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目的探讨联合检测PPROM孕妇PCT、IL-6、CRP水平的变化在早期诊断宫内感染、发现绒毛膜羊膜炎以及新生儿败血症临床价值。方法选择PPROM孕妇100例作为研究组,同期同孕周的正常孕妇80例作为对照组,检测两组孕妇外周血、分娩时脐血PCT、IL-6、CRP水平;PPROM孕妇分娩后对胎盘胎膜行病理学检查,追踪新生儿感染情况。结果研究组孕妇外周血中PCT、IL-6、CRP表达均明显高于对照组,差异有统计学意义(P<0.01);研究组中有组织学绒毛膜羊膜炎63例,无绒毛膜羊膜炎37例,两组孕妇外周血PCT、IL-6及CRP浓度比较差异均有统计学意义(P<0.01),但非绒毛膜羊膜炎组与对照组比较差异无统计学意义(P>0.05)。PCT、IL-6、CRP各自诊断绒毛膜羊膜炎的敏感性一般,特异性、阳性预测值及阴性预测值均较低,但三者同时阳性诊断绒毛膜羊膜炎的敏感性、特异性及阳性预测值分别为65.08%、94.59%、95.35%。脐血PCT、IL-6、CRP水平在败血症新生儿中显著升高,与新生儿肺炎组、非感染组及对照组新生儿比较差异均有统计学意义(P<0.01)。结论 PPROM孕妇外周血中PCT、IL-6、CRP浓度升高,三者同时阳性预测绒毛膜羊膜炎的价值高,脐血中PCT、IL-6、CRP水平有利于早期诊断新生儿败血症情况。
Objective To investigate the changes of PCT, IL-6 and CRP levels in pregnant women with combined PPROM test in the early diagnosis of intrauterine infection and the clinical value of chorioamnionitis and neonatal sepsis. Methods 100 pregnant women with PPROM were selected as the study group, and 80 normal pregnant women in the same gestational week were used as the control group. The levels of PCT, IL-6 and CRP in umbilical cord blood of two pregnant women were measured. Membrane pathology examination, tracking of neonatal infections. Results The expression of PCT, IL-6 and CRP in peripheral blood of pregnant women were significantly higher than that of the control group (P <0.01). There were 63 cases of histological chorioamnionitis and no chorioamnion There were significant differences in the levels of PCT, IL-6 and CRP between the two groups (P <0.01), but there was no significant difference between the non-chorioamniaticitis group and the control group (P> 0.05 ). Sensitivity, specificity, positive predictive value and negative predictive value of PCT, IL-6 and CRP in diagnosis of chorioamnionitis were lower, but the sensitivity, specificity and positive diagnosis of chorioamnionitis were all positive The predicted values were 65.08%, 94.59% and 95.35% respectively. The levels of PCT, IL-6 and CRP in umbilical cord blood increased significantly in neonates with sepsis, which were significantly different from those in neonates with neonatal pneumonia, non-infected and control (P <0.01). Conclusion The levels of PCT, IL-6 and CRP in peripheral blood of PPROM pregnant women are higher than those in normal pregnant women. Simultaneous positive predictive values for chorioamnionitis are high, and the levels of PCT, IL-6 and CRP in umbilical cord blood are favorable for the early diagnosis of neonatal sepsis.