高磷酸化胰岛素样生长因子结合蛋白-1联合宫颈指数预测早产分娩时间的价值

The Value of Insulin-Like Growth Factor Bingding Protein-1 and Cervical Index in the Prediction of the Diagnosis-Delivery Interval for Premature Delivery

目的:探讨高磷酸化胰岛素样生长因子结合蛋白-1(phosphorylated insulin-like growth factor binding pro-tein-1,phIGFBP-1)联合宫颈指数对早产分娩时间的预测价值。方法:188例先兆早产妊娠妇女,应用单克隆抗体检测宫颈分泌物中phIGFBP-1,同时经会阴超声检测宫颈指数,按照检测结果分为两指标阳性组、两指标之一阳性组、两指标阴性组,随访至分娩,比较各组患者距离分娩时间(the diagnosis-to-delivery interval,DDI)。结果:两指标阳性组DDI明显短于单一指标阳性组及两指标阴性组(P<0.05)。联合应用两指标对1周内分娩预测敏感度、特异度、阳性预测值和阴性预测值分别为100.0%(33/33)、30.3%(47/155)、65.0%(26/40)和100.0%(47/47)。两指标阳性组中宫颈指数大于0.8者,1周内分娩率为100.0%(14/14),48 h内分娩率为85.7%(12/14)。两指标阴性组中2周内分娩的阴性预测值为100%(47/47)。结论:宫颈分泌物phIGFBP-1联合宫颈指数有望成为预测早产分娩时间的客观指标而应用于临床。

Objective：To assess the efficacy of cervical phosphorylated insulin-like growth factor binding protein-1（phIGFBP-1） in combination with cervical index measurement for the prediction of the diagnosis-delivery interval（DDI） for preterm delivery.Methods：A total of 188 threatened premature delivery women complaining with uterine contractions were recruited in this study,who received cervical swabs for phIGFBP-1 detection and transperineal ultrasound scan to assess cervical index.According to these results,all the patients are divided into three groups：double-positive group,one-positive group,double-negative group,they were followed until delivery.An analysis of the DDI between groups was carried out.Results：The DDI of double-positive group was shorter than that of double-negative group and one-positive group（P0.05）.When combining the two methods in forecasting DDI within one week,the values of the sensitivity,specificity,the positive predictive value and the negative predictive value were 100.0%（33/33）,30.3%（47/155）,65.0%（26/40）,100.0%（47/47） respectively.In doublepositive group,all the patients deliveried within one week and 85.7% of them deliveried within 48 hours when their cervical index were more than 0.8.The negative predictive value of double-negative group for delivery within two weeks was 100%（47/ 47）.Conclusions：The combination of cervical phIGFBP-1 and cervical index measurement may serve as an objective indication for the prediction of the DDI for premature delivery,and as a guide for clinical treatment.