血清β-HCG hs-CRP IL-6联合检测对胎膜早破合并宫内感染的诊断价值分析
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摘要
目的:分析血清人绒毛膜促性腺激素(β-HCG)、超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)联合检测对胎膜早破合并宫内感染的诊断价值。方法:我院2016年6月至2017年6月期间确诊的82例胎膜早破孕妇根据胎膜组织学诊断是否发生宫内感染分为感染组和对照组,抽取两组孕妇空腹静脉血标本,检测血清β-HCG、hs-CRP、IL-6水平,并按照受试者工作特征(ROC)曲线确定三项血清指标的临界值,据此对所有患者进行宫内感染预测和诊断。结果:本组82例胎膜早破孕妇中,38例(46.34%)发生宫内感染,包括轻度感染15例、中度感染15例、重度感染8例。与对照组孕妇相比,感染组孕妇血清β-HCG、hs-CRP、IL-6水平显著高(P<0.05)。血清β-HCG、hs-CRP、IL-6水平比较,宫内轻度感染孕妇<中度感染孕妇<重度感染孕妇(P<0.05)。根据ROC曲线确定血清β-HCG、hs-CRP、IL-6水平的诊断临界值分别为3.32ng/mL、4.09mg/L、14.15mg/L,此三项血清指标联合诊断胎膜早破合并宫内感染的灵敏度、特异度、准确性分别达到92.11%、90.91%、91.46%,均高于其任意一项单独诊断。结论:胎膜早破合并宫内感染孕妇血清β-HCG、hs-CRP、IL-6水平明显高于未感染孕妇,且与感染严重程度密切相关,三项联合检测有助于提高胎膜早破合并宫内感染的诊断效能。
Objective:To analyze the diagnostic value of combined detection of serum human chorionic gonadotropin(β-HCG),high-sensitivity C-reactive protein(hs-CRP) and interleukin-6(IL-6) for premature rupture of membranes with intrauterine infection.Methods:82 pregnant women with premature rupture of membranes diagnosed in the hospital from June 2016 to June 2017 were divided into the infected group and the control group according to the presence of intrauterine infection.The fasting venous blood samples of both groups were collected to detect levels of serum β-HCG,hs-CRP and IL-6.The critical values of the three serum indicators were determined according to the receiver operating characteristic(ROC) curve.Prediction and diagnosed of intrauterine infection were performed.Results:Of the 82 pregnant women with premature rupture of membranes,38 cases(46.34%) had intrauterine infection,including 15 cases of mild infection,15 cases of moderate infection and 8 cases of severe infection.Compared with the control group,levels of serum β-HCG,hs-CRP and IL-6 were significantly higher in the infected group(P <0.05).Levels of serum β-HCG,hs-CRP and IL-6 showed pregnant women with mild intrauterine infection < moderate infection < sever infection(P <0.05).According to the ROC curves,the diagnostic thresholds of serum β-HCG,hs-CRP and IL-6 were 3.32 ng/mL,4.09 mg/L and 14.15 mg/L,respectively.The sensitivity,specificity and accuracy of combined detection of the three serum indicators in diagnosis of intrauterine infection were 92.11%,90.91%and 91.46%,respectively,higher than those any indicator alone(P <0.05).Conclusion:The levels of serumβ-HCG,hs-CRP and IL-6 are significantly higher in pregnant women with premature rupture of membranes and intrauterine infection than in uninfected pregnant women,and they are closely related to the severity of infection.Combined detection of the three serum indicators can improve the diagnostic efficiency for premature rupture of membranes with intrauterine infection.
Objective:To analyze the diagnostic value of combined detection of serum human chorionic gonadotropin(β-HCG),high-sensitivity C-reactive protein(hs-CRP) and interleukin-6(IL-6) for premature rupture of membranes with intrauterine infection.Methods:82 pregnant women with premature rupture of membranes diagnosed in the hospital from June 2016 to June 2017 were divided into the infected group and the control group according to the presence of intrauterine infection.The fasting venous blood samples of both groups were collected to detect levels of serum β-HCG,hs-CRP and IL-6.The critical values of the three serum indicators were determined according to the receiver operating characteristic(ROC) curve.Prediction and diagnosed of intrauterine infection were performed.Results:Of the 82 pregnant women with premature rupture of membranes,38 cases(46.34%) had intrauterine infection,including 15 cases of mild infection,15 cases of moderate infection and 8 cases of severe infection.Compared with the control group,levels of serum β-HCG,hs-CRP and IL-6 were significantly higher in the infected group(P <0.05).Levels of serum β-HCG,hs-CRP and IL-6 showed pregnant women with mild intrauterine infection < moderate infection < sever infection(P <0.05).According to the ROC curves,the diagnostic thresholds of serum β-HCG,hs-CRP and IL-6 were 3.32 ng/mL,4.09 mg/L and 14.15 mg/L,respectively.The sensitivity,specificity and accuracy of combined detection of the three serum indicators in diagnosis of intrauterine infection were 92.11%,90.91%and 91.46%,respectively,higher than those any indicator alone(P <0.05).Conclusion:The levels of serumβ-HCG,hs-CRP and IL-6 are significantly higher in pregnant women with premature rupture of membranes and intrauterine infection than in uninfected pregnant women,and they are closely related to the severity of infection.Combined detection of the three serum indicators can improve the diagnostic efficiency for premature rupture of membranes with intrauterine infection.
引文
[1]杨碧玉,张国琼.C反应蛋白白细胞介素-6及白细胞计数在足月胎膜早破宫内感染中的意义[J].河北医学,2016,22(2):264~266.
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[8]Li K,Yu H,Wang X,et al.Predictive value of procalcitonin or c-reactive protein for subclinical intrauterine infection in patients with premature rupture of membranes(PROM).[J].Prenat Med,2016,10(4):23~28.
[9]李惠芬,章艳,楼霞,等.hs-CRP与CRP预测胎膜早破早产儿宫内感染的价值研究[J].中华医院感染学杂志,2018,28(2):257~260.
[2]席红,梁春娇,张薇,等.胎膜早破后羊水残余量与宫内感染对新生儿预后的影响[J].中国妇幼保健,2017,32(14):3211~3213.
[3]吴翼君,余静,管利荣.CRP以及PCT检测应用于胎膜早破新生儿细菌感染的诊断意义[J].标记免疫分析与临床,2015,22(7):640.
[4]谢幸,苟文丽.妇产科学[M].第8版.北京:人民卫生出版社,2013.138~139.
[5]孙晓霞,张兆波,张玉枝,等.血清β-HCG,hs CRP及CRP检测对胎膜早破宫内感染的诊断价值[J].现代生物医学进展,2016,16(22):4363~4366.
[6]Atalay E,Cenk G,Cuneyt Eftal T,et al.The effect of associated structural malformations in the prediction of chromosomal abnormality risk of fetuses with echogenic bowel[J].Journal of Maternal-Fetal Medicine,2014,29(1):41~45.
[7]刘雪彩,陈月花,张桂英,等.胎膜早破对妊娠结局的影响[J].宁夏医科大学学报,2016,38(2):200~202.
[8]Li K,Yu H,Wang X,et al.Predictive value of procalcitonin or c-reactive protein for subclinical intrauterine infection in patients with premature rupture of membranes(PROM).[J].Prenat Med,2016,10(4):23~28.
[9]李惠芬,章艳,楼霞,等.hs-CRP与CRP预测胎膜早破早产儿宫内感染的价值研究[J].中华医院感染学杂志,2018,28(2):257~260.