Nowak M, Oszukowski P, Pieta A, Szpakowski M, Małafiej E, Malinowski A, Wierzbicka E, Drzazga W
Instytutu Centrum Zdrowia Matki Polki.
Ginekol Pol. 1998 Dec;69(12):997-1002.
The purpose of our study was to evaluate the use of maternal serum IL-8, IL-6, IFN-gamma levels in the predicting of the efficacy of tocolytic therapy in preterm labor.
We investigated prospectively the group of 47 women in singleton pregnancies with threatened preterm labor in less than 36 weeks gestation and administered tocolytic therapy.
In 19 of them tocolysis failed (group II and they delivered premature newborns (the group I--successful tocolysis consisted of remaining 28 women). The incidence of clinical chorioamnionitis, histologic chorioamnionitis and inherited infection of newborns was significantly higher among women refractory to tocolytic therapy (10.2%, 36.8%, 26.3% versus 0%, 3.6%, 0%, respectively, p < 0.05). Maternal serum IL-8, IL-6, IFN-gamma (by means of ELISA technique) and CRP, WBC, ESR levels were measured at the admission to the study. The mean WBC, ESR and the median (range) IFN-gamma (0 (0-7.1) and 0.9 (0-10.4) pg/ml, respectively) didn't differ in both groups. The concentrations of serum IL-8, IL-6, CRP were significantly higher in the group of failed tocolysis (median (range): IL-8: 22.7 (6.3-83.2) vs 3.0 (0-26.0) pg/ml; IL-6: 7.4 (0-21.0) vs 0 (0-11.3) pg/ml; CRP: 1.8 (0.6-7.0) vs 0.6 (0.6-3.9) mg/dl; p < 0.05). Serum IL-8 determinations (definition of abnormal test: > 8 pg/ml) were found the most reliable in the prediction of tocolysis failure with a sensitivity 87.5%, specificity 81.8%, positive predictive value 77.8%, negative predictive value 90% and accuracy 84.2%. Also reliable were IL-6 determinations (IL-6 > 6 pg/ml had a sensitivity 75%, specificity 90.9%, positive predictive value 85.7%, negative predictive value 83.3% and accuracy 84.2%) and CRP determinations (CRP > 1.2 mg/dl had a sensitivity 75%, specificity 81.8%, positive predictive value 75%, negative predictive value 81.8% and accuracy 78.9%). The efficacy of IFN-gamma, WBC and ESR was significantly lower.
Our data revealed that the maternal serum IL-8, IL-6 and CRP determinations are very useful in the predicting of the efficacy of tocolytic therapy in women with threatened preterm labor. The use of IFN-gamma, WBC, ESR was significantly lower.
本研究旨在评估母体血清白细胞介素-8（IL-8）、白细胞介素-6（IL-6）、γ干扰素（IFN-γ）水平对早产宫缩抑制治疗疗效的预测作用。
我们前瞻性地研究了47名单胎妊娠、妊娠小于36周且有早产先兆并接受宫缩抑制治疗的妇女。
其中19人宫缩抑制治疗失败（第二组），她们分娩了早产儿（第一组为宫缩抑制治疗成功组，由其余28名妇女组成）。宫缩抑制治疗无效的妇女中临床绒毛膜羊膜炎、组织学绒毛膜羊膜炎及新生儿先天性感染的发生率显著更高（分别为10.2%、36.8%、26.3%，而成功组分别为0%、3.6%、0%，p<0.05）。在研究入组时检测母体血清IL-8、IL-6、IFN-γ（采用酶联免疫吸附测定技术）以及C反应蛋白（CRP）、白细胞（WBC）、红细胞沉降率（ESR）水平。两组的平均WBC、ESR以及IFN-γ的中位数（范围）（分别为0（0 - 7.1）和0.9（0 - 10.4）pg/ml）无差异。宫缩抑制治疗失败组的血清IL-8、IL-6、CRP浓度显著更高（中位数（范围）：IL-8：22.7（6.3 - 83.2）对3.0（0 - 26.0）pg/ml；IL-6：7.4（0 - 21.0）对0（0 - 11.3）pg/ml；CRP：1.8（0.6 - 7.0）对0.6（0.6 - 3.9）mg/dl；p<0.05）。血清IL-8测定（异常检测定义：>8 pg/ml）在预测宫缩抑制治疗失败方面最为可靠，敏感性为87.5%，特异性为8,1.8%，阳性预测值为77.8%，阴性预测值为90%，准确性为84.2%。IL-6测定（IL-6>6 pg/ml）也较为可靠，敏感性为75%，特异性为90.9%，阳性预测值为85.7%，阴性预测值为83.3%，准确性为84.2%；CRP测定（CRP>1.2 mg/dl）同样可靠其敏感性为75%，特异性为81.8%，阳性预测值为75%，阴性预测值为81.8%，准确性为78.9%。IFN-γ、WBC和ESR的预测效力显著较低。
我们的数据表明，母体血清IL-8、IL-6和CRP测定对于预测有早产先兆妇女宫缩抑制治疗的疗效非常有用。IFN-γ、WBC、ESR的预测效力显著较低。
