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目的研究胎儿纤维连接蛋白(fFN)在广州地区孕妇早产预测中的应用价值。方法随机选择2008年2月至2009年1月于中山大学孙逸仙纪念医院门诊产检或住院的中晚期妊娠孕妇124例为研究对象。取阴道后穹窿分泌物,应用胎儿纤维连接蛋白快速测试条进行检测,同时取样检测白带常规和细菌性阴道病、支原体、衣原体。记录7d、14d、34周、37周内分娩的情况,追踪妊娠结局。分析敏感性、特异性、阳性预测值、阴性预测值。结果 124例患者中,7d、14d、34周、37周内分娩分别为2、4、10、18例,其对应敏感性、特异性、阳性预测价值、阴性预测价值分别为(7d)100%、77.8%、6.9%、100%,(14d)75%、78.3%、10.3%、98.9%,(34周)50%、78.9%、17.2%、94.7%,(37周)33.3%、78.3%、20.7%、87.4%。排除18例早产后,fFN阳性者23例,其中下生殖道感染者17例,占73.9%;fFN阴性83例,其中下生殖道感染者18例,占21.7%,两者比较差异具有统计学意义(P<0.05)。对出现fFN阳性、有先兆早产症状的患者给予宫缩抑制剂及促胎肺成熟的治疗,取得良好效果。实际发生早产的孕妇18例,约占全部分娩孕妇的14.5%,其中34周内分娩的孕妇10例,占8%,除2例由于分娩时孕周不足28周外,其余分娩的患儿全部存活。结论中晚孕行fFN检测可预测早产,预测早产的阴性预测价值和近期预测价值均较高,但其阳性预测价值和远期预测价值低,其原因与生殖道感染的干扰有关,对fFN检测阴性者避免过度处理,fFN检测阳性者结合临床及时处理。在整个妊娠期间,需连续监测fFN的变化,及早发现异常,对早产进行早诊断,早治疗,减少围产儿的致病率和死亡率。
Objective To investigate the value of fetal fibronectin (fFN) in the prediction of preterm birth in pregnant women in Guangzhou. Methods From February 2008 to January 2009, 124 pregnant women of middle and late pregnancy who were examined or hospitalized at Sun Yat-sen Memorial Hospital of Sun Yat-sen University were randomly selected as the research object. Take vaginal fornix secretion, the application of fetal fibronectin fast test strip for detection, while sampling and testing vaginal discharge and bacterial vaginosis, mycoplasma, chlamydia. Record 7d, 14d, 34 weeks, 37 weeks of childbirth, tracking pregnancy outcomes. Analysis of sensitivity, specificity, positive predictive value, negative predictive value. Results Among the 124 patients, there were 2, 4, 10, and 18 cases of childbirth within 7 days, 14 days, 34 weeks and 37 weeks respectively. The corresponding sensitivity, specificity, positive predictive value and negative predictive value were (7d) , 77.8%, 6.9%, 100%, (14d) 75%, 78.3%, 10.3%, 98.9%, 34 weeks 50% 78.9% 17.2% 94.7% , 20.7%, 87.4%. Excluding 18 cases of preterm delivery, fFN positive in 23 cases, including 17 cases of lower genital tract infection, accounting for 73.9%; fFN negative 83 cases, including 18 cases of lower genital tract infection, accounting for 21.7%, the difference between the two statistics Significance (P <0.05). On the emergence of fFN positive, symptoms of threatened preterm delivery of patients with tocolytic and promote fetal lung maturation of treatment, and achieved good results. The actual occurrence of premature birth in 18 cases of pregnant women, accounting for 14.5% of all pregnant women delivered, of which 34 cases of pregnant women delivered within 10 weeks, accounting for 8%, except 2 cases due to gestational age less than 28 weeks during childbirth, the rest of the childbirth Survival. Conclusions The fFN test in middle and late pregnancy predicts preterm delivery. The negative predictive value and recent predictive value in predicting preterm labor are high, but the positive predictive value and the low forward predictive value are low, which are related to the interference of reproductive tract infection. The detection of fFN Negatives to avoid over-treatment, fFN positive detection combined with clinical treatment in time. Throughout the pregnancy, the need for continuous monitoring of changes in fFN, early detection of abnormalities, early diagnosis of premature birth, early treatment, reduce perinatal morbidity and mortality.