阴道液HCG的定性测定在胎膜早破诊断中的应用价值

Qualitative Determination of Vaginal Fluid HCG in the Diagnosis of Premature Rupture of Membrane

目的观察定性测定阴道液绒毛膜促性腺激素(HCG)对于胎膜早破(PROM)的临床诊断价值。方法随机选取我院在2013年9月至2014年9月收治的130例胎膜早破孕妇为研究对象(PROM组),同时选取同期在我院顺利分娩的140例非胎膜早破正常孕妇作为对照,对两组分别进行阴道液HCG定性检测、单一p H试纸检测以及阴道液联合p H试纸检测。同时采用放射免疫法对胎膜早破孕妇进行阴道液HCG定量检测。结果阴道液HCG定性检测、p H试纸检测、两者联合检测的阳性率分别为96.9%、89.2%、86.2%,均明显高于正常妊娠组5.7%、20.7%、2.9%,差异存在统计学意义(P<0.05)。阴道液HCG定性检测法诊断PROM的特异性(94.2%)、敏感性(96.9%)、准确性(95.5%)、阳性预测值(94.4%)、阴性预测值(96.6%)均明显高于单一的p H试纸检测法(79.2%、89.2%、84.3%、80.9%、88.1%),两者联合检测法的特异性、敏感性、准确性、阳性预测值、阴性预测值分别为97.6%、86.2%、91.7%、97.2%、87.4%,其中特异性、准确性、阳性预测值均明显高于单一的p H试纸检测法,差异有统计学意义(P<0.05)。PROM患者阴道液HCG平均水平为(367.4±34.5)IU/L,显著高于正常妊娠组的(40.2±5.3)IU/L,且阴道液HCG定性、定量检测价值对比不存在统计学意义(P>0.05)。结论胎膜早破采用阴道液HCG定性检测法的特异性、灵敏性以及准确性均显著高于p H试纸,且具有操作简便、准确、快捷等优点,在胎膜早破诊断中具有较高的应用价值。临床联合应用p H试纸检测法可大大提高诊断特异性,值得在临床上进一步推广。

Objective To observe the clinical value of qualitative determination of human chorionic gonadotrophin（HCG） of vaginal fluid in the diagnosis of premature rupture of membrane（PROM）. Methods 130 cases of PROM in our hospital from September 2013 to September 2014 were selected as the PROM group, and 140 cases of normal pregnant women with successful delivery without PROM were selected as the control. The results of qualitative determination of HCG of vaginal fluid, single p H test, and qualitative determination of HCG combined with p H test of two groups were compared. Radioimmunoassay was used for quantitative determination of HCG. Results The positive rate of HCG detection, p H test and combined detection of PROM group was 96.9%, 89.2% and 86.2% respectively, significantly higher than 5.7%, 20.7% and 2.9% of narmal group, respectively（all P 0.05）. The specificity, sensitivity, accuracy, positive predictive value, and negative predictive value of HCG qualitative detection were 94.2%, 96.9%, 95.5%, 94.4% and 96.6% respectively, significantly higher than 79.2%, 89.2%, 84.3%, 80.9% and 88.1% of single p H test, respectively（P 0.05）. The specificity, sensitivity, accuracy, positive predictive value, and negative predictive value of combined detection were 97.6%, 86.2%, 91.7%, 97.2% and 87.4% respectively, in which,the specificity, accuracy and positive predictive value were significantly higher than those of single p H test（P 0.05）. The HCG level of PROM group was（367.4 ± 34.5） IU/L, significantly higher than（40.2 ± 5.3） IU/L of normal group（P 0.05）. No statistical difference was found between the values of qualitative detection and quantitative detection of HCG of vaginal fluid（P 0.05）. Conclusions Qualitative determination of vaginal fluid HCG has higher specificity, sensitivity and accuracy compared with single p H test, with the advantages of easy to operation, accurate and fast. The combined application of vaginal fluid HCG detection and p H test can greatly improve the diagnostic specificity, which is worthy of clinical promotion.