胰岛素样生长因子结合蛋白-1/胎儿纤维连接蛋白联检联合宫颈长度预测早产的价值

The Value of Insulin-like Growth Factor Binding Protein-1/fetal Fibronec tin Cohort Test Combined with Cervical Length in Predicting Preterm De livery

目的探讨宫颈分泌物中胰岛素样生长因子结合蛋白-1/胎儿纤维连接蛋白(insulin-like growth factor binding protein-1/fetal fibronectin,IGFBP-1/fFN)联检与超声行宫颈长度(cervical length,CL)联合检测在预测早产中的临床应用价值。方法选取2021年3月—2022年3月苏州大学附属太仓医院收治的140例先兆早产孕妇为研究对象,按照妊娠结局分为早产组(n=38),足月产组(n=102)。对比两组孕妇的IGFBP-1/fFN和宫颈长度的检查结果。分析CL、IGFBP-1/fFN、CL+IGFBP-1/fFN用于预测早产的准确率、特异度、灵敏度、阴性预测值与阳性预测值。结果早产组CL(20.1±13.5)mm显著低于足月产组,差异有统计学意义(t=-6.859,P<0.001);在预测早产方面,IGFBP-1/fFN可实现的准确率、特异度、灵敏度、阴性预测值与阳性预测值依次为77.1%、78.4%、73.6%、88.8%、56.0%;CL可实现的准确率、特异度、灵敏度、阴性预测值与阳性预测值依次为83.5%、95.0%、52.6%、84.3%、80.0%;IGFBP-1/fFN+CL可实现的准确率、特异度、灵敏度、阴性预测值与阳性预测值依次为86.4%、99.0%、52.6%、84.9%、95.2%。使用孕妇宫颈分泌物中IGFBP-1/fFN联检预测早产的灵敏度较高,IGFBP-1/fFN联检与CL联合检测在预测早产的特异度和准确率以及预测早产的阳性预测值均高于分别单独使用IGFBP-1/fFN、CL的诊断。结论IGFBP-1/fFN联检+CL,能够使先兆早产预测的准确率、特异度以及阳性预测值明显提升,在一定程度上有助于先兆早产的预测。

Objective To investigate the clinical value of insulin-like growth factor binding protein-1/fetal fibronectin(IGFBP-1/fFN)combined with ultrasound in cervical secretions in predicting preterm labor.The value of combined ultrasound cervical length(CL)test in predicting preterm labor.Methods 140 pregnant women with preterm labor admitted to the Department of Obstetrics and Gynecology,Taicang Hospital of Soochow University,from March 2021 to March 2022 were selected.They were divided into preterm delivery group(n=38)and full-term delivery group(n=102)according to pregnancy outcome.The findings of IGFBP-1/fFN and cervical length were compared between the two groups of pregnant women.The accuracy,specificity,sensitivity,negative predictive value and positive predictive value of CL,IGFBP-1/fFN,and CL+IGFBP-1/fFN for predicting preterm labor were analyzed.Results The CL of the preterm delivery group(20.1±13.5)mm was significantly lower than the term delivery group,the difference was statistically significant difference(t=-6.859,P<0.001).The accuracy,specificity,sensitivity,negative and positive predictive values achieved by IGFBP-1/fFN were 77.1%,78.4%,73.6%,88.8%,and 56.0%,respectively,in predicting preterm labor;the accuracy,specificity,sensitivity,negative and positive predictive values achieved by CL were 83.5%,95.0%,52.6%,84.3%,and 80.0%,respectively.The accuracy,specificity,sensitivity,negative predictive value and positive predictive value achieved by IGFBP-1/fFN+CL were 86.4%,99.0%,52.6%,84.9%and 95.2%,respectively.The sensitivity of the IGFBP-1/fFN test in cervical secretions of pregnant women was higher,and the specificity and accuracy of the IGFBP-1/fFN test combined with the CL test in predicting preterm labor and the positive predictive value of preterm labor were higher than those of the IGFBP-1/fFN and CL tests alone.Conclusion The IGFBP-1/fFN co-test+CL can significantly improve the accuracy and specificity as well as the positive predictive value of preterm labor prediction,which can help in the prediction of preterm labor to some extent.