2020 年第 9 期 第 15 卷

联合检测血清肾上腺髓质素前体和降钙素原及C反应蛋白对未足月胎膜早破合并绒毛膜羊膜炎的早期诊断及病情评估价值

Diagnostic value of joint detection of serum proadrenomedullin, procalcitonin and C-reactive protein for preterm premature rupture of membranes complicated with chorioamnionitis

作者：夏书琴1哈斯图雅1刘晓敏1贾海琴2王静媛3

英文作者：Xia Shuqin1 Hasituya1 Liu Xiaomin1 Jia Haiqin2 Wang Jingyuan3

单位：1内蒙古自治区人民医院妇产科，呼和浩特010017；2内蒙古自治区人民医院检验科，呼和浩特010017；3内蒙古自治区人民医院病理科，呼和浩特010017

英文单位：1Department of Obstetrics and Gynecology Inner Mongolia People′s Hospital Huhhot 010017 China; 2Department of Laboratory Medicine Inner Mongolia People′s Hospital Huhhot 010017 China; 3Department of Pathology Inner Mongolia People′s Hospital Huhhot 010017 China

关键词：未足月胎膜早破；绒毛膜羊膜炎；肾上腺髓质素前体；降钙素原；C反应蛋白

英文关键词：Pretermprematureruptureofmembranes;Chorioamnionitis;Proadrenomedullin;Procalcitonin;C-reactiveprotein

• 摘要：

• 目的 探讨联合检测血清肾上腺髓质素前体(pro-ADM)、降钙素原、C反应蛋白（CRP）对未足月胎膜早破合并绒毛膜羊膜炎的早期诊断及病情评估价值。方法 选取2016年1月至2018年4月内蒙古自治区人民医院收治的孕28～34＋6周的胎膜早破单胎产妇83例为观察组，根据术后病理结果分为胎膜早破无绒毛膜羊膜炎组（观察组A，40例）和胎膜早破合并绒毛膜羊膜炎组（观察组B，43例）；选取同期无胎膜早破的健康待产产妇为对照组（30例）。比较3组产妇血清pro-ADM、降钙素原及CRP检测水平，并比较观察组B不同严重程度绒毛膜羊膜炎患者的检测结果差异。观察绒毛膜羊膜炎对母儿结局的影响。结果 观察组A的pro-ADM和CRP水平明显高于对照组，观察组B的pro-ADM、降钙素原、CRP水平均明显高于观察组A和对照组［（1.71±0.52）nmol/L比（0.57±0.18）、（0.22±0.10）nmol/L， （1.07±0.35）μg/L比（0.45±0.22）、（0.41±0.17）μg/L， （14.7±12.6）mg/L比（6.5±1.3）、（3.7±1.6）mg/L］，差异均有统计学意义（均P＜0.01）。观察组B随绒毛膜羊膜炎病情程度加重，各项检测指标均逐渐增加，Ⅱ级（14例）、Ⅲ级（10例）产妇pro-ADM、降钙素原、CRP水平均明显高于Ⅰ级（19例），Ⅲ级产妇CRP水平明显高于Ⅱ级，差异均有统计学意义（均P＜0.01）。观察组B产妇产后出血、产褥感染以及新生儿窒息、新生儿感染发生率均明显高于观察组A，差异均有统计学意义（均P＜0.05）。结论 联合检测pro-ADM、降钙素原及CRP可以为未足月胎膜早破合并绒毛膜羊膜炎的早期诊断及感染严重程度的评估提供依据，合并绒毛膜羊膜炎患者的母儿结局不良。

• Objective To explore the value of joint detection of serum proadrenomedullin(pro-ADM), procalcitonin(PCT) and C-reactive protein(CRP) in diagnosing premature rupture of membranes with chorioamnionitis and in the evaluation of infection severity. Methods From January 2016 to April 2018, 83 singleton primiparas with preterm premature rupture of membranes(gestational 28-34＋6 weeks) admitted to Inner Mongolia People′s Hospital were selected as the observation group. According to histopathological test results, they were divided into non-chorioamnionitis group（observation group A, 40 cases） and chorioamnionitis group（observation group B, 43 cases). Thirty healthy parturients were enrolled as control group. Serum levels of pro-ADM, PCT and CRP were detected and compared among groups and chorioamnionitis patients with different infection severity. Pregnancy outcomes of mothers and infants were observed. Results Levels of serum pro-ADM and CRP in observation group A were significantly higher than those in control group; levels of serum pro-ADM, PCT and CRP in observation group B were significantly higher than those in observation group A and control group［（1.71±0.52）nmol/L vs （0.57±0.18）,（0.22±0.10）nmol/L; （1.07±0.35）μg/L vs （0.45±0.22）,（0.41±0.17）μg/L; （14.7±12.6）mg/L vs （6.5±1.3）,（3.7±1.6）mg/L］（all P＜0.01）. These indicators increased with the severity of chorioamnionitis in observation group B; levels of serum pro-ADM, PCT and CRP in grade Ⅱ and grade Ⅲ were significantly higher than those in grade Ⅰ; CRP level in grade Ⅲ was significantly higher than that in grade Ⅱ（all P＜0.01）. In group B there were significantly higher incidence rates of postpartum hemorrhage, puerperal infection, neonatal asphyxia and neonatal infection, as compared with observation group A(all P<0.05). Conclusions Combined detection of serum pro-ADM, PCT and CRP can provide reference for early diagnosis and infection evaluation of chorioamnionitis in puerperants with preterm premature rupture of membranes. Chorioamnionitis may result in poor maternal and fetal outcomes.