血清CRP、PCT联合检测诊断未足月胎膜早破合并绒毛膜羊膜炎的价值

Diagnostic Value of Combined Detection of Serum C-Reactive Protein and Procalcitonin in Preterm Premature Rupture of Membranes Complicated by Chorioamnionitis

目的探讨血清C-反应蛋白(CRP)、降钙素原(PCT)联合检测对未足月胎膜早破合并绒毛膜羊膜炎的诊断价值。方法选择200例未足月胎膜早破患者[观察组,其中破膜至分娩时间的时长为≥24h(长时组)110例,破膜至分娩时间的时长为<24h(短时组)90例]和120例正常未足月孕妇(对照组)。检测各组血清CRP、PCT的水平。对绒毛膜羊膜炎的诊断以病理学检查为金标准,并计算血清CRP、PCT、CRP+PCT诊断绒毛膜羊膜炎的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比及阴性似然比。结果长时组应用抗生素前血清CRP、PCT水平均高于同组和短时、对照2组入院2h内,长时、短时2组入院2h内血清PCT水平均高于对照组入院2h内(均P<0.05)。血清PCT诊断绒毛膜羊膜炎的敏感性、特异性、阳性预测值及阴性预测值与血清CRP诊断比较差异无统计学意义(P>0.05)。血清CRP+PCT诊断绒毛膜羊膜炎的敏感性、特异性、阳性预测值及阴性预测值均高于血清CRP、PCT诊断(均P<0.05);血清CRP+PCT诊断绒毛膜羊膜炎的阳性似然比高于血清CRP、PCT诊断,阴性似然比低于血清CRP、PCT诊断。结论血清CRP、PCT联合检测对未足月胎膜早破并发绒毛膜羊膜炎的有重要诊断价值。胎膜早破时间越长,血清CRP、PCT水平越高,绒毛膜羊膜炎的发病率也越高。

Objective To investigate the diagnostic value of combined detection of serum C-reactive protein(CRP)and procalcitonin(PCT)in preterm premature rupture of membranes(PROM)complicated by chorioamnionitis.Methods Two hundred patients with preterm PROM were divided into two groups:long duration group(duration of rupture of membranes≥24 hours,n=110)and short duration group(duration of rupture of membranes<24 hours,n=90).In addition,120 normal non-full-term pregnant women were selected as control group.Serum CRP and PCT levels were measured in all the three groups.The chorioamnionitis was diagnosed using pathologic examination as the gold standard.The sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio of CRP,PCT and their combination were calculated in the diagnosis of chorioamnionitis.Results Serum CRP and PCT levels in long duration group were higher than those in short duration group before antibiotic therapy.Compared with control group,serum PCT levels increased in patients with preterm PROM within 2 hours after hospital admission(P<0.05).The sensitivity,specificity,positive predictive value and negative predictive value of PCT detection were not significantly different from those of CRP detection(P>0.05),but those of CRP+PCT detection were higher than those of CRP or PCT detection(P<0.05).The positive likelihood ratio of CRP+PCT detection was higher than that of CRP or PCT detection,but the negative likelihood ratio of CRP+PCT detection was lower than that of CRP or PCT detection.Conclusion Combined serum CRP and PCT detection has important value in the diagnosis of preterm PROM complicated by chorioamnionitis.Serum CRP and PCT levels and incidence of chorioamnionitis increase with the duration of rupture of membranes.