宫颈结构变化与可溶性细胞粘附分子-1水平对早产预测价值的临床研究

摘要

目的：研究宫颈结构变化与可溶性细胞粘附分子-1水平（sICAM -1）对早产预测的价值。方法选取有先兆早产表现孕妇120例进入研究，并选取无先兆早产表现的孕妇80例作为正常对照组进入研究。所有孕妇均行超声检查宫颈结构变化以及用酶联免疫吸附法检测血清 sICAM -1水平。分析宫颈结构变化和 sICAM -1水平与早产之间的关系。结果①根据分娩结局把有先兆早产表现120例孕妇分为足月分娩组59例和早产组61例。②早产组宫颈长度和 sICAM -1水平分别为（28.45±1.9）mm 和（348.32±31.45）ng/ ml，宫颈漏斗形成率和宫颈指数分别为60.66℅和（0.82±0.04）。早产组宫颈长度小于足月分娩组和正常对照组（均 P ﹤0.01），而宫颈漏斗发生率、宫颈指数及血清sICAM -1水平均分别高于足月分娩组和正常对照组（均 P ﹤0.01）。③ROC 曲线分析示，宫颈长度和 sICAM -1的 cut-off 值分别为29.3 mm 和390.1 ng/ ml，曲线下的面积分别为0.84和0.79。④以宫颈长度29.3 mm 和血清 sICAM -1水平390.1 ng/ ml 为临界点，联合二者行平行试验，预测早产的灵敏度、特异度、阳性预测值和阴性预测值均在90℅以上， Youden 指数为0.88，阳性似然比和阴性似然比分别为13.07和0.05。结论宫颈漏斗形成可能增加早产的风险。宫颈长度和血清 sICAM -1水平二者联合检测能有效预测早产。%Objective To study the value of the cervical structural changes and soluble cell adhesion molecule - 1(sICAM - 1)in the prediction of premature delivery. Methods 120 pregnant women with threatened premature delivery were studied. 80 pregnant women with no signs of premature delivery were selected as the normal control group. All pregnant women were observed the cervical structure changes by ultra-sound. The serum sICAM - 1 levels were detected by enzyme - linked immunosorbent assay. The relationship between the changes of cervical structure and the levels of sICAM - 1 in serum with premature delivery were analyzed. Results ①120 cases with threatened premature delivery were divided into premature labor group(59 cases)and term labor group(61 cases)according to the outcome of labor. ②In premature labor group, the cervical length and sICAM - 1 level was(28. 45 ± 1. 9)mm and(348. 32 ± 31. 45)ng/ ml respectively. The incidence rate of cervix infundib-ulum and cervical index was 60. 66℅ and(0. 82 ± 0. 04)respectively. The cervical length of premature labor group was smaller than that of term labor group and normal control group( P ﹤ 0. 01). The incidence rate of cervix infundibulum,the cervical index and sICAM - 1 level was higher than that of the normal control group( P ﹤ 0. 01). ③The ROC curve showed that cutoff value of cervical length and sICAM - 1 level was 29. 3 mm and 390. 1 ng/ ml respectively,the area under the curve was 0. 84 and 0. 79,respectively. ④ In parallel test of cervical length combined with sICAM - 1 level when their critical point was 29. 3 mm and 390. 1 ng/ ml respectively,the sensitivity,specificity,positive predictive value and negative predictive value of the prediction of premature delivery was more than 90℅ ,Youden index was 0. 88,positive likelihood ratio and negative likelihood ratio was 13. 07 and 0. 05 respectively. Conclusion The formation of cervix infundibulum may increase the risk of premature birth. The combination of cervical length and sICAM - 1 level can effectively predict premature delivery.