宫颈机能不全患者血清炎症指标及羊水微生物检测分析

Analysis of serum inflammatory markers and amniotic fluid microbial detection in patients with cervical incompetence

目的研究宫颈口扩张、羊膜囊膨出至阴道的宫颈机能不全患者羊水微生物及外周血炎症指标情况。方法收集青岛大学附属山东省妇幼保健院2017年1月至2022年12月因宫颈口扩张、羊膜囊膨出的单胎孕妇38例(实验组),行紧急宫颈环扎之前抽取羊水行细菌病原体培养、羊水葡萄糖检测;同孕周健康孕妇44名(正常组),抽取外周血,比较两组外周血清中性粒细胞/淋巴细胞比值(NLR)、白细胞、中性粒细胞比及中性粒细胞百分比,绘制受试者工作特征曲线(ROC),根据曲线下面积(AUC)评价各项炎症指标的敏感度和特异度。结果宫颈机能不全组患者与正常组相比,中性粒细胞/淋巴细胞比值(NLR)[(5.7±3.1)vs(3.9±1.1)]、中性粒细胞比例[(78.2±6.3)%vs(71.5±9.7)%]、白细胞[(10.0±2.5)×10^(9)/L vs(8.8±1.7)×10^(9)/L]、中性粒细胞[(7.6±2.7)×10^(9)/L vs(6.4±1.4)×10^(9)/L]明显增高,差异有统计学意义(t=3.48、3.71、2.47、2.50,P<0.05)。NLR、中性粒细胞百分比、白细胞、中性粒细胞的AUC分别为0.709(95%CI:0.595~0.823)、0.769(95%CI:0.663~0.874)、0.634(95%CI:0.509~0.759)、0.645(95%CI:0.521~0.770)。与其他血清学指标相比,NLR、中性粒细胞百分比敏感度、特异度较高。紧急宫颈环扎患者羊水病原体培养为阴性。羊水葡萄糖平均值1.85 mmol/L,3例患者羊水葡萄糖值低于参考值上限0.889 mmol/L。结论宫颈口扩张、羊膜囊膨出情况下的宫颈机能不全患者与正常孕妇相比,外周血炎症指标升高。

Objective To investigate the changes of infection indices in patients with amniotic sac exposure undergoing cervical incompetence.Methods We analyzed the clinical of pregnant women in Shan⁃dong Maternal and Child Health Hospital from January 2017 to December 2022.The women were divided into emergency cervical cerclage patients with amniotic sac exposure(38 cases)and the control group(44 cases).The clinical data between the two groups were analyzed and compared.The operating characteristic curve was drew to analyze the value of these markers in the second trimester of pregnancy according to the area under the curve(AUC).Results Compared with the normal group,the neutrophil/lymphocyte ratio(NLR)[(5.7±3.1)vs(3.9±1.1)],neutrophil ratio[(78.2±6.3)%vs(71.5±9.7)%],white blood cells[(10.0±2.5)×10^(9)/L vs(8.8±1.7)×10^(9)/L],neutrophils[(7.6±2.7)×10^(9)/L vs(6.4±1.4)×10^(9)/L]significantly increased,the difference was statistically significant(t=3.48,3.71,2.47,2.50,P<0.05).The AUCs of NLR,percentage of neutrophils,white blood cells,and neutrophils were 0.709(95%CI:0.595~0.823),0.769(95%CI:0.663~0.874),and 0.634(95%CI:0.509~0.759),respectively,0.645(95%CI:0.521~0.770).Compared with other serological indicators,NLR and neutrophil percentage have higher sensitivity and specificity.The results of amniotic fluid pathogen cul⁃ture in patients with emergency cervical cerclage were negative.The average amniotic fluid glucose value was 1.85 mmol/L,and the amniotic fluid glucose value in 3 patients was lower than the upper limit of the reference val⁃ue of 0.889 mmol/L.Conclusion Compared with the normal pregnant women,the index of peripheral blood in⁃fection was higher in patients with amniotic sac exposure who undergoing emergency cervical cerclage.