C-反应蛋白、新蝶呤水平与亚临床感染胎膜早破的相关性研究

Relationship between C-reactive protein,neopterin and subclinical premature rupture of membranes

目的探讨足月胎膜早破孕妇血清C-反应蛋白(CRP)和新蝶呤(Npt)水平与亚临床感染的相关性,为早期诊断提供参考。方法选取2009年1月-2012年1月剖宫产分娩的足月胎膜早破孕妇40例为试验组;同期剖宫产分娩的正常足月孕妇40例为对照组,所有孕妇入院后抽取静脉血3ml,胎盘娩出后取胎膜组织进行病理组织学检查,采用酶联免疫吸附法(ELISA)测定孕妇血清中CRP、Npt水平。结果试验组孕妇血清CRP(4.55±1.72)mg/L和Npt(15.06±5.05)nmol/L,均高于对照组(3.14±1.16)mg/L和(10.29±3.96)nmol/L(P<0.05);试验组孕妇血清CRP和Npt水平有一定的相关性(r=0.346,P<0.05);两组80例孕妇胎膜病理检查,发现绒毛膜羊膜炎38例(试验组29例、对照组9例),血清CRP诊断绒毛膜羊膜炎的灵敏度和特异度分别为63.16%和52.38%,而Npt诊断绒毛膜羊膜炎的灵敏度和特异度分别为73.68%和61.90%。结论孕妇血清中CRP和Npt水平与亚临床感染足月胎膜早破有相关性,通过检测孕妇血清CRP和Npt水平间接反应亚临床感染胎膜早破孕妇和宫内胎儿感染的严重程度。

OBJECTIVE To explore the correlation between the serum levels of C-reactive protein （CRP） and neopterin in pregnant women with term premature rupture of membrane （PROM） and subclinical infection so as to guide the early diagnosis. METHODS A total of 40 pregnant women with term PROM who received cesarean section in the hospital from Jan 2009 to Jan 2010 were selected as the experimental group, 40 normal term pregnant women who received cesarean section in the hospital during the same period were selected as the control group. The maternal blood samples（3ml） were abstracted from all the study objects; after the delivery of the placenta, the fetal membrane tissues were obtained for the histopathological examination. ELISA was used to detect the maternal serum levels of CRP and neopterin in the two groups. RESULTS The maternal serum levels of CRP and neopterin in experimental group were （4. 55±1.72） mg/L and （15.06±5.05）nmol/L, respectively, which were significantly higher than those in the control group （3.14± 1.16）mg/L and（10.29±3.96）nmol/L, respectively（P〈0.05） ; in experimental group, there was correlation between the serum CRP level and the serum neopterin level（r= 0. 346, P〈0. 05）. Of the pregnant women in the two groups who received pathological examination of Setal membrane, 38 pregnant women were found with chorioamnionitis, including 29 pregnant women in the experimental group and 9 pregnant women in the control group. The sensitivity and specificity of the serum CRP in diagnosis of chorioamnionitis were 63.16 % and 52.38 %, respectively; the sensitivity and specificity of the serum neopterin in diagnosis of chorioamnionitis were 73.68% and 61.90%, respectively. CONCLUSION The levels of CRP, neopterin in maternal serum of the pregnant women are associated with TPROM caused by subclinical infection, the levels of CRP and neopterin in maternal serum can reflect the severity of the subclinicalinfection of the TPROM pregnant women and the infections in the intrauterine fetal.