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目的探讨孕中期羊水中生化物质与妊娠结局的关系。方法选择133例孕16～24周的单胎孕妇,常规羊膜腔穿刺抽取羊水3ml,测定其葡萄糖、C-反应蛋白、瘦素、甲胎蛋白与α1-抗胰蛋白酶的含量,并观察妊娠结局。结果孕中期羊水中葡萄糖含量与新生儿出生体重呈线性正相关(r=0.182,P=0.04),以羊水葡萄糖含量﹥2.7mmol/L为临界值,预测巨大儿发生的敏感性为53.8%,特异性为67.8%。早产组孕中期羊水α1-抗胰蛋白酶含量[(1901.36±914.87)μg/ml]明显高于足月分娩组[(1025.03±656.94)μg/ml](P=0.006)。ROC曲线分析表明以羊水α1-抗胰蛋白酶值﹥1245μg/ml为临界值,预测早产发生的敏感性为80%,特异性为72%,相关分析表明孕中期羊水α1-抗胰蛋白酶含量与新生儿出生体重呈线性负相关(r=-0.255,P=0.022)。结论孕中期羊水中葡萄糖、C-反应蛋白、瘦素和甲胎蛋白不能作为预测早产和胎膜早破的指标,孕中期羊水中葡萄糖、C-反应蛋白、瘦素不能作为预测糖代谢异常和妊娠高血压疾病的指标,孕中期羊水α1-抗胰蛋白酶可作为预测早产的特异性指标。
Objective To explore the relationship between biochemical substances in amniotic fluid and pregnancy outcome in the second trimester of pregnancy. Methods A total of 133 pregnant women with single fetus between 16 and 24 weeks of gestation were enrolled in the study. Amniotic fluid 3ml was collected by routine amniocentesis. The levels of glucose, C-reactive protein, leptin, alpha-fetoprotein and alpha1-antitrypsin were measured. . Results There was a linear positive correlation between glucose content in newborns and newborn birth weight (r = 0.182, P = 0.04) in the second trimester of pregnancy. The sensitivity of the macrosomia was 53.8% when the amniotic fluid glucose> 2.7 mmol / Specificity was 67.8%. The level of α1-antitrypsin in the second trimester of preterm labor group was significantly higher than that in term delivery group [(1025.03 ± 656.94) μg / ml] [(1901.36 ± 914.87) μg / ml] (P = 0.006). ROC curve analysis showed that the sensitivity and specificity of prenatal birth were 80% and 72%, respectively, based on the α1-antitrypsin value of amniotic fluid> 1245μg / ml. Correlation analysis showed that the α1-antitrypsin content of the second trimester amniotic fluid Birth weight was negatively correlated (r = -0.255, P = 0.022). Conclusion Glucose, C-reactive protein, leptin and alpha-fetoprotein in the second trimester of amniotic fluid can not be used as predictors of premature labor and premature rupture of membranes. Glucose, C-reactive protein and leptin in the second trimester of amniotic fluid can not be used as predictors of glucose metabolism, Pregnancy-induced hypertension disease indicators, the second trimester amniotic fluid α1-antitrypsin can be used as a specific indicator of preterm birth.