宫颈阴道分泌物非磷酸化胰岛素样生长因子结合蛋白1与残余羊水指数监测在未足月胎膜早破中的诊断价值

Value of non phosphorylated insulin -like growth factor binding protein -1 in cervical vaginal excretion and residual amniotic fluid index monitoring in the diagnosis of premature rupture of membranes

目的：通过对疑似未足月胎膜早破（PPROM）孕妇进行宫颈阴道分泌物非磷酸化胰岛素样生长因子结合蛋白1（IGFBP-1）与残余羊水指数（AFI）监测，探讨快速诊断 PPROM的方法，以及残余羊水对母儿预后的影响。方法采用快速层析法对96例疑似 PPROM孕妇进行宫颈阴道分泌物 IGFBP-1检测，腹部 B超监测 AFI，分析病因，比较妊娠结局及新生儿预后情况。结果92例宫颈阴道分泌物 IGFBP-1阳性者均确诊为 PPROM，导致 PPROM的危险因素主要为：生殖道感染，流产、引产史，原因不明（包括无证据的感染、胎膜发育不良或其他不明确因素），双胎、多胎、巨大儿，臀位或头盆不称，妊娠期高血压疾病，子宫肌瘤或畸形，营养不良及羊水过多。92例 PPROM孕妇，破膜至分娩时间为（105．7±13．9）h，剖宫产率为51．1％，孕妇发热率为7．6％，胎盘早剥率为4．3％，胎儿宫内窘迫发生率为14．1％，围产期感染率为21．7％，新生儿窒息率为7．6％，新生儿死亡率为7．6％。AFI≤40 mm 组与 AFI ＞40 mm 组比较，破膜至分娩时间显著缩短（t ＝10.904，P ＜0．05），新生儿死亡率显著升高（χ^2＝4．359，P ＜0．05）。结论宫颈阴道分泌物 IGFBP-1与 AFI监测，可快速诊断 PPROM，也可评估妊娠结果及新生儿预后。

Objective To explore the method of rapid diagnosis preterm premature rupture of membrane （PPROM）and prognosis factors of residual amniotic fluid in mother and infant through monitoring nonphosphorylated insulin -like growth factor binding protein -1 （IGFBP -1）and the residual amniotic fluid index （AFI）of the cervi-covaginal secretions from PPROM women.Methods 96 cases of PPROM were tested IGFBP -1 of cervicovaginal secretions,AFI were tested by abdominal ultrasound through fast chromatography methods,and the cause was ana-lyzed.The pregnancy outcome and neonatal prognosis were compared.Results 92 cases positive of IGFBP -1 were diagnosed with PPROM.The risk factors of PPROMwere mainly reproductive tract infections,abortion,induced labor history and unknown causes （including no evidence of infection,fetal membrane dysplasia unclear or other factors）, the twins,multiplets,macrosomia,breech or cephalopelvic disproportion,gestational hypertension disease,uterine fibroids or deformity,malnutrition and polyhydramnios.In the 92 patients with PPROM pregnant women,the duration from premature rupture of membrane to delivery was （105.7 ±13.9）h,cesarean section rate was 51.1%,fever rate of pregnant women was 7.6%,the rate of placental abruption was 4.3%,the rate of fetal distress was14.1%,perinatal infection rate was 21.7%,and neonatal asphyxia rate was 7.6%,the neonatal mortality was 7.6%.To compare the AFI≤40mm group with AFI 〉40 mm group,the duration from premature rupture of membrane to delivery was short-ened remarkably （t =10.904,P 〈0.05）,the neonatal mortality rate was significantly increased （χ^2 =4.359,P 〈0.05）.Conclusion Measurement of IGFBP -1 and AFI in cervicovaginal secretions can rapid diagnosis PPROMand evaluate the results of pregnancy and neonatal prognosis,and can guide clinical improvement of pregnancy safety and reduce neonatal mortality.