血清降钙素原、基质金属蛋白酶-9和可溶性细胞间黏附分子-1联合检测对绒毛膜羊膜炎的诊断价值

Diagnostic value of combined detection of serum pro-calcitonin,matrix metalloproteinase-9 and soluble intercellular adhesion molecule 1 in chorioamnionitis

目的探讨血清降钙素原(PCT)、基质金属蛋白酶-9(MMP-9)和可溶性细胞间黏附分子-1(sICAM-1)联合检测对诊断绒毛膜羊膜炎的价值。方法选取2019年3月至2021年12月于河北省优抚医院就诊的83例单胎妊娠发生胎膜早破的产妇进行回顾性研究;根据胎盘病理及患者有无绒毛膜羊膜炎临床表现将患者分为4组,即临床表现和病理诊断均符合绒毛膜羊膜炎19例患者为临床+病理组;无明显临床表现但胎盘病理诊断为绒毛膜羊膜炎患者为病理组(17例);具有一定临床表现但病理诊断为阴性的患者为临床组(20例);其余27例患者临床表现和病理诊断均为阴性,为对照组。比较各组产妇血清PCT、MMP-9和ICAM-1水平,应用Spearman相关性分析绒毛膜羊膜炎产妇血清PCT、MMP-9和ICAM-1间的相关性;应用受试者工作特征曲线(ROC)分析3种指标单独使用和联合检测对绒毛膜羊膜炎的诊断价值。结果各组产妇血清PCT、MMP-9和sICAM-1水平差异有统计学意义(F=35.907、75.807、44.363,P均<0.001)。临床+病理组产妇PCT、MMP-9和sICAM-1水平均显著高于其他3组(P均<0.001)。但病理组和临床组产妇PCT、MMP-9和sICAM-1水平差异无统计学意义(t=0.328、P=0.671,t=0.449、P=0.551,t=0.173、P=0.826)。Spearman相关性分析结果显示,绒毛膜羊膜炎产妇血清PCT与MMP-9、sICAM-1均呈正相关(r=0.420、P=0.001,r=0.343、P=0.010),血清MMP-9与sICAM-1呈显著正相关(r=0.424、P=0.001)。以胎盘病理诊断为金标准,评估血清PCT、MMP-9和sICAM-1水平对绒毛膜羊膜炎的诊断价值。PCT阈值设为61.020 pg/ml时,其特异度和灵敏度分别为87.2%和83.3%,ROC曲线下面积(AUC)为0.917(95%CI:0.825~0.955);MMP-9阈值为111.412 ng/ml时,特异度和灵敏度分别为72.3%和97.2%,AUC为0.927(95%CI:0.837~0.962);sICAM-1阈值为1149.635 ng/ml时,特异度和灵敏度分别为83.0%和86.1%,AUC为0.879(95%CI:0.798~0.902);联合检测特异度和灵敏度分别为93.1%和93.4%,AUC为0.951(95%CI:0.874~0.969),联合检测AUC较PCT、MMP-9和sICAM-1单独检测AUC差异无统计学意义(Z=0.500、P=0.617,Z=0.901、P=0.368),联合检测AUC显著高于sICAM-1单独检测AUC,差异具有统计学意义(Z=3.158、P=0.018)。结论血清PCT、MMP-9和sICAM-1联合检测辅助诊断绒毛膜羊膜炎有较好的灵敏度和特异性。

Objective To investigate the value of combined detection of serum calcitonin(PCT),matrix metalloproteinase-9(MMP-9)and soluble intercellular adhesion molecule 1(sICAM-1)in the diagnosis of chorioamnionitis.Methods From March 2019 to December 2021,a total of 83 women with premature rupture of membranes(PROM)in single pregnancy in Hebei Youfu Hospital were selected,retrospectively.According to the placental pathology and clinical manifestations of chorioamnionitis,patients were divided into four groups;19 patients with clinical and pathological findings consistent with chorioamnionitis were classified as clinical+pathological group,17 patients without obvious clinical manifestations but with placental pathology diagnosed as chorioamnionitis were classified as pathological group,20 patients with certain clinical manifestations but negative pathological diagnosis were classified as clinical group.The clinical manifestations and pathological diagnosis of the remaining 27 patients were negative,and they were enrolled in control group.The levels of serum PCT,MMP-9 and ICAM-1 among different groups of postpartum women were compared,and Spearman correlation analysis was used to analyze the correlations between serum PCT,MMP-9 and ICAM-1 among postpartum women with chorioamnionitis.The diagnostic value of chorioamnionitis of the three indicators alone and combination were analyzed by receiver operating characteristic curve(ROC).Results There were significant differences in the levels of serum PCT,MMP-9 and sICAM-1 in each group of postpartum women(F=35.907,75.807,44.363,all P<0.001).The levels of PCT,MMP-9 and sICAM-1 in the clinical+pathological group were significantly higher than those of the other three groups(all P<0.001).However,there was no significant difference in the levels of PCT,MMP-9 and sICAM-1 between pathological group and clinical group(t=0.328,P=0.671;t=0.449,P=0.551;t=0.173,P=0.826).Spearman correlation analysis showed that serum PCT of cases with chorioamnionitis was positively correlated with MMP-9 and sICAM-1(r=0.420,P=0.001;r=0.343,P=0.010),while serum MMP-9 was positively correlated with sICAM-1(r=0.424,P=0.001),both with significant differences.The diagnostic values of serum PCT,MMP-9 and sICAM-1 levels for chorioamnionitis were analyzed by diagnosing placental pathology as the gold standard.When the PCT threshold was 61.020 pg/ml,its specificity and sensitivity were 87.2%and 83.3%,respectively,and the AUC was 0.917(95%CI:0.825-0.955);When the MMP-9 threshold was 111.412 ng/ml,the specificity and sensitivity were 72.3%and 97.2%,respectively,and the AUC was 0.927(95%CI:0.837-0.962);When the sICAM-1 threshold was 1149.635 ng/ml,the specificity and sensitivity were 83.0%and 86.1%,respectively,and the AUC was 0.879(95%CI:0.798-0.902).The specificity and sensitivity of the combined detection of the above three indicators were 93.1%and 93.4%,respectively,with the AUC of 0.951(95%CI:0.874-0.969).The combined detection of AUC showed no significant difference compared with PCT and MMP-9 alone(Z=0.500,P=0.617;Z=0.901,P=0.368).The combined detection of AUC was significantly higher than that of sICAM-1 alone(Z=3.158,P=0.018).Conclusions Combined detection of serum PCT,MMP-9 and sICAM-1 has good sensitivity and specificity in assisting in diagnosis of chorioamnionitis.