Revah A, Hannah M E, Sue-A-Quan A K
Department of Obstetrics and Gynaecology, Sunnybrook and Women's Health Sciences Centre, University of Toronto, Ontario, Canada.
Am J Perinatol. 1998;15(11):613-21. doi: 10.1055/s-2007-994079.
The objective of this study was to determine if cervicovaginal fibronectin is predictive of preterm birth. Articles involving human subjects published in English between January 1976 and December 1997 were retrieved from MEDLINE using the keywords: fibronectin, fetal fibronectin, oncofetal fibronectin, preterm, PROM, preterm birth, and preterm labor. We included studies that were prospective, enrolled women at less than 37 weeks' gestation and blinded caregivers to the fetal fibronectin test results. Of the 24 studies meeting the inclusion criteria, 15 included symptomatic women; 8 included asymptomatic women; and 1 study included both. Data were abstracted independently by two authors and a meta-analysis of results of test characteristics, using summary values, was undertaken where possible. For symptomatic women, the sensitivity for delivery within 7 to 10 days of sampling was excellent (summary value [95% confidence interval ¿CI¿]: 98% [95%, 100%]). For delivery within 14 days, the sensitivity was somewhat lower (summary value [95% CI]: 82% [74%, 90%]) and lower still for delivery within 21 days (summary value [95% CI]: 73% [67%, 80%]). For delivery less than 34 weeks the sensitivity was good, but poor for delivery less than 37 weeks (summary value [95% CI]: 87% [81%, 94%], 54% [51%, 58%] respectively). For asymptomatic women, the sensitivity of fetal fibronectin for delivery less than 34 and less than 37 weeks was poor (summary value [95% CI]: 43% [36%, 50%] and 64%[57%, 71%] respectively). The specificity of fetal fibronectin for symptomatic and asymptomatic women was over 80% for all outcomes. For symptomatic women, a negative test for fetal fibronectin should be useful at ruling out the likelihood of delivery within 7 to 10 days of sampling. For asymptomatic women, testing for fetal fibronectin is unlikely to be useful as many women at risk will be misclassified as normal.
本研究的目的是确定宫颈阴道纤连蛋白是否可预测早产。使用关键词“纤连蛋白”“胎儿纤连蛋白”“癌胚纤连蛋白”“早产”“胎膜早破”“早产分娩”和“早产临产”，从1976年1月至1997年12月期间发表的英文涉及人体受试者的文章中检索出相关文献。我们纳入了前瞻性研究，这些研究招募妊娠小于37周的妇女，并对护理人员隐瞒胎儿纤连蛋白检测结果。在符合纳入标准的24项研究中，15项纳入有症状的妇女；8项纳入无症状的妇女；1项同时纳入了两者。数据由两位作者独立提取，并尽可能对检测特征结果进行汇总值的荟萃分析。对于有症状的妇女，采样后7至10天内分娩的敏感性极佳（汇总值[95%置信区间（CI）]：98%[95%，100%]）。对于14天内分娩，敏感性略低（汇总值[95%CI]：82%[74%，90%]），21天内分娩的敏感性更低（汇总值[95%CI]：73%[67%，80%]）。对于小于34周分娩，敏感性良好，但对于小于37周分娩则较差（汇总值[95%CI]：分别为87%[81%，94%]，54%[51%，58%]）。对于无症状的妇女，胎儿纤连蛋白对小于34周和小于37周分娩的敏感性较差（汇总值[95%CI]：分别为43%[36%，50%]和64%[57%，71%]）。对于有症状和无症状的妇女，胎儿纤连蛋白对所有结局的特异性均超过80%。对于有症状的妇女，胎儿纤连蛋白检测呈阴性应有助于排除采样后7至10天内分娩的可能性。对于无症状的妇女，检测胎儿纤连蛋白不太可能有用，因为许多有风险的妇女会被误分类为正常。
