外周血CD64联合IL-6、MMP-9预测胎膜早破孕妇宫内感染中的价值

The value of peripheral blood CD64 combined with IL-6 and MMP-9 in predicting intrauterine infection in pregnant women with premature rupture of membranes

目的探讨外周血中性粒细胞(CD64)联合白介素-6(IL-6)、基质金属蛋白酶-9(MMP-9)在预测胎膜早破孕妇宫内感染中的价值,为胎膜早破孕妇宫内感染的早期诊治提供参考。方法选择2015年6月至2017年5月间本院收治的胎膜早破孕妇156例进行研究(观察组),另选取同期足月分娩孕妇65例设为对照组。观察组中早发胎膜早破66例(早发亚组),足月胎膜早破90例(足月亚组);发生宫内感染54例(感染亚组),宫内未感染102例(未感染亚组),比较各组受试者外周血CD64、IL-6、MMP-9水平,并应用受试者工作特征曲线(ROC)分析三项指标在预测胎膜早破孕妇宫内感染中的价值。结果观察组产妇的CD64、IL-6及MMP-9水平分别为(5.91±1.11)MFI、(625.63±30.78)ng/L、(299.67±53.82)ng/L,均明显高于对照组的(3.73±1.02)MFI、(313.12±21.16)ng/L、(68.87±22.67)ng/L,差异有统计学意义(P<0.05);早发亚组产妇的外周血CD64、IL-6及MMP-9水平分别为(6.81±1.06)MFI、(657.52±30.67)ng/L,(382.67±89.71)ng/L,均明显高于足月亚组的(5.13±1.02)MFI、(603.31±29.28)ng/L、(287.57±61.52)ng/L,差异有统计学意义(P<0.05);感染亚组产妇的外周血CD64、IL-6及MMP-9水平分别为(7.91±1.23)MFI、(675.22±34.28)ng/L、(421.31±69.57)ng/L,均明显高于未感染亚组的(5.02±1.03)MFI、(589.17±33.48)ng/L、(291.55±67.63)ng/L,差异有统计学意义(P<0.05)。外周血CD64、IL-6、MMP-9水平预测胎膜早破孕妇宫内感染的临界值分别为6.7 MFI、344.75 ng/L和346.20 ng/L,其AUC分别为0.887、0.796和0.830,且三项指标联合检测的AUC为0.946,约登指数为0.906,阳性预测值95.10%,阴性预测值79.63%,准确率(89.74%)、敏感性(89.81%)、特异性(89.58%),均高于单项指标预测。结论外周血CD64联合IL-6、MMP-9水平联合检测在胎膜早破孕妇宫内感染的发生中具有较高临床价值,有望成为胎膜早破及宫内感染的早期诊断指标。

Objective To investigate the predictive value of peripheral blood CD64 combined with interleukin-6(IL-6)and matrix metalloproteinase(MMP-9)in predicting intrauterine infection in in pregnant women with premature rupture of fetal membranes,and provide A reference for early diagnosis and treatment of intrauterine infection in pregnant women.Methods A total of 156 pregnant women with premature rupture of membranes were enrolled in our hospital from June 2015 to May 2017 as the observation group.In addition,65 cases of full-term pregnant women at the same period were selected as the control group.Sixty-six cases of early premature rupture of membranes were included in the study as earlyonset early-onset subgroup,90 cases of term premature rupture of membranes as full-term subgroups,and 54 cases of intrauterine infection as infection subgroups.Intrauterine infection was not found in 102 patients(set as uninfected subgroup).The levels of CD64,IL-6,and MMP-9 in the peripheral blood of the subjects were compared.The receiver operating characteristic curve(ROC)was used to analyze the three indicators for the predicting the value of intrauterine infection in premature rupture of membranes in pregnant women.Results The levels of CD64,IL-6 and MMP-9 in the observation group[(5.91±1.11)MFI,(625.63±30.78)ng/L,(299.67±53.82)ng/L],were significantly higher than those in the control group((3.73±1.02)MFI,(313.12±21.16)ng/L,(68.87±22.67)ng/L)The levels of CD64,IL-6 and MMP-9 in the women of the early-onset subgroup[(6.81±1.06)MFI,(657.52±30.67)ng/L,(382.67±89.71)ng/L],were significantly higher than those in the term group((5.13±1.02)MFI,(603.31±29.28)ng/L,(287.57±61.52)ng/L)The levels of CD64,IL-6 and MMP-9 in peripheral blood of subgroups of maternal women[(7.91±1.23)MFI,(675.22±34.28)ng/L,(421.31±69.57)ng/L],were significantly higher than those of uninfected subgroups((5.02±1.03)MFI,(589.17±33.48)ng/L,(291.55±67.63)ng/L)There was significant difference between the groups(P<0.05).The critical values of CD64,IL-6 and MMP-9 levels in peripheral blood for predicting intrauterine infection in premature rupture of membranes were 6.7 MFI,344.75 ng/L and 346.20 ng/L,respectively,and their AUC were 0.887,0.796 and 0.830,respectively.For the combined detection of the three indexes,the AUC(0.946),the Youden index(0.906),the positive predictive value(95.10%),the negative predictive value(79.63%),the accuracy rate(89.74%),sensitivity(89.81%),and specificity(89.58%)were higher than those of the individual index prediction.Conclusion The combined detection of peripheral blood CD64 combined with IL-6 and MMP-9 levels had high clinical predictive value in the occurrence of intrauterine infection in premature rupture of membranes and might be an early diagnostic indicator of premature rupture of membranes and intrauterine infection.