目的:探讨宫颈分泌物中高磷酸化胰岛素样生长因子结合蛋白-1(ph IGFBP-1)检测及腹部超声检测宫颈长度(CL)在预测早产方面的临床价值。方法:对120例孕检诊断为早产高危风险的孕妇进行宫颈分泌物ph IGFBP-1及CL检测,并做好记录,根据妊娠结局分为早产组(30例)和正常组(88例),其中有2例与妊娠28周前自然流产,分别计算ph IGFBP-1、CL及二者联合应用预测早产的相关诊断学评价指标。结果:早产30例、正常分娩88例、2例于妊娠28周之前分别自然流产。早产的主要因素分布分为胎膜早破14例、多胎妊娠3例、贫血4例、胎儿窘迫3例、子宫因素3例、其他原因3例。早产组的CL(3.28±0.49)cm显著低于正常组的(3.94±0.55)cm,ph IGFBP-1阳性率60.00%显著高于正常组的6.82%(P<0.05)。CL预测早产的灵敏度86.67%,特异度79.55%,误诊率20.45%,漏诊率13.33%,阳性预测值59.09%,阴性预测值94.59%,ROC曲线下面积Az=0.818。ph IGFBP-1阳性预测早产的灵敏度60.00%,特异度93.18%,误诊率6.82%,漏诊率40.00%,阳性预测值75.00%,阴性预测值87.23%,ROC曲线下面积Az=0.809。CL+ph IGFBP-1阳性预测早产的灵敏度93.33%,特异度95.45%,误诊率4.55%,漏诊率6.67%,阳性预测值87.5%,阴性预测值97.67%,ROC曲线下面积Az=0.906。结论:CL+ph IGFBP-1阳性对早产预测的灵敏度、特异度、阳性预测值、Az值均较二者单独应用时显著提高,将二者联合应用于临床早产预测能够提高预测的准确性。 Objective: To investigate the clinical value of ph IGFBP-1 in detecting cervical secretion and cervical length (CL) by abdominal ultrasonography in predicting preterm birth. Methods: 120 cases of pregnant women who were diagnosed as high risk of preterm birth were examined by ph IGFBP-1 and CL in cervical secretions. According to pregnancy outcome, they were divided into preterm group (30 cases) and normal group (88 cases) Two of them were spontaneous abortion 28 weeks before gestation, and the relative diagnostic evaluation indexes of ph IGFBP-1, CL and their combination prediction of preterm labor were calculated respectively. Results: There were 30 cases of premature delivery, 88 cases of normal delivery and 2 cases of spontaneous abortion before 28 weeks gestation respectively. The main factors of premature delivery were divided into 14 cases of premature rupture of membranes, 3 cases of multiple pregnancies, 4 cases of anemia, 3 cases of fetal distress, uterine factors in 3 cases, 3 cases of other reasons. CL (3.28 ± 0.49) cm in preterm group was significantly lower than that in normal group (3.94 ± 0.55) cm, ph IGFBP-1 positive rate was 60.00%, significantly higher than that in normal group (6.82%, P <0.05). The sensitivity of CL predictive preterm labor was 86.67%, specificity was 79.55%, misdiagnosis rate was 20.45%, misdiagnosis rate was 13.33%, positive predictive value was 59.09%, negative predictive value was 94.59% and area under ROC curve was 0.818. The sensitivity, specificity and accuracy of IGFBP-1 positive predictive preterm labor were 60.00%, 93.18%, 6.82%, 40.00% respectively. The positive predictive value was 75.00% and the negative predictive value was 87.23%. The area under the ROC curve was 0.809. The positive predictive value of CL + ph IGFBP-1 for preterm delivery was 93.33%, specificity was 95.45%, misdiagnosis rate was 4.55%, misdiagnosis rate was 6.67%, positive predictive value was 87.5%, negative predictive value was 97.67%, and area under ROC curve was 0.906. CONCLUSION: The sensitivity, specificity, positive predictive value and Az value of CL + ph IGFBP-1 positive predictive value for preterm birth are significantly higher than those of the two alone. The combined application of the two in predicting premature labor can improve the predictive accuracy.