外周血血清白细胞介素-6和白细胞介素-8联合检测诊断宫内感染的效果

Effect of combined detection of interleukin-6 and interleukin-8 in peripheral serum in diagnosis of intrauterine infection

目的 检测孕妇外周血血清白细胞介素-6(IL-6)和白细胞介素-8(IL-8)表达水平,探讨二者联合检测对孕妇宫内感染的诊断价值和应用效果。方法 选取2017年6月-2019年6月在瑞安市人民医院住院分娩并发生胎膜早破的孕妇120例为观察组,其中经胎盘病理检查确诊患有绒毛膜羊膜炎的孕妇45例作为感染组,确诊未感染孕妇75例作为未感染组,另选取同期在该院门诊定期产检且足月分娩的健康孕妇110例作为对照组。采用酶联免疫吸附法(ELISA)检测所有研究对象血清和羊水标本中IL-6、IL-8水平;分析感染组患者血清IL-6、IL-8水平与临床病理参数的关系;ROC曲线分析血清IL-6、IL-8水平对宫内感染的诊断价值;比较感染组和未感染组患者年龄、感染程度及妊娠结局情况,并比较C-反应蛋白(CRP)、白细胞(WBC)、肿瘤坏死因子(TNF-α)、血清IL-6、IL-8及两者联合诊断对宫内感染的诊断价值。结果 感染组患者血清IL-6和IL-8水平[(529.77±132.49)pg/ml、(741.15±435.64)pg/ml]均高于对照组[(319.65±118.09)pg/ml、(534.15±111.43)pg/ml],差异均有统计学意义(t=13.628、13.231,均P<0.05);感染组患者血清和羊水IL-6、IL-8水平[血清:(529.77±132.49)pg/ml、(741.15±435.64)pg/ml,羊水:(538.74±134.70)pg/ml、(803.64±120.55)pg/ml]均高于未感染组[血清:(357.36±124.89)pg/ml、(558.94±136.85)pg/ml,羊水:(338.11±133.74)pg/ml、(596.78±114.82)pg/ml],差异均有统计学意义(血清t=10.494、10.930,羊水t=6.400、7.494,均P<0.05)。血清IL-6、IL-8水平与患者的感染程度、妊娠结局有关(均P<0.05)。血清IL-6对宫内感染诊断的曲线下面积(AUC)为0.790,灵敏度为75.0%,特异度为76.2%;IL-8对宫内感染诊断的AUC为0.800,灵敏度为63.9%,特异度为86.9%;两者联合检测的AUC为0.874,灵敏度为83.3%,特异度为81.0%。感染组患者血清CRP、WBC及TNF-α水平[(14.03±3.27)mg/L、(13.75±4.63)×10^(9)/L及(682.18±284.14)ng/ml]水平均显著高于未感染组[(6.48±2.93)mg/L、(10.02±3.1)×10^(9)/L及(373.86±170.89)ng/ml],差异均有统计学意义(t=10.313、3.914及5.400,均P<0.05)。血清IL-6、IL-8及两者联合检测诊断效果优于CRP、WBC及TNF-α单独检测。结论 IL-6、IL-8在宫内感染患者血清和羊水中表达升高,与临床病理特征有关,血清IL-6、IL-8水平对宫内感染具有一定的诊断效能,与相关指标比较检测效果更优。

Objective To measure the expression levels of interleukin-6(IL-6) and interleukin-8(IL-8) in the peripheral blood of pregnant women, and to explore the diagnostic value and application effect of the combined detection of interleukin-6(IL-6) and interleukin-8(IL-8) in intrauterine infection of pregnant women.Methods From June 2017 to June 2019, 120 pregnant women with premature rupture of membranes delivered in Ruian People’s Hospital were selected as the observation group, among them, 45 pregnant women with chorioamnionitis confirmed by placental pathology were taken as the infected group, and 75 pregnant women without chorioamnionitis confirmed by placental pathology were taken as the uninfected group, in addition, 110 healthy pregnant women with regular antenatal examination and full-term delivery in the outpatient department of the hospital were selected as the control group.The levels of IL-6 and IL-8 in serum and amniotic fluid of all subjects were detected by ELISA;the relationship between serum IL-6, IL-8 levels and clinicopathological parameters was analyzed;ROC curve was used to analyze the diagnostic value of serum IL-6 and IL-8 levels for intrauterine infection;the age, infection degree and pregnancy outcome of patients in the infected group and the uninfected group were compared, the diagnostic value of C-reactive protein(CRP), white blood cell(WBC), tumor necrosis factor(TNF-α), serum IL-6, IL-8 and their combination for intrauterine infection were compared.Results The levels of serum IL-6 and IL-8 in the infected group [(529.77±132.49) pg/ml,(741.15±435.64) pg/ml] were higher than those in the control group [(319.65±118.09) pg/ml,(534.15±111.43) pg/ml], the difference was statistically obvious(t=13.628, 13.231, all P<0.05);the levels of IL-6 and IL-8 in serum and amniotic fluid in the infected group [serum:(529.77±132.49) pg/ml,(741.15±435.64) pg/ml, amniotic fluid:(538.74±134.70) pg/ml,(803.64±120.55) pg/ml] were higher than those in the uninfected group [serum:(357.36±124.89) pg/ml,(558.94±136.85) pg/ml, amniotic fluid:(338.11±133.74) pg/ml,(596.78±114.82) p/ml], and the differences were statistically obvious(serum: t=10.494, 10.930, amniotic fluid: t=6.400, 7.494, all P<0.05).The levels of serum IL-6 and IL-8 were related to the infection degree and pregnancy outcome of the patients(P<0.05).The area under the curve(AUC) of serum IL-6 in diagnosis of intrauterine infection was 0.790, the sensitivity was 75.0%, and the specificity was 76.2%;the AUC of IL-8 in the diagnosis of intrauterine infection was 0.800, the sensitivity was 63.9%, and the specificity was 86.9%;the AUC of the two combination was 0.874, the sensitivity was 83.3%, and the specificity was 81.0%.The levels of serum CRP, WBC and TNF-α [(14.03±3.27) mg/L,(13.75±4.63) ×10^(9)/L and(682.18±284.14) ng/ml] in the infected group were obviously higher than those in the uninfected group [(6.48±2.93) mg/L,(10.02±3.1) ×10^(9)/L and(373.86±170.89) ng/ml], the differences were statistically obvious(t=10.313, 3.914 and 5.400, all P<0.05).The diagnostic effect of serum IL-6, IL-8 and their combination was better than that of CRP, WBC and TNF-α alone.Conclusion The expression of IL-6 and IL-8 in serum and amniotic fluid of patients with intrauterine infection is increased, which is related to the clinicopathological characteristics. Serum IL-6 and IL-8 levels have a certain diagnostic efficacy for intrauterine infection, and theyhave better detection effect than related indicators.