Li H Y, Chang T S
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 2000 Sep;63(9):686-90.
Diagnosis of premature rupture of membranes (PROM) is difficult in equivocal cases. The concentrations of human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and creatinine are high in amniotic fluid. The purpose of this study was to determine the usefulness of vaginal fluid hCG, AFP and creatinine measurements in the detection of PROM.
About 3 ml of normal saline was used to irrigate the posterior vaginal fornix and was collected for the measurement of hCG, AFP and creatinine. The control group included 10 normal pregnant women in the third trimester (> 28 weeks of gestational age). Levels of hCG, AFP and creatinine were compared with those of 10 women with confirmed PROM.
The median levels of vaginal fluid hCG of normal pregnant women and pregnant women with confirmed PROM were 35.0 mIU/ml and 478.0 mIU/ml (p = 0.0046), respectively. For AFP, the corresponding values were 0.80 ng/ml and 54.24 ng/ml (p < 0.0001), respectively, and for creatinine, the values were 0.05 mg/dl and 0.95 mg/dl (p < 0.0001), respectively. All three markers were significantly higher in the experimental group than in the control group. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for hCG were 80%, 70%, 72.7%, 77.8% and 75%, respectively. For AFP, these values were 90%, 100%, 100%, 90.9%, and 95.0%, respectively, and for creatinine, they were 90%, 100%, 100%, 90.9%, and 95%, respectively. The diagnostic value of AFP or creatinine level in vaginal washing may be better than that of hCG, though the difference was not statistically significant, probably due to the limited case number.
Creatinine in vaginal fluid washings is a useful marker for PROM. It was less expensive and easier to measure than hCG and AFP, and appears to be more accurate than hCG.
在难以明确诊断的病例中，胎膜早破（PROM）的诊断较为困难。羊水中人绒毛膜促性腺激素（hCG）、甲胎蛋白（AFP）和肌酐的浓度较高。本研究的目的是确定检测阴道液中hCG、AFP和肌酐水平对诊断胎膜早破的有效性。
用约3ml生理盐水冲洗阴道后穹窿并收集样本，用于检测hCG、AFP和肌酐。对照组包括10名孕晚期（孕周>28周）的正常孕妇。将其hCG、AFP和肌酐水平与10名确诊为胎膜早破的孕妇进行比较。
正常孕妇和确诊为胎膜早破孕妇的阴道液hCG中位数水平分别为35.0mIU/ml和478.0mIU/ml（p = 0.0046）。AFP的相应值分别为0.80ng/ml和54.24ng/ml（p < 0.0001），肌酐的相应值分别为0.05mg/dl和0.95mg/dl（p < 0.0001）。实验组的所有三项标志物均显著高于对照组。hCG的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为80%、70%、72.7%、77.8%和75%。AFP的这些值分别为90%、100%、100%、90.9%和95.0%，肌酐的这些值分别为90%、100%、100%、90.9%和95%。阴道冲洗液中AFP或肌酐水平的诊断价值可能优于hCG，尽管差异无统计学意义，可能是由于病例数有限。
阴道冲洗液中的肌酐是诊断胎膜早破的有用标志物。它比hCG和AFP成本更低、检测更容易，且似乎比hCG更准确。
