胎膜早破合并羊膜腔感染危险因素调查

Analysis of risk factors for premature rupture of membranes combined with amniotic cavity infection

目的 探讨胎膜早破合并羊膜腔感染的危险因素,并分析血清白细胞介素-6(IL-6)和降钙素原(PCT)水平在诊断中的价值。方法 选取于本院确诊为胎膜早破的孕妇156例,根据是否合并羊膜腔感染分为感染组和非感染组。收集两组孕妇的临床资料,并检测其血清IL-6、PCT水平。采用统计学方法分析胎膜早破合并羊膜腔感染的危险因素,并评估血清IL-6、PCT水平在诊断中的敏感性、特异性。结果 156例胎膜早破患者中,59例并发羊膜腔感染,感染率37.82%。其中,49例合并下生殖道感染(83.05%),包括细菌性阴道病(20.34%)、解脲支原体(10.17%)、沙眼衣原体(18.64%)、B族链球菌(5.08%)、假丝酵母菌病(15.25%)及混合感染(13.56%)。未并发羊膜腔感染者中,42例合并下生殖道感染(43.30%),包括细菌性阴道病(8.25%)、解脲支原体(9.28%)、沙眼衣原体(6.19%)、B族链球菌(4.12%)、假丝酵母菌病(11.34%)及混合感染(4.12%)。两组比较,下生殖道总感染率及细菌性阴道病、沙眼衣原体、混合感染感染率差异显著(P<0.05)。对比分析胎膜早破并发羊膜腔感染的患者与未感染患者临床资料,单变量分析显示子宫畸形、阴道清洁度、多胎妊娠、妊娠期糖尿病合并症以及羊水过少等因素差异有统计学意义(P<0.05),年龄、孕前BMI、孕次、宫颈手术史、剖宫产史和人流史差异无统计学意义(P>0.05)。进一步进行多变量分析发现,阴道清洁度Ⅲ~Ⅳ度、妊娠期糖尿病合并症以及羊水过少是导致胎膜早破并发羊膜腔感染的独立风险因素(P<0.05)。在研究的59例合并羊膜腔感染的患者中,23例表现为轻度感染,20例为中度感染,16例为重度感染。在未感染的对照组中,患者的血清IL-6水平为(4.20±1.79)μg/L,轻度感染组为(6.76±1.91)μg/L,中度感染组为(9.64±2.57)μg/L,重度感染组则为(14.18±4.05)μg/L。未感染组的血清PCT水平为(5.27±1.56)μg/L,轻度感染组为(8.45±1.98)μg/L,中度感染组为(12.64±3.33)μg/L,重度感染组为(18.50±7.72)μg/L。不同分组患者血清IL-6和PCT水平差异有统计学意义(P<0.05)。ROC曲线分析显示,血清IL-6的曲线下面积(AUC)为0.934,最佳截断值为5.35μg/L,其敏感度为93.2%,特异性为80.4%;血清PCT的AUC为0.964,最佳截断值为7.74μg/L,敏感度为89.8%,特异性为93.8%。联合诊断的AUC为0.987,敏感度为96.6%,特异性为94.8%。结论 胎膜早破合并羊膜腔感染的危险因素包括阴道清洁度、妊娠期糖尿病合并症以及羊水过少。血清IL-6、PCT水平在诊断胎膜早破合并羊膜腔感染中具有较高的敏感性和特异性,可作为临床诊断的重要参考指标。

Objective To explore the risk factors of premature rupture of membranes combined with amniotic cavity infection,and analyze the value of serum interleukin-6(IL-6)and procalcitonin(PCT)levels in diagnosis.Methods A total of 156 pregnant women diagnosed with premature rupture of membranes in our hospital were selected and divided into an infected group and a non-infected group according to whether they were combined with amniotic cavity infection.The clinical data of pregnant women in the two groups were collected,and their serum levels of interleukin-6(IL-6)and procalcitonin(PCT)were detected.Statistical methods were used to analyze the risk factors of premature rupture of membranes combined with amniotic cavity infection,and to evaluate the sensitivity and specificity of serum IL-6 and PCT levels in diagnosis.Results Among 156 patients with premature rupture of membranes,59 cases had concurrent amniotic cavity infection,with an infection rate of 37.82%.Among them,49 cases had lower genital tract infections(83.05%),including bacterial vaginosis(20.34%),Ureaplasma urealyticum(10.17%),Chlamydia trachomatis(18.64%),group B Streptococcus(5.08%),Candidiasis(15.25%)and mixed infections(13.56%).Among those without concurrent amniotic cavity infection,42 cases had lower genital tract infections(43.30%),including bacterial vaginosis(8.25%),U.urealyticum(9.28%),C.trachomatis(6.19%),group B Streptococcus(4.12%),Candidiasis(11.34%)and mixed infections(4.12%).Comparing the two groups,there were significant differences in the total infection rate of the lower genital tract and the infection rates of bacterial vaginosis,Chlamydia trachomatis,and mixed infections(P<0.05).When comparing and analyzing the clinical data of patients with premature rupture of membranes complicated with amniotic cavity infection and those without infection,univariate analysis showed that there were statistically significant differences in factors such as uterine malformation,vaginal cleanliness,multiple pregnancies,gestational diabetes complications,and oligohydramnios(P<0.05).Age,pre-pregnancy BMI,pregnancy times,history of cervical surgery,history of cesarean section,and history of induced abortion did not show statistically significant differences(P>0.05).Further multivariate analysis of that vaginal cleanliness of grade III to IV,gestational diabetes complications,and oligohydramnios were independent risk factors for premature rupture of membranes complicated with amniotic cavity infection(P<0.05).Among the 59 patients with amniotic cavity infection in the study,23 cases showed mild infection,20 cases were moderately infected,and 16 cases were severely infected.In the uninfected control group,the serum IL-6 level of patients was(4.20±1.79)μg/L,in the mild infection group it was(6.76±1.91)μg/L,in the moderate infection group it was(9.64±2.57)μg/L,and in the severe infection group it was(14.18±4.05)μg/L.The serum PCT level in the uninfected group was(5.27±1.56)μg/L,in the mild infection group it was(8.45±1.98)μg/L,in the moderate infection group it was(12.64±3.33)μg/L,and in the severe infection group it was(18.50±7.72)μg/L.There were statistically significant differences in serum IL-6 and PCT levels among patients in different groups(P<0.05).ROC curve analysis showed that:the area under the curve(AUC)of serum IL-6 was 0.934,the optimal cut-off value was 5.35μg/L,its sensitivity was 93.2%,and its specificity was 80.4%;the AUC of serum PCT was 0.964,the optimal cut-off value was 7.74μg/L,the sensitivity was 89.8%,and the specificity was 93.8%.The AUC of combined diagnosis was 0.987,the sensitivity was 96.6%,and the specificity was 94.8%.Conclusion The risk factors for premature rupture of membranes combined with amniotic cavity infection included vaginal cleanliness,gestational diabetes complications and oligohydramnios.Serum IL-6 and PCT levels had high sensitivity and specificity in the diagnosis of premature rupture of membranes combined with amniotic cavity infection and can be used as important reference indicators for clinical diagnosis.