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目的探讨宫颈长度、胎儿纤维连接蛋白及可溶性细胞间粘附分子-1(s ICAM-1)在早产预测中的应用效果。方法2013年10月-2016年10月收集1 085例健康孕妇作为健康对照组,1 079例足月分娩孕妇作为足月分娩组,1 073例有先兆早产表现的孕妇作为早产组。对3组孕妇的宫颈长度、胎儿纤维连接蛋白及s ICAM-1水平进行检测,并对不同的指标进行两两组合以及3项指标联合检测,分析不同组合方案在早产预测方面的效果。结果早产组的宫颈长度、胎儿纤维连接蛋白及s ICAM-1水平与健康对照组、足月分娩组比较差异有统计学意义(P<0.05),宫颈长度测量结果均显著短于上述两组(P<0.05),s ICAM-1水平检测结果则显著高于上述两组(P<0.05),胎儿纤维连接蛋白阳性率显著高于上述两组(P<0.05);健康对照组与足月分娩组各项指标比较差异均无统计学意义(均P>0.05);两两组合在早产预测方面,胎儿纤维连接蛋白+s ICAM-1组合的敏感性、诊断指数以及阳性似然比最高,而3项指标联合预测的效果最佳,显著优于其他组合方式,可以达到最佳的阳性、阴性预测值。结论在早产预测中,宫颈长度、胎儿纤维连接蛋白、s ICAM-1均属于十分重要的指标,通过3者联合检测的方式可以获得更好的早产预测效果。
Objective To investigate the effect of cervical length, fetal fibronectin and soluble intercellular adhesion molecule-1 (s ICAM-1) in predicting preterm birth. Methods From October 2013 to October 2016, 1 085 healthy pregnant women were collected as healthy control group, and 1,079 pregnant women with full-term delivery were enrolled as full-term delivery group. The cervical length, fetal fibronectin and s ICAM-1 levels in 3 groups of pregnant women were detected, and the combination of different indexes and the combination of 3 indexes were used to analyze the effect of different combinations in predicting preterm labor. Results The cervical length, fetal fibronectin and s ICAM-1 levels in preterm group were significantly lower than those in healthy control group and term delivery group (P <0.05), and the results of cervical length measurement were significantly shorter than those in the two groups (P <0.05). The positive rate of s ICAM-1 in sICAM-1 was significantly higher than those in the above two groups (P <0.05), and the positive rate of fetal fibronectin was significantly higher in both healthy control group and term delivery There was no significant difference between the two groups (all P> 0.05). The sensitivity, diagnostic index and positive likelihood ratio of fetal fibronectin + sICAM-1 combination were the highest in both groups The joint prediction of the three indicators has the best effect, which is significantly better than other combinations and can achieve the best positive and negative predictive value. Conclusions Cervix length, Fetal fibronectin and s ICAM-1 are all very important indicators in preterm birth prediction. The combination of these three methods can achieve better prediction of preterm birth.