Clinical value of ultrasonic fetal membrane thickness combined with serum IL-6 and CRP in predicting premature delivery in the second and third trimesters of pregnancy
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摘要:
目的 探讨孕中晚期超声胎膜厚度检测联合血清白介素-6(IL-6)、C反应蛋白(CRP)预测早产发生的临床价值。 方法 收集2019年1月1日~2020年12月31日于我院建档进行产检和分娩的599例孕妇作为研究对象，根据分娩时间将孕妇分为早产组(n=86)和足月组(n=513)，分析两组孕妇孕中、晚期血清IL-6、CRP及超声胎膜厚度，采用ROC曲线分析上述3项指标对孕妇早产的预测价值，并比较两组孕妇通过各指标诊断的阳性率。 结果 在孕23~25周和孕32~34周，早产组孕妇血清IL-6、CRP水平高于足月组(P < 0.05)，胎膜厚度低于足月组(P < 0.05)；ROC曲线分析结果显示，超声胎膜厚度联合血清IL-6、CRP预测早产的ROC曲线下面积高于3项指标单独预测的ROC曲线下面积(P < 0.05)；且联合预测的准确度、敏感度和特异性均较高。早产组孕妇血清IL-6、CRP和胎膜厚度单项诊断和联合诊断早产的阳性率均高于足月组(P < 0.05)。 结论 与足月生产孕妇比较，早产孕妇中晚期的血清IL-6、CRP水平明显更高，胎膜厚度更高，联合检测血清IL-6、CRP和胎膜厚度对于预测孕妇早产具有较高的应用价值。 Abstract:Objective To explore the clinical value of ultrasonic fetal membrane thickness combined with serum interleukin-6 (IL-6) and C-reactive protein (CRP) in predicting premature delivery in the second and third trimesters of pregnancy. Methods A total of 599 pregnant women undergoing prenatal examination and delivery in the hospital were enrolled as the research objects from January 1st, 2019 to December 31st, 2020. According to different delivery time, they were divided into premature delivery group (n=86) and full-term group (n=513). The serum IL-6, CRP and ultrasonic fetal membrane thickness in both groups were analyzed in the second and third trimesters of pregnancy. The predictive value of the above three indexes for premature delivery was analyzed by ROC curves. The positive rates of different indexes were compared between the two groups. Results Within 23-25 and 32-34 gestational weeks, levels of serum IL-6 and CRP in premature delivery group were significantly higher than those in full-term group (P < 0.05), while thickness of fetal membranes was thinner than that in fullterm group (P < 0.05). The ROC curves analysis showed that the area under the ROC curve of ultrasonic fetal membrane thickness combined with serum IL-6 and CRP for predicting premature delivery was greater than that of single index (P < 0.05). The accuracy, sensitivity and specificity of combined prediction were higher. The positive rates of premature delivery by single diagnosis and combined diagnosis in premature delivery group were higher than those in full-term group (P < 0.05). Conclusion Compared with full-term pregnant women, levels of serum IL-6 and CRP are significantly higher, and thickness of fetal membranes is thicker in pregnant women with premature deliver in the second and third trimesters. The combined detection of serum IL-6, CRP and fetal membrane thickness has higher predictive value for premature delivery. -
图 1 血清IL-6、CRP水平及超声胎膜厚度对早产单项预测与联合预测的ROC曲线
Figure 1. ROC curves of serum IL-6 and CRP levels and ultrasonic membrane thickness for single and combined prediction of premature delivery.
图 2 超声检测孕中晚期孕妇胎膜厚度的影像图
注: 检测的胎膜厚度值分别为1.3 mm（A）、1.5 mm（B）和1.8 mm（C）.
Figure 2. Image of membrane thickness of pregnant woman measured by ultrasound in the middle and late trimester.
表 1 两组孕妇孕中晚期血清IL-6、CRP水平及胎膜厚度比较
Table 1. Comparison of serum IL- 6, CRP levels and fetal membrane thickness between the two groups during middle and late pregnancy (Mean±SD)
组别 IL-6(μg/L) CRP(mg/L) 胎膜厚度(mm) 孕23~25周 孕32~34周 孕23~25周 孕32~34周 孕23~25周 孕32~34周 早产组(n=86) 6.45±2.19 8.52±2.68a 11.36±2.37 14.49±3.15a 1.21±0.27 1.24±0.24 足月组(n=513) 3.67±1.04 4.05±1.33 4.69±1.34 4.85±1.25 1.46±0.25 1.43±0.26 t 18.800 24.072 37.423 49.864 8.482 6.339 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 aP < 0.05 vs孕23~25周. IL-6: 白介素-6; CRP: C反应蛋白. 
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表 2 ROC曲线各项指标对早产的曲线下面积值
Table 2. AUC values of ROC curve for each indicator about premature delivery
指标 曲线下面积 SE P 截断值 95% CI IL-6 0.776 0.041 < 0.001 > 5.823 μg/L 0.695~0.857 CRP 0.758 0.040 < 0.001 > 10.122 mg/L 0.679~0.837 胎膜厚度 0.725 0.047 < 0.001 < 1.309 mm 0.633~0.817 联合预测 0.878 0.031 < 0.001 0.818~0.938
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表 3 各项指标预测早产的准确度、敏感度和特异性
Table 3. Accuracy, sensitivity, and specificity of various indicators for predicting preterm birth (%)
指标 准确度 敏感度 特异性 IL-6 74.96 69.12 77.96 CRP 77.96 57.60 83.14 胎膜厚度 71.95 63.44 75.96 联合预测 87.98 67.28 93.66
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表 4 两组孕妇血清IL-6、CRP水平及胎膜厚度的单项、联合诊断阳性率比较
Table 4. The positive rates of serum IL-6, CRP levels and membrane thickness were compared between the two groups by single and combined diagnosis [n(%)]
组别 IL-6 CRP 胎膜厚度 IL-6+CRP+胎膜厚度 早产组(n=86) 62(72.09) 71(82.56) 65(75.58) 76(88.37) 足月组(n=513) 296(57.70) 302(58.87) 299(58.28) 314(61.20) χ2 6.345 17.592 9.243 23.992 P 0.012 < 0.001 0.002 < 0.001
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