胎儿纤维连接蛋白在预测复发性流产患者早期妊娠胚胎丢失中的作用

摘要

Objective To discuss the clinical value of fetal fibronectin when predicting the first-trimester fatal loss in recurrent miscarriage.Methods We measured fetal fibronectin concentrations in cervical and vaginal secretions in 84 cases of recurrent miscarriage admitted in our hospital from 2008 to 2011 as observation group.And we also tested it in 31 uncomplicated pregnant women.Tests were given in first-trimester.Age and previous miscarriage number were also compared.Follow-up was given till 14 weeks of pregnancy.Results In observation group,57.14％ of patients were tested by positive fFN results,while in control group,the percentage reduced to 12.90％.It had statistical significant difference (P ＜ 0.01).In positive fFN patients,29.17％ leaded to fatal loss in observation group,while 8.33％ in control group (P ＜ 0.05).The sensitivity and accuracy for predicting miscarriage by fFN test in recurrent miscarriage in first-trimester were 82.35％ and 49.25％.Positive fFN could be found more in women over 35 years old and in women under age of 35 years.Conclusion The presence of cervicovaginal fetal fibronectin in the second and third trimesters of pregnancy identifies a subgroup of women who are at high risk of recurrent miscarriage.The measure of cervical fetal fibronectin had great sensitivity in first-trimester to predict the fatal loss,particularly for women aged over 35 years.%目的 探讨检测胎儿纤维连接蛋白(fetal fibronectin,fFN)在预测复发性流产患者早期妊娠胚胎丢失中的临床价值.方法 分析2008年至2011年就诊于我院有复发性流产史的早期妊娠患者84例作为实验组,另选取31例正常早期妊娠者作为对照组.两组均行fFN检测,并追踪随访至妊娠14周,记录妊娠结局.结果 两组患者年龄、孕龄、孕次相比较无统计学差异(P＞0.05).实验组fFN阳性率为57.14％,明显高于对照组的12.90％,差异有统计学意义(P＜0.01).实验组本次妊娠结局为自然流产者共17例,发生率为20.24％,对照组3例发生自然流产,发生率为9.68％,差异无统计学意义.实验组fFN(+)患者流产发生率为29.17％,fFN(-)患者流产发生率仅为8.33％(3/36),差异有统计学意义(P＜0.05).实验组fFN阳性预测流产发生的敏感性、特异性分别为82.35％、49.25％.复发性自然流产患者中,年龄在36 ～ 39岁的患者,fFN阳性率、流产率均高于35岁以下的患者.结论 在早期妊娠阶段,复发性自然流产患者进行fFN检测,预测流产的敏感性高,有助于评估安胎结局.在临床工作中,应加强高龄复发性流产患者的监测.