肝素结合蛋白在产时发热合并急性绒毛膜羊膜炎患者中的预测价值

Predictive value of heparin-binding protein in patients with intrapartum fever complicating acute chorioamnionitis

目的探讨肝素结合蛋白(HBP)在产时发热合并急性绒毛膜羊膜炎患者中的预测价值。方法选取2020年12月至2021年5月该院产时发热产妇130例,胎盘病理检查提示合并组织型急性绒毛膜羊膜炎110例为观察组,未合并急性绒毛膜羊膜炎20例为对照组。所有受试者于产时发热时抽取静脉血,比较两组血浆HBP、白细胞总数(WBC)、中性粒细胞数(NEU)、中性粒细胞百分比(NEU%)、C反应蛋白(CRP)、降钙素原(PCT)水平,分析单一指标和两两联合对产时发热合并急性绒毛膜羊膜炎的预测价值。结果与对照组比较,观察组血浆HBP水平明显升高(P<0.01)。HBP、WBC、NEU、NEU%、CRP及PCT预测产时发热合并急性绒毛膜羊膜炎的最佳截断值分别为21.14 ng/mL、15.69×10^(9)/L、12.98×10^(9)/L、91.25%、5.52 mg/L、0.043 ng/mL,对应的曲线下面积(AUC)分别为0.93、0.58、0.59、0.51、0.63、0.61,灵敏度分别为79.10%、43.60%、55.50%、15.50%、76.40%、60.00%,特异度分别为95.00%、80.00%、70.00%、95.00%、50.00%、55.00%,约登指数分别为0.74、0.24、0.11、0.26、0.26、0.25。各指标与HBP联合时,新指标的灵敏度均为79.10%,特异度均为95.00%,约登指数均为0.74,其余指标间两两联合诊断效能均较低。结论血浆HBP对产时发热合并急性绒毛膜羊膜炎有一定的预测价值。

Objective To explore the predictive value of heparin binding protein(HBP)in intrapartum fever complicating acute chorioamnionitis.Methods One hundred and thirty patients with intrapartum fever in this hospital from December 2020 to May 2021 were selected.One hundred and ten patients with complicating tissue type acute chorioamnionitis suggested by placental pathology examination served as the observation group and 20 patients without complicating acute chorioamnionitis as the control group.The venous blood in all subjects was collected at the time of intrapartum fever.The plasma HBP,total white blood cell count(WBC),neutrophil count(NEU),neutrophil ratio(NEU%),C-reactive protein(CRP)and procalcitonin(PCT)levels were compared between the two groups.The predictive value of single indicator and pairwise combination of indicators for intrapartum fever complicating acute chorioamnionitis was analyzed.Results Compared with the control group,the plasma HBP level in the observation group was significantly increased(P<0.01).The optimal cutoff values of HBP,WBC,NEU,NEU%,CRP and PCT were 21.14 ng/mL,15.69×10^(9)/L,12.98×10^(9)/L,91.25%,91.25%,5.52 mg/L and 0.043 ng/mL,the corresponding areas under the curve(AUC)were 0.93,0.58,0.59,0.51,0.63 and 0.61,respectively,the sensitivities were 79.10%,43.60%,55.50%,15.50%,76.40%and 60.00%respectively,and the specificities were 95.00%,80.00%,70.00%,95.00%,50.00%and 55.00%respectively,the Jorden indexes were 0.74,0.24,0.11,0.26,0.26 and 0.25 res-pectively.When the various indexes were combined with HBP,the sensitivity of the new indexes were all 79.10%,the specificities were all 95.00%,the Jorden indexes were all 0.74.The pairwise combination diagnosis of the other indexes had lower efficiency.Conclusion Plasma HBP has certain predictive value for intrapartum fever complicating acute chorioamnionitis.