血清MMP-9、β-hCG联合检测对胎膜早破合并宫内支原体感染的预测价值

Predictive Value of Serum MMP-9 and β-hCG for Premature Rupture of Membranes Complicated with Intrauterine Mycoplasma Infection

【目的】探讨血清基质金属蛋白酶-9(MMP-9)、β-人绒毛膜促性腺激素(β-hCG)联合检测对胎膜早破(PROM)合并宫内支原体感染的预测价值。【方法】选取2018年3月至2020年5月在中航工业西安医院诊治的199例PROM孕妇,并根据产后胎膜病理学检查分为未感染组(126例)、支原体感染组(73例),另外选取100例同期在中航工业西安医院定期产检的正常妊娠孕妇作为对照组。收集各组体重指数(BMI)、产次、流产/引产史、妊娠期糖尿病、妊娠期高血压等一般资料;采用酶联免疫吸附法(ELISA)检测各组血清MMP-9、β-hCG水平;绘制受试者工作特征(ROC)曲线评估血清MMP-9、β-hCG水平对孕妇发生PROM合并宫内支原体感染的预测价值;采用多因素Logistic回归模型分析孕妇发生PROM合并宫内支原体感染的影响因素。【结果】对照组、未感染组、支原体感染组年龄、BMI、孕周、初产占比、妊娠期糖尿病占比比较,差异均无统计学意义(P>0.05),流产/引产史、妊娠期高血压占比比较,差异均有统计学意义(P<0.05);与对照组相比,未感染组、支原体感染组血清MMP-9、β-hCG表达水平均较高(P<0.05);与未感染组相比,支原体感染组血清MMP-9、β-hCG表达水平均较高(P<0.05)。血清MMP-9、β-hCG单独预测孕妇发生PROM合并宫内支原体感染的曲线下面积(AUC)分别为0.814、0.834,截断值分别为370.72ng/L、16.46mol/mL,敏感度分别为74.00%、83.60%,特异度分别为77.00%、71.20%,两者联合预测的AUC为0.907,敏感度为79.50%,特异度为88.50%;MMP-9高表达、β-hCG高表达均是孕妇发生PROM合并宫内支原体感染的独立危险因素(P<0.05)。【结论】血清MMP-9、β-hCG水平与孕妇发生PROM合并宫内支原体感染密切相关,两者联合诊断效能较高,可成为早期诊断PROM合并宫内支原体感染的辅助指标。

【Objective】To investigate the predictive value of serum matrix metalloproteinase-9(MMP-9)and β-human chorionic gonadotropin(β-hCG)in predicting premature rupture of membranes(PROM)complicated with intrauterine mycoplasma infection.【Methods】A total of 199 cases of PROM pregnant women in AVIC Xi'an Hospital from March 2018 to May 2020 were selected.They were divided into non infection group(126 cases)and mycoplasma infection group(73 cases)according to the pathological examination of postpartum fetal membrane.Another 100 cases of normal pregnant women in our hospital during the same period were selected as the control group.The expression levels of MMP-9 and β-hCG in serum were detected by enzyme-linked immunosorbent assay(ELISA),body mass index(BMI),birth history,abortion/induced labor history,gestational diabetes mellitus and pregnancy induced hypertension were collected and compared among the three groups;the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum MMP-9 and β-hCG in pregnant women with PROM complicated with intrauterine mycoplasma infection;and multivariate Logistic regression model was used to analyze the influencing factors of PROM complicated with intrauterine mycoplasma infection.【Results】There were no significant differences in age,BMI,gestational weeks,the proportion of primipara and the proportion of gestational diabetes mellitus between the control group,the non infection group and the mycoplasma infection group(P>0.05),while the differences in the proportion of abortion/induced labor history and the proportion of pregnancy induced hypertension were statistically significant(P<0.05);compared with those in the control group,the levels of serum MMP-9 and β-hCG in the non infection group and the mycoplasma infection group were higher(P<0.05);compared with those in the non infection group,the levels of serum MMP-9 and β-hCG in the mycoplasma infection group were higher(P<0.05);the area under the curve(AUC)of serum MMP-9 and β-hCG in predicting PROM complicated with intrauterine mycoplasma infection in pregnant women was 0.814,0.834,respectively,the cut-off value was 370.72 ng/L and 16.46 mol/ml,respectively,the sensitivity was 74.00% and 83.60% respectively,the specificity was 77.00% and 71.00%,respectively.The AUC of combined prediction was 0.907,the sensitivity was 79.50%,and the specificity was 88.50%;the high expression of MMP-9 and the high expression of β-hCG were independent risk factors of PROM complicated with intrauterine mycoplasma infection(P<0.05).【Conclusion】The levels of serum MMP-9 and β-hCG are closely related to the occurrence of PROM complicated with intrauterine mycoplasma infection in pregnant women.The combined diagnosis efficiency of the two methods is high,which may be the auxiliary biological indicators for the early diagnosis of PROM complicated with intrauterine mycoplasma infection.