血清β-hCG及IL-1的变化在诊断胎膜早破感染中的价值

The Value of Serumβ-hCG and IL-1 in Diagnosis of Infections in Premature Rupture of Membranes

目的探讨血清β-人绒毛膜促性腺激素(β-hCG)及白介素-1(IL-1)在诊断胎膜早破感染中的作用。方法选取本院收治的足月胎膜早破孕妇100例为研究对象。另取正常足月孕妇50例作为对照组(NPW组),分娩前1 h,抽肘静脉血3 mL,分别测定血清β-hCG及IL-1水平,产后留取胎膜及胎盘组织,行病理检查确定是否有绒毛膜羊膜炎。结果 100例胎膜早破中,病理证实胎膜早破无感染者(NIPRM)56例,胎膜早破合并绒毛膜羊膜炎者(IPRM)44例,血清β-hCG在NPW组中为7 557.86±2 922.06 IU/L,在NIPRM组中为18 636.96±14 379.104 IU/L,在IPRM组中为50 310.34±22 874.82 IU/L,三组之间比较差异均有显著性(P<0.05)。制作ROC曲线,NPW组与NIPRM组曲线下面积为0.80,NIPRM组与IPRM组曲线下面积为0.87,即血清β-hCG诊断胎膜早破及胎膜早破合并绒毛膜羊膜炎均有一定临床价值。NPW组血清IL-1水平(0.12±0.04 ng/mL)与NIPRM组(0.13±0.03 ng/mL)间差异无显著性(P>0.05),但NIPRM组与IPRM组(0.58±0.05 ng/mL)间差异有显著性(P<0.05)。制作ROC曲线,NIPRM组与IPRM组下面积为0.84,根据ROC曲线坐标,当血清IL-1取0.38 ng/mL时,诊断胎膜早破合并绒毛膜炎敏感性为76.5%,特异性为72.6%。结论血清β-hCG及IL-1的变化在诊断胎膜早破及胎膜早破合并绒毛膜羊膜炎方面均有一定临床价值,有望成为临床应用的特异性指标。

Objective To study the role of serumβ-hCG and IL-1 in diagnosis of infection in premature rupture of membranes. Methods A total of 100 term-pregnancy patients with premature rupture of membranes in our hospital were enrolled for this study,and 50 normal pregnant women were used as control. One hour before delivery,3ml venous blood were collected, serumβ-hCG and IL-1 were detected. The grade of infection and non-infection of fetal and placental tissues were determined by pathological analysis. Results In 100 term-pregnancy patients, 56 cases were non-infected and 44 cases were infected. The average values of serumβ-hCG in normal pregnant, non-infection and infection of premature rupture of membranes women （ NIPRM and I PRM） were 7 557. 86 ± 2 922. 06 I U/L, 18 636. 96 ± 14 379. 10 IU/L and 50 310. 34 ± 22 874. 82 IU/L, respectively. There are statistically significant difference in the three groups （P 〈0. 05）. According to ROC curve, the area under the curve（AUC） of the normal and the premature rupture of membranes groups is 0. 80 ,and the AUC of the non-infection and infection of premature rupture of membranes groups is 0. 87. The difference of serum IL-1 level between the normal pregnant （0. 12 ±0. 04） and premature rupture of membranes women （0. 13 ± 0. 03 ） is no statistically significant, while the difference of serum IL-1 level between premature rupture of membranes and the infection of premature rupture of membranes group （0. 58 ± 0. 05 ）ng/mL has a statistically significant. According to the ROC curve, the AUC of（ non or infection） premature rupture of membranes group is 0. 84. When IL-1 take 0. 38 ng/mL, the sensitivity and specificity of diagnosis infections in premature rupture of membranes are 76. 5% and 72. 6% respectively. Conclusion The clinical value of Serumβ-hCG and IL-1 may be a specific index in diagnesis of NIPRM and 1PRM in the future.