晚期先兆流产患者阴道分泌物及宫颈管长度变化及对预后的相关性

Changes of vaginal discharge and cervical canal length in patients with late preterm abortion and their correlation with prognosis

目的:探讨晚期先兆流产患者阴道分泌物及宫颈管长度变化及对预后的相关性。方法:选取200例流产先兆孕妇(研究组)和100名产检的健康孕妇(健康组)为研究对象,研究组孕妇根据保胎结局分为保胎成功组(n=133)和难免流产组(n=67)。采用ELISA法检测各组阴道分泌物胎儿纤连蛋白(FFN)和白细胞介素8(IL-8)表达情况;化学发光免疫分析各组阴道分泌物胰岛素样生长因子结合蛋白1(IGFBP-1)表达情况;B型彩色超声诊断仪检测各组宫颈管长度;Logistic回归分析影响晚期先兆流产患者预后的危险因素;受试者工作特征(ROC)曲线分析各指标独立和联合检测的预测价值。结果:研究组孕妇FFN、IL-8、IGFBP-1表达较对照组高,宫颈长度较对照组短,差异均有统计学意义(P<0.05)。200例先兆流产产妇保胎成功者133例,保胎成功率为66.50%。回归分析显示,贫血、RSA、宫颈机能不全、感染、FFN、IL-8、IGFBP-1,宫颈长度≤30mm是影响晚期先兆流产患者预后的单因素(P<0.05);宫颈机能不全、感染、FFN、IL-8、IGFBP-1和宫颈长度≤30mm是影响晚期先兆流产患者预后的独立危险因素(P<0.05)。ROC曲线分析显示,FFN、IL-8、IGFBP-1和宫颈长度单项及联合早期预测晚期先兆流产产妇发生难免流产以联合检测的敏感度最高,联合检测的曲线下面积(AUC)最高。结论:晚期先兆流产产妇FFN、IL-8、IGFBP-1较同阶段正常产妇升高,宫颈长度同阶段正常产妇缩小;阴道分泌物中FFN、IL-8、IGFBP-1检测联合颈管长度测量对晚期先兆流产预后的预测有一定临床价值。

Objective:To analyze the changes of vaginal discharge and cervical canal length in patients with late preterm abortion and their correlation with prognosis.Methods:The clinical data of 200 pregnant women with aura of miscarriage were retrospectively analyzed as the study group,and the patients in the study group were divided into the group of successful preservation(n=133)and refractory miscarriage(n=67)according to the preservation outcome,another 100 healthy mothers who underwent maternity examination at the same period were selected as the healthy group.The expression of FFN and IL-8 in each group was detected by ELISA,the expression of IGFBP-1 in each group was analyzed by chemiluminescence immunoassay,and the length of cervical canal in each group was detected by B-type color ultrasound diagnostic instrument.Logistic regression analysis was used to analyze the risk factors affecting the prognosis of patients with late preeclampsia,and receiver operating characteristic(ROC)curves were drawn to study the predictive value of each index independently and in combination.Results:The expression of FFN,IL-8 and IGFBP-1 in the study group was higher than that in the control group,and the cervical length was shorter than that in the control group,and the difference was statistically significant(P<0.05).133 cases of 200 women with preterm abortion were successfully preserved,and the success rate of preservation was 66.50%.Regression analysis shows that anemia,RSA,cervical insufficiency,infection,FFN,IL-8,IGFBP-1,and cervical length≤30 mm were the single factors affecting the prognosis of patients with late preterm abortion(P<0.05).Cervical insufficiency,infection,FFN,IL-8,IGFBP-1 and cervical length≤30 mm were independent risk factors affecting the prognosis of patients with late preterm abortion(P<0.05).ROC curve analysis showed that FFN,IL-8,IGFBP-1 and cervical length alone or in combination could early predict the inevitable abortion of pregnant women with late threatened abortion.The sensitivity of joint detection was the highest,and the area under the curve(AUC)of joint detection was the highest.Conclusion:FFN,IL-8 and IGFBP-1 are significantly higher and cervical length is significantly smaller in women with late preeclampsia compared with normal women at the same stage.The combination of FFN,IL-8 and IGFBP-1 in vaginal secretions and cervical length measurement has clinical value in predicting the prognosis of late preeclampsia.