hs-CRP与CRP预测胎膜早破早产儿宫内感染的价值研究

Value of hs-CRP and CRP in prediction of intrauterine infection in premature infants of premature rupture of fetal membranes

目的研究和分析超敏C-反应蛋白(hs-CRP)、C-反应蛋白(CRP)预测胎膜早破(PROM)早产儿宫内感染的价值,为PROM早产儿宫内感染的临床诊治工作提供客观依据。方法选取2016年1月-2017年1月期间医院收治的未足月PROM孕妇104例作为病例组,选取健康早产妊娠孕妇50例作为早产妊娠组,选取同期健康足月妊娠孕妇50例作为对照组对三组研究对象入院时、分娩后1d和3d的血清hs-CRP、CRP水平进行检测和比较,对三组新生儿的宫内感染率进行观察和分析。结果分娩前、后各时点,病例组孕妇的血浆hs-CRP、CRP水平均高于早产妊娠组,早产妊娠组孕妇的血浆hs-CRP、CRP水平均高于对照组,发生新生儿宫内感染的病例组孕妇的血浆hs-CRP、CRP水平均高于未发生新生儿宫内感染的病例组孕妇,差异均有统计学意义(P<0.05);病例组、对照组、早产妊娠组新生儿宫内感染率分别为55.77%、8.00%和14.00%,病例组新生儿宫内感染率显著高于对照组和早产妊娠组,差异均有统计学意义(P<0.05);孕妇入院时血浆hs-CRP、CRP水平在预测RPOM早产儿宫内感染中的AUC分别为0.740和0.744,当应用两种指标进行联合检测时,AUC提升至0.828,联合检测在预测PROM早产儿宫内感染中灵敏度显著高于单独检测血浆hs-CRP或CRP水平(P<0.05),而三种方法的特异度差异无统计学意义。结论 PROM早产儿宫内感染率较高,发生新生儿宫内感染的孕妇可表现为外周血hs-CRP、CRP水平的升高,联合检测这两项指标可辅助预测PROM早产儿宫内感染的发生。

OBJECTIVE To study the value of high-sensitivity C-reactive protein（hs-CRP）and C-reactive protein（CRP）in prediction of intrauterine infection in premature infants of premature rupture of fetal membranes（PROM）so as to provide objective basis for clinical diagnosis and treatment of the PROM premature infants with intrauterine infection.METHODS A total of 104 pregnant women with PROM who were treated in hospitals from Jan 2016 to Jan 2017 were chosen as the case group,and 50 healthy preterm pregnant women were assigned as the preterm pregnancy group,meanwhile,50 healthy full-term pregnant women were set as the control group.The levels of serum hs-CRP and CRP of the three groups of study objects were detected and compared at the admission to the hospital and 1 day and 3 days after the delivery,and the incidence rates of intrauterine infection in the three groups of neonates were observed.RESULTS The levels of serum hs-CRP and CRP of the case group were higher than those of the preterm pregnancy group before the delivery and at the time points after the delivery,the levels of serum hs-CRP and CRP of the preterm pregnancy group were higher than those of the control group,and the levels of serum hs-CRP and CRP of the pregnant women with neonatal intrauterine infection in the case group were higher than those of the pregnant women without neonatal intrauterine infection in the case group,and there were significant differences（P 0.05）.The incidence rate of neonatal intrauterine infection of the case group was55.77%,significantly higher than 8.00% of the control group and 14.00% of the preterm pregnancy group,and there was significant difference（P〈0.05）.The AUC of the serum hs-CRP was 0.740 in prediction of intrauterine infection in premature infants of PROM at the admission to the hospital,the AUC of the CRP 0.744;the AUC was increased to 0.828 when the two types of indexes were combined for detection;the sensitivity of the serum hsCRP combined with CRP was significantly higher than that of single serum hs-CRP or CRP in prediction of intrauterine infection in premature infants of PROM（P〈0.05）,however,there was no significant difference in the specificity among the three kinds of methods.CONCLUSIONThe incidence rate of intrauterine infection is high in the premature infants of PROM,the pregnant women with neonatal intrauterine infection show the elevated levels of peripheral blood hs-CRP and CRP,and the combined detection of the two types of indexes may assist the prediction of intrauterine infection in the premature infants of PROM.