细胞间粘附分子1在亚临床型绒毛膜羊膜炎诊断中的作用

The Values of the Maternal Intercellular Adhesion Molecule 1 Level for Determination of Subclinical-typed Chorioamnionitis in Premature Rupture of Membranes

目的 比较胎膜早破 (premature rupture of membranes,PROM)患者血清可溶性细胞间粘附分子 1(soluble intercellular adhesion m olecule1,s ICAM- 1)与 C-反应蛋白 (c- reactive protein,CRP)在亚临床型绒毛膜羊膜炎诊断中的作用。 方法 应用双抗体夹心酶联免疫吸附法测定 5 5例胎膜早破孕妇 [其中足月胎膜早破 (term prem ature rupture of mem brances,TPROM)者 37例 ,早产胎膜早破 (preterm premature rupture of membranes,PPROM)者 18例 ]和 2 0例正常足月孕妇血清s ICAM- 1、CRP浓度 ,并进行胎盘、胎膜病理检查 ,以组织学绒毛膜羊膜炎作为诊断的金标准。 结果 (1)胎膜早破组患者血清 s ICAM- 1、CRP浓度均显著高于正常足月孕妇 ;(2 )发生绒毛膜羊膜炎患者 ,血清 s ICAM- 1、CRP浓度均高于未发生绒毛膜羊膜炎孕妇 ;(3)血清 s ICAM- 1浓度在 PPROM组与 TPROM组相近 ,血清 CRP浓度在 PPROM却高于 TPROM组 ;(4 )以母血 s ICAM- 1≥ 10 4 .7μg/ L 作为绒毛膜羊膜炎的诊断阈值 ,其敏感性、特异性、阳性预测值、阴性预测值、Kappa指数及ROC曲线下面积分别为 10 0 %、91.2 %、87.5 %、10 0 %、0 .2 0、0 .995 ,明显优于血清 C-反应蛋白指标 ;(5 )亚临床型绒毛膜羊膜组与临床绒毛膜羊膜炎组患者比?

Objective To compare the diagnostic value of soluble intercellular adhesion molecule 1 (sICAM-1) with c-reactive protein (CRP) in serum of women with premature rupture of membranes (PROM) for detecting chorioamnionitis. Methods 55 pregnant women with term PROM including 18 pregnant women with preterm premature rupture of membranes (PPROM) and 20 normal pregnant women at term were enrolled. Maternal serum sICAM-1, CRP were measured by Sandwish enzyme-linked immunoabsorbent assay (ELISA). Chorioamnionitis was histologically confirmed after delivery. Results (1)Maternal serum levels of sICAM-1 and CRP were statistically significantly higher in women with PROM than that without it;(2)Maternal serum levels of sICAM-1 and CRP were statistically significantly higher in women with chorioamnionitis than those without it;(3)In the complicated chorioamnionitis group and in the uncomplicated with chorioamnionitis group, serum levels of sICAM-1 in PPROM women were similar with those in TPROM women, whereas serum levels of CRP in PPROM women were statistically significantly higher than those in TPROM women;(4)The sensitivity, specificity, postive predictive value, negtive predictive value, Kappa index and area under receiver operating characteristic (ROC) curve of maternal serum sICAM-1(cutoff 104.7 μg/L) and CRP(cutoff 10.3 mg/L) for diagnosing chorioamnionitis were 100%, 91.2%, 87.5%, 100%, 0.20, 0.995 and 81.0%, 73.5%, 65.4%, 86.2%, 0.13, 0.811, respectively; (5) Maternal serum levels of sICAM-1 compared with one another among mild histologic chorioamnionitis group, severe histologic chorioamnionitis group and clinical chorioamnionitis group, the difference are statistically significantly (P<0.001), the order of concentration from high level to low level was compatible to the severity of chorioamnionitis. Conclusions (1)Serum levels of sICAM-1 are determined only by infective processes and are not influenced by gestational age and labor. In terms of this characteristic, serum levels of sICAM-1 is a better biologic marker to diagnose intraamniotic infection in pregnant women with PROM;(2)Serum concentration of sICAM-1 are associated with the severity of chorioamnionitis, which can be used to direct clinical management. Monitoring dynamically serum concentration of sICAM-1 is useful for predicting fetal prognosis, which is of important value for reducing neonatal mortality and preventing late sequelae.