胎儿纤维连接蛋白对宫颈环扎术后早产的预测

Prediction for premature delivery after cervical cerclage by fetal fibronection

目的:研究胎儿纤维连接蛋白(fFN)对宫颈环扎术后早产的预测价值。方法:选择31例诊断为宫颈机能不全需行宫颈环扎术的住院保胎孕妇,取阴道后穹窿分泌物应用Rapid fFN TLiIQ System进行检测,追踪2周内和34周内分娩的情况。结果:31例患者中,2周内分娩2例,fFN阳性预测宫颈环扎术后孕妇2周内发生早产的敏感性、特异性、阳性预测值、阴性预测值分别为100.0%、69.0%、18.2%、100.0%。34周内分娩6例,fFN阳性预测宫颈环扎术后孕妇34周内发生早产的敏感性、特异性、阳性预测值、阴性预测值分别为66.7%、72.0%、36.4%、90.0%。早产6例占全部分娩孕妇的19.4%,均为34周内分娩,其中2例孕周<28周;剖宫产7例,阴道分娩22例,新生儿均转NICU观察,全部存活,均已出院。结论:宫颈环扎术后行fFN检测可预测早产,其阴性预测价值较高,阳性预测价值低,fFN检测阳性者需结合患者临床表现。

Objective： To explore the value of fetal fibronection （fFN） for the prediction of premature delivery after cervical cer- clage. Methods： 31 patients with cervical incompetence who had to have cerbical cerclage were selected, and the secretions from patients posterior fornix were taken as samples and examined by Rapid fFN TLiIQ System. The delivery situations in 2 and 34 weeks were tracked. Results：① Among the 31 cases, 2 patients delivered in 2 weeks. The sensibility, specibility, positive and negative predictive val- ue of fFN for premature delivery after cervical cerlage in 2 weeks was 100%, 18.2%, 100%, 69. 0% respectively. ②Among the 31 cases, 6 patients delivered in 34 weeks. The sensibility, specibility, positive and negative predictive value of fFN for premature delivery after cervi- cal cerlage in 34 weeks was 66. 7%, 36.4%, 90. 0%, 72. 0% respectively. ③Among the 31 cases, 6 patients （ 19.4% ） delivered in 34 weeks, all of them were before 34 weeks including 2 cases of less than 28 weeks, 7 cases delivered with cesareans, 22 cases by virginal de- livery. All infants were transfered into NICU and all of them were alive. Conclusion： fFn has a higher value for the prediction of premature delivery after cervical cerclage, but the negative predictive value is high and positive value is low, so the patients with fFN positive result need to be combined with clinical finding.