阴道液和血清β-hCG在胎膜早破诊断和感染判断上的应用价值

Value of vaginal fluid and serum β-hCG levels for predicting premature rupture of membranes and diagnosing infection

目的 评价阴道液绒毛膜促性腺激素 (β humanchorionicgonadotropin ,β hCG)的定性 (早孕试条 )和定量检测诊断胎膜早破的价值 ;探讨血清 β hCG水平对胎膜早破合并感染的诊断意义。 方法 选择 10 0例足月妊娠妇女为研究对象 ,利用早孕试条定性检测阴道液 β hCG水平 ,硝嗪试纸检测阴道液pH值变化 ,放射免疫法定量检测阴道液和血清 β hCG浓度 ,免疫浊度法检测血清C 反应蛋白含量 ,并对胎盘胎膜进行病理学检查和临床绒毛膜羊膜炎症状的观察。结果 ①早孕试条诊断胎膜早破的敏感度、特异度、阳性预测值和阴性预测值分别为 :94 2 0 %、93 5 5 %、97 0 1%和 87 88% ,与pH试纸比较无显著差异 (P >0 0 5 )。②早孕试条和pH试纸联合检测敏感度 :84 0 6% ,特异度 :10 0 0 0 % ,阳性预测值 :10 0 0 0 % ,与单一pH试纸应用比较 ,特异度显著提高 (P <0 0 5 )。③阴道液 β hCG水平的定量检测诊断胎膜早破的价值与定性方法无显著性差异 (P >0 .0 5 )。④胎膜早破感染组血清 β hCG水平比无感染组显著升高 (2 3 2 3± 8 66ng/mlvs 16 85± 7 2 2ng/ml ,P <0 0 5 )。⑤血清 β hCG≥ 2MOM或CRP≥ 10mg/L时 ,绒毛膜羊膜炎的发生率较对照组显著升高 (P均 <0 0 1)。⑥血清 β hCG和CRP水平改变在诊断胎膜早?

Objective To evaluate the value of vaginal fluid β hCG levels measured with qualitative and quantitative determination in predicting premature rupture of membranes (PROM) ; and to study the diagnosic value of serum β hCG levels in PROM with infection. Methods One hundred term pregnancy patients were enrolled for study . The vaginal fluid β hCG levels were detected qualitatively by early pregnancy test and measured quantitatively with radioimmunoassy. Vaginal fluid pH were assayed by nitrazine test. The concentrations of serum β hCG and c reactive protein were estimated by radioimmunoassay and immunoprecipitation nephelometric assay respectively. Placental tissues were examined histologically and chorioamnionitis was observed. Results ①For qualitative measurement of vaginal fluid β hCG levels to detect PROM , sensitivity ?specificity ?positive predictive value and negative predictive value were 94 20%?93 55%?97 01%and 87 88% respectively.There was no statistically significant difference between this measurement and nitrazine test ( P >0 05).②When the qualitative measurement was combined with nitrazine test for diagnosing PROM, sensitivity was 84 06%,specificity was 100 00%,positive predictive value was 100 00%.The specificity was significantly higher than that of nitrazine test alone( P <0 05). ③There was no significant difference between the value of quantitative determination and that of qualitative detection of vaginal fluid β hCG concentrations.( P >0 05). ④The serum β hCG levels of PROM patients with infection were significantly higher than that without infection [(23 23±8 66) ng/ml vs (16 85±7 22)ng/ml, P <0 05].⑤Taking the multiples of the median (MOM) of the serum β hCG levels in the normal term pregnancy women as demarcation ,the incidences of chorioamnionitis in the group of serum β hCG levels ≥2MOM or of C reactive protein concentrations≥10 mg/L were significantly higher than those in the control group( P <0 01).⑥There was no difference in the incidences of chorioamnionitis between the group of serum β hCG levels ≥2MOM and the group of C reactive protein concentrations≥10 mg/L.Conclusion The qualitative and quantitative measurements of vaginal fluid β hCG levels were good methods for diagnosing PROM, especially the qualitative method (early pergnancy test ). When combining the qualitative measurement with nitrazine test, specificity rised significantly, and that was suitable to diagnose the cases of equivocal PROM especially; When the serum β hCG levels of PROM patients were≥2MOM, the incidences of chorioamnionitis rised significantly. It suggests that maternal serum β hCG levels may be served as a valuable clinical index for identificatiing infection in PROM patients.