The Values of the Maternal Intercellular Adhesion Molecule 1 Level for Determination of Subclinical-typed Chorioamnionitis in Premature Rupture of Membranes
- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF PERINATAL MEDICINE
- Issue:
- 4
- DOI:
- 10.3760/cma.j.issn.1007-9408.2003.04.004
- Key Word:
- 胞间粘附分子1;绒毛膜羊膜炎;诊断
Abstract： 目的比较胎膜早破(premature rupture of membranes, PROM)患者血清可溶性细胞间粘附分子1(soluble intercellular adhesion molecule 1,sICAM-1)与C-反应蛋白(c-reactive protein,CRP)在亚临床型绒毛膜羊膜炎诊断中的作用. 方法应用双抗体夹心酶联免疫吸附法测定55例胎膜早破孕妇[其中足月胎膜早破(term premature rupture of membrances,TPROM)者37例,早产胎膜早破(preterm premature rupture of membranes, PPROM)者18例]和20例正常足月孕妇血清sICAM-1、CRP浓度,并进行胎盘、胎膜病理检查,以组织学绒毛膜羊膜炎作为诊断的金标准. 结果 (1)胎膜早破组患者血清sICAM-1、CRP浓度均显著高于正常足月孕妇;(2)发生绒毛膜羊膜炎患者, 血清sICAM-1、CRP浓度均高于未发生绒毛膜羊膜炎孕妇;(3)血清sICAM-1浓度在PPROM组与TPROM组相近,血清CRP浓度在PPROM却高于TPROM组;(4)以母血sICAM-1≥104.7 μg/L作为绒毛膜羊膜炎的诊断阈值,其敏感性、特异性、阳性预测值、阴性预测值、Kappa 指数及ROC曲线下面积分别为100%、91.2%、87.5%、100%、0.20、0.995,明显优于血清C-反应蛋白指标;(5)亚临床型绒毛膜羊膜组与临床绒毛膜羊膜炎组患者比较,血清sICAM-1浓度差异有显著意义(P<0.001),浓度高低顺序与绒毛膜羊膜炎的分型有良好的依从性. 结论 (1)血清sICAM-1浓度不受孕龄和临产发动影响,是早期诊断羊膜腔感染的较好的生物学指标;(2)血清sICAM-1浓度与绒毛膜羊膜炎分型密切相关可用于指导临床处理;(3)监测血清sICAM-1浓度可能有助于预测胎儿预后,对降低新生儿死亡率和预防远期并发症有一定价值.
- [1]赵欣.早产与胎膜早破[J].2001,(1).
- [2]尹利荣,刘映,马鸿达.过期与延期妊娠胎盘形态学变化及其与妊娠结局的关系[J].1998,(7).
- [3]JAN LAURIN,KAREL MARŠÁL,PER HÅKAN PERSSON,etc.Ultrasound measurement of fetal blood flow in predicting fetal outcome[J].1987,94(10).
- [4]朱晴晖,章谷生.细胞粘附分子的家族、临床意义和检测[J].1995,(3).
- [5]C M, Salafia,N, Haynes,V J, Merluzzi,etc.Distribution of ICAM-1 within decidua and placenta and its gestational age-associated changes.[J].1900,11(3).
- [6]Niederhut A,Solbach C,Kaufmann M,etc.Cytokine release from placental endothelial cells, a process associated with preterm labour in the absence of intrauterine infection.[J].1999,11(1).
- [7]R L, Naeye,E C, Peters.Causes and consequences of premature rupture of fetal membranes.[J].1980,1.
- [8]D K, Richardson,J S, Schwartz,P J, Weinbaum,etc.Diagnostic tests in obstetrics: a method for improved evaluation.[J].1985,152.
- [9]P.Gareth R. Seaward,Mary E. Hannah,Terri L. Myhr,etc.International Multicenter Term PROM Study: Evaluation of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term[J].1998,179(3).
- [10]R, Seth,F D, Raymond,M W, Makgoba.Circulating ICAM-1 isoforms: diagnostic prospects for inflammatory and immune disorders.[J].1991,338.
- [11]S G, Lencki,M B, Maciulla,G S, Eglinton.Maternal and umbilical cord serum interleukin levels in preterm labor with clinical chorioamnionitis.[J].1994,170.
- [12]Keelan JA.,Sato TA.,McCowan LME.,etc.Expression of intercellular adhesion molecule-1 (ICAM-1) in choriodeciduawith labour and delivery at term and preterm[J].1999,11(4).