细胞因子在未足月胎膜早破并发绒毛膜羊膜炎的变化及诊断价值

Changes and Diagnostic Value of Serum Level of Cytokines in Chorioamnionitis and Preterm Premature Rupture of Membrane

目的研究相关细胞因子在未足月胎膜早破患者母血、脐血中的含量,探讨其与绒毛膜羊膜炎及未足月胎膜早破的关系。方法未足月胎膜早破80例研究对象分为绒毛膜羊膜炎组34例(观察组)和非绒毛膜羊膜炎组46例(对照组)。采用酶联免疫吸附法检测母血和脐血中的白细胞介素(IL)-6、IL-2、IL-10的含量及分娩后胎盘病理学检查。对各指标绘制ROC工作曲线比较各细胞因子诊断绒毛膜羊膜炎的敏感度、特异性、尤登(Youden)指数、ROC曲线下面积并记录早产儿预后情况。结果观察组母血及脐血中IL-6均高于对照组(P<0.05);IL-10在母血及脐血中值均低于对照组(P<0.05);IL-2水平在两组母血及脐血中的含量均无明显差别(P>0.05)。采用母血和脐血IL-6、IL-2大于截断值诊断绒毛膜羊膜炎的敏感度分别为91.4%、40.0%和85.7%、91.4%,特异性分别为82.2%、77.8%和93.3%、24.4%,Youden指数为0.736、0.178和0.790、0.158,ROC曲线下面积Az为0.940、0.567和0.956、0.550。母血和脐血IL-10大于截断值时排除绒毛膜羊膜炎的敏感度分别为77.8%、88.9%,特异性分别为88.6%、80.0%,Youden指数为0.664、0.689,ROC曲线下面积Az为0.901、0.928。观察组早产儿并发症发生率为35.2%(12/34),对照组发生率为6.5%(3/46),差异有统计学意义(P<0.05)。结论妊娠妇女母血、脐血中IL-6、IL-10水平变化与绒毛膜羊膜炎有关,检测二者的浓度变化对未足月胎膜早破并发绒毛膜羊膜炎有一定的诊断价值;早发现早治疗绒毛膜羊膜炎,可改善早产儿预后。

Objective To investigate the level of cytokines in maternal serum and umbilical cord blood of preterm premature rupture of membrane（PPROM）,and study on relationship between PPROM and chorioamnionitis Methods 80 cases of PPROM were selected as research object. All cases were assigned into observation group（34 cases）with chorioamnionitis and control group（46 cases）without chorioamnionitis respectively. Levels of IL-6,IL-2,IL-10 were detected of all cases by enzyme-linked immunosorbent assay （ELISA） and pathological examination of placenta and umbilical cord after childbirth. The ROC working curve was draw a for each index.The cytokines in the diagnosis of degree of chorioamnionitis sensitivity, specificity, Uden （Youden） index, and area under the ROC curve were obserred. Neonatal prognosis was recorded. Results The levels of IL-6 in maternal serum and umbilical cord serum in observation group were significantly higher than those in control group（P〈0.05）. The plasma concentrations of IL-10 were significantly lower than those in control group（P〈0.05）. The level of IL-2 between two group had no significant difference（P〉0.05）.When levels of IL-6,IL-2 in maternal serum and umbilical cord blood higher than the cut-off point,sensitivity of these index for diagnosis of chorioamnionitis were 91.4%,40.0% and 85.7%、91.4%.The specificity were 82.2%,77.8% and 93.3%,24.4%.Youden index were 0.736,0.178 and 0.790,0.158. Area under the ROC curve of Az were 0.940,0.567 and 0.956,0.550. When levels of IL-10 in maternal serum and umbilical cord blood higher than the cut-off point,sensitivity of these index for elimination of chorioamnionitis were 77.8%,88.9%.The specificity were 88.6%,80.0%.Youden index were 0.664,0.689. Area under the ROC curve of Az were 0.901,0.928.The rate of complication of premature infants in observation group was 35.2% （12/34）. The rate in control group was 6.5%（3/46）. The difference was significant（P〈0.05）. Conclusion The changes of IL-6,IL-10 in maternal serum and umbilical cord blood of women are associated with chorioamnionitis. The results are valuable for PPROM complicating chorioamnionitis.Early detection and treatment of chorioamnionitis can improve the prognosis of premature infants.