外周血粒细胞集落刺激因子、肿瘤坏死因子-α水平对未足月胎膜早破并宫内感染的诊断价值

Peripheral blood granulocyte colony stimulating factor and tumor necrosis factor-αlevels in the diagnosis of preterm premature rupture of membranes with intrauterine infection

目的 分析外周血粒细胞集落刺激因子(G-CSF)、肿瘤坏死因子-α(TNF-α)水平对未足月胎膜早破(PPROM)并宫内感染的诊断价值。方法 选取2018年12月——2020年12月天津市北辰区中医医院来院就诊的胎膜早破患者90例(研究组),另选取同期孕检的正常孕妇90例(对照组)。检测并对比2组研究对象外周血G-CSF和TNF-α水平。研究组患者根据是否发生宫内感染再分为感染组和未感染组,比较感染组和未感染组患者外周血G-CSF和TNF-α水平及其他临床资料。采用Logistic回归分析法确认影响足月胎膜早破并宫内感染的危险因素。利用受试者工作特征曲线(ROC)评价外周血G-CSF和TNF-α水平对PPROM并发宫内感染患者的诊断价值。结果研究组患者外周血G-CSF和TNF-α水平均高于对照组(P<0.05);感染组患者非单胎、羊水过少、生殖道感染占比及外周血G-CSF、TNF-α水平均高于未感染组(P<0.05);Logistic回归分析结果显示羊水过少、生殖道感染、外周血G-CSF和TNF-α水平均是影响PPROM患者的危险因素(P<0.05);ROC曲线确定G-CSF以71.516ng/L为最佳截断点,诊断PPROM发生宫内感染的曲线下面积(AUC)为0.799(95%CI:0.758-0.906),约登指数为0.500;TNF-α以763.65ng/L为最佳截断点,诊断PPROM发生宫内感染的AUC为0.736(95%CI:0.633-0.824),约登指数为0.462;二者联合诊断(即均为阳性则判定为阳性结果)的AUC与约登指数分别为0.862(95%CI:0.773-0.926)和0.552。结论 PPROM患者中外周血G-CSF和TNF-α水平异常,且其是影响胎膜早破并宫内感染的危险因素,对于宫内感染的诊断有较高的价值。

Objective To analyze the diagnostic value of peripheral blood granulocyte colony stimulating factor(GCSF)and tumor necrosis factor-α(TNF-α)levels in preterm premature rupture of membranes(PPROM)with intrauterine infection.Methods The study subjects were selected as 90 cases of premature rupture of membranes(research group)from December 2018 to December 2020(research group)Beichen District Hospital of Traditional Chinese Medicine,and 90 cases of normal pregnant women(control group)were selected during pregnancy examination during the same period.G-CSF and TNF in peripheral blood were detected and compared between the two groups-αLevel.Patients in the study group were divided into infected group and non-infected group according to whether intrauterine infection occurred,and the peripheral blood G-CSF and TNF-αlevels and other clinical data of the two groups were compared.Logistic regression analysis was used to confirm the risk factors affecting term premature rupture of membranes and intrauterine infection.The receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of peripheral blood G-CSF and TNF-αfor PPROM complicated by intrauterine infection.Results The levels of G-CSF and TNF-αin the peripheral blood of the study group were higher than those of the control group(P<0.05).The proportion of non-singleton,oligohydramnios,genital tract infection and peripheral blood G-CSF and TNF-αlevels in the infected group were higher than those in the non-infected group(P<0.05).Logistic regression analysis showed that oligohydramnios,genital tract infection,peripheral blood G-CSF and TNF-αlevels were risk factors affecting PPROM patients(P<0.05).ROC curve confirms that 71.516ng/L was the best cut-off point for G-CSF to diagnose PPROM intrauterine infection.The area under the curve(AUC)was 0.799(95% CI:0.758-0.906),and the Youden index was 0.500.With 763.65ng/L as the best cut-off point for TNF-α,the AUC for the diagnosis of intrauterine infection in PPROM was 0.736(95% CI:0.633-0.824),and the Youden index was 0.462.The AUC and yoden index of the combined diagnosis(positive results were determined if they were both positive)were 0.862(95% CI:0.773-0.926)and 0.552,respectively.Conclusion The levels of G-CSF and TNF-αin peripheral blood are abnormal in PPROM patients,and they are risk factors that affect premature rupture of membranes and intrauterine infection,and have a high value for the diagnosis of intrauterine infection.