宫颈长度测量联合胎儿纤维连接蛋白检测对早产的预测价值

Value of combined use of cervical length measurement and quantitative fetal fibronectin detection in predicting preterm birth

目的探讨宫颈长度测量联合胎儿纤维连接蛋白(fFN)测定对早产的预测价值。方法采用ELISA定量测定28～34周先兆早产孕妇阴道分泌物中的fFN水平,同时经阴道B超测量宫颈长度。分析fFN定量及测量宫颈长度对7d内早产的预测价值。结果 353例有先兆早产症状的孕妇中,34例(9.6%)在7d内发生早产。在宫颈长度<20mm的孕妇中,当取25ng/ml作为fFN临界值时,31例被认为是低风险,其中1例(3.2%)在7d内发生早产。fFN≥25ng/ml者的7d早产率高于<25ng/ml者(29.3%vs.3.2%)(P<0.01)。在宫颈长度≥20mm的孕妇中,当fFN临界值取200ng/ml时,63例被认为是高风险,其中6例(9.5%)在7d内发生早产。fFN≥200ng/ml者的7d早产率高于<200ng/ml者(9.5%vs.2.7%)(P<0.05)。有先兆早产症状的孕妇7d早产率与宫颈长度呈负相关(P<0.05),而与fFN浓度呈正相关(P<0.05)。结论 fFN定量检测联合宫颈长度测量能够提高先兆早产孕妇在7d内早产的预测价值。

Objective To explore the value of combined use of cervical length measurement and quantitative fetal fibronectin（fFN）detection in predicting preterm birth.Methods The fFN in vaginal fluids was detected by ELISA and the cervical length was measured by B-ultrasonography in353 pregnant women with the manifestation of threatened premature labor during 28 and 34 weeks gestation.The value of combined use of cervical length measurement and quantitative fFN detection in predicting preterm birth was analyzed.Results Preterm birth in 7 days occurred in 34（9.6%）of 353 pregnant women with the manifestation of threatened premature labor.Taking the fFN 25 ng/ml as the cutoff value in pregnant women with the cervical length of〈20 mm,31 cases were defined as low risk for preterm birth,of whom one case（3.2%）occurred preterm birth in 7 days.Taking the fFN ≥25 ng/ml,the incidence of preterm birth in 7 days was higher than that when taking the fFN〈25 ng/ml（29.3% vs.3.2%）（P〈0.01）.Taking the fFN 200 ng/ml as the cutoff value,63 cases were defined as high risk for preterm birth,of whom 6 cases（9.5%）occurred preterm birth in 7 days.The incidence of preterm birth in 7 days was higher when taking the fFN ≥200 ng/ml than that when taking the fFN〈200 ng/ml（9.5% vs.2.7%）（P〈0.05）.The incidence of preterm birth in 7 days was negatively correlated to the cervical length（P〈0.05）,but was positively correlated to fFN level in vaginal fluids（P〈0.05）.Conclusion Combined use of cervical length measurement and quantitative fFN detection can improve the efficiency of predicting preterm birth in pregnant women with the manifestations of threatened premature labor.