胎膜早破产妇外周血指标的改变对合并羊膜感染的诊断价值

The changes and value of hematological index in diagnosis of intraamniotic infection for premature rupture of membranes patients

目的检测胎膜早破产妇外周血指标的改变及对是否合并羊膜感染的诊断价值,以期为此类产妇的临床诊疗提供参考。方法选取2015年1月至2017年1月我院收治的足月胎膜早破产妇的临床资料。依据是否存在羊膜炎症分为观察组(合并)及对照组(不合并)。共纳入观察组42例,对照组45例。检测两组分娩前外周血白介素-6(IL-6)、人绒毛膜促性腺激素(HCG)及C-反应蛋白(CRP)。结果观察组产妇外周血HCG(24.1±6.3vs 18.5±5.1;t=4.571,P<0.01)、CRP(21.6±5.5vs 15.9±4.3;t=4.854,P<0.01)及IL-6(29.8±7.1vs 16.8±5.9;t=9.313,P<0.01)水平均显著高于对照组,差异均具有统计学意义。ROC曲线分析显示,以23.1ng/L为截点值,IL-6诊断胎膜早破产妇合并羊膜感染的敏感性为82.22%,特异性为80.95%,曲线下面积为0.90,优于HCG及CRP。观察组IL-6水平与HCG(r=0.766,P<0.01)及CRP(r=0.693,P<0.01)间均呈现显著正相关关系。结论合并羊膜感染的胎膜早破足月产妇外周血IL-6、HCG及CRP水平均显著升高,其中IL-6水平对合并羊膜感染的诊断价值较佳。

Objective To analyze the changes and value of haematological index in diagnosis of intraamniotic infection for premature rupture of membranes.Methods Clinical data of premature rupture of membranes patients received treatment at our hospital from 2015 to 2017 were analyzed.Patients were divided into two groups by whether suffer from intraamniotic infection confirmed by pathology,Group A：yes;Group B：no CLEA.Results Total of 87 patients were analyzed,Group A 42 cases,Group B 45 cases.Group A patients had higher levels of CRP（21.6±5.5 vs 15.9±4.3;t=4.854,P〈0.01）,HCG（24.1±6.3 vs 18.5±5.1;t=4.571,P〈0.01）and IL-6（29.8±7.1 vs 16.8±5.9;t=9.313,P〈0.01）than these of Group B patients,the difference were statistically significant.ROC analysis showed that the Il-6 cut-off point value of 23.1 ng/L,as used for the diagnosis of intraamniotic infection for premature rupture of membranes,provided a sensitivity of 82.22%,a specificity of 80.95%,an AUC of 0.90,better than these of CRP and HCG.Correlation analysis showed that,for Group A patients,the levels of IL-6 had significant positive correlation with CRP（r=0.693,P〈0.01）and HCG（r=0.766,P〈0.01）.Conclusion Premature rupture of membranes patients combined with intraamniotic infection had higher levels of CRP,IL-6 and HCG,meanwhile IL-6 showed a better diagnostic value.