抑制素A、孕酮和胎儿纤维连接蛋白联合检测在预测先兆流产结局中的临床价值研究

Clinical Value of Combination Detection of Inhibin A,Progesterone and Fetal Fibronectin in Predicting the Outcome of Threatened Abortion

目的探讨抑制素A、孕酮和胎儿纤维连接蛋白(fetal fibronectin,f FN)联合检测在先兆流产预测中的临床应用价值。方法随机选择170例具有先兆流产症状的患者作为本次研究的对象,经过保胎治疗后继续妊娠的75例孕妇作为先兆流产组,保胎治疗后流产的45例孕妇作为流产组,另随机选择50例同期笔者医院建档的正常妊娠的孕妇作为对照组。分别检测各孕妇入院产检时机体的抑制素A、孕酮和f FN的水平,比较各组孕妇的抑制素A、孕酮水平和f FN阳性率之间的差异。结果流产组、先兆流产组、正常妊娠组孕妇的抑制素A和孕酮水平依次升高,f FN阳性率依次降低,差异有统计学意义(P<0.05)。抑制素A、孕酮水平和f FN阳性率以及联合检测在对先兆性流产预测的ROC曲线下面积分别为0.899、0.866、0.785、0.944。抑制素A、孕酮水平和f FN阳性率联合检测的敏感度为92.04%,特异性为89.17%,准确度为87.95%,阳性预测值为98.45%,阴性预测值为89.38%,Youden指数为0.812。结论抑制素A、孕酮联合胎儿纤维连接蛋白对于孕妇先兆性流产结局具有一定的预测价值,能够明显提升预测的准确度和特异性以及准确度。

Objective To study the clinical value of combination dection of inhibin A, progesterone and fetal fibronectin in predic- ting the outcome of threatened abortion. Methods One hundred and seventy patient with symptoms of threatened abortion were selected as the object of this study. After miscarriage treatment, 75 patients continued the pregnancy as the threatened abortion group and 45 pa- tients miscarriage after miscarriage treatment as the abortion group, another 50 normal pregnant women at same period in our hospital were as the control group. Inhibin A, progesterone and fetal fibronectin were detected and compared between the three groups. Results The inhibin A and progesterone levels increased in turn from abortion group, threatened abortion group to normal pregnancy group, fFN positive rates were lower in turn. The difference were statistically significant （P 〈 0.05 ）. The area under the ROC curve （AUC） of inhibin A, and progesterone levels fFN positive rate for prediction of threatened abortion were 0. 899, 0. 866, 0. 785, while the AUC of the combine that three index was 0. 944. The sensitivity of the combined detection was 92.04% , the specificity was 89.17% , accuracy was 87.95% , positive predictive value was 98.45% , negative predictive value was 89.38% , and Youden index was 0. 812. Conclusion Combined detection of inhibin A, progesterone and fetal fibronectin in predicting the outcomes of threatened abortion of pregnant women have a better predictive value than single index, it can enhance the accuracy, specificity and accuracy of forecasts.