognosis,there is no difference between the two,it is rapid and accurate to diagnose the infections in patients with premature rupture of membranes by combining serum β-hCG and CRP.