Gurbuz A, Karateke A, Ozturkmen M, Kabaca C
Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, 81030 Kadikoy, Istanbul, Turkey.
Int J Gynaecol Obstet. 2004 May;85(2):132-8. doi: 10.1016/j.ijgo.2003.10.007.
We planned to determine whether the concentration of human chorionic gonadotropin (hCG) in cervical secretions could be a useful marker for accurate diagnosis of preterm labor, and whether the use of cervical hCG assay in combination with the Bishop score would improve the prediction of delivery within 7 days, and to determine the cut-off values for hCG in prediction of delivery within 100 h, 7 and 14 days, as well as before 35 and 37 weeks of gestation in a group of women at high risk for preterm delivery.
The study was conducted in the perinatology department of Zeynep Kamil Women and Children Diseases Education and Research Hospital between February 2002 and February 2003. One hundred and two subjects with a diagnosis of threatened preterm labor with intact membranes were included in the study. For hCG measurements, a cotton swab was rolled intracervically for 10 s to absorb fluid. Bishop scores were assessed. The correlation test was employed for the variables influencing hCG values. The ROC curve analysis was used to establish an optimal cut-off concentration for cervical hCG and an optimal cut-off level for Bishop score. The continuous variables were analyzed by the unpaired, independent, two-tailed t-test and categorical data were analyzed by the chi-square test.
A significant positive correlation was present between the cervical hCG concentrations and Bishop scores (r=0.72, P<0.0001), and a highly negative correlation between the cervical hCG concentrations and the time interval from sampling time until delivery (r=-0.80, P<0.0001) was detected. The cut-off value for cervical hCG concentration and its sensitivity, specificity, positive and negative predictive values, accuracy, relative risk and likelihood ratio for accurate determination of delivery within 100 h were > or =32 mIU/ml, 98%, 55%, 70%, 96%, 77%, 19.68 and 2.18, respectively. However, these values were > or =32 mIU/ml, 97%, 84%, 89%, 95%, 92%, 17.37 and 6.06, respectively, for prediction of delivery within 7 days; > or =30 mIU/ml, 97%, 79%, 87%, 94%, 89%, 15.15 and 4.62, respectively, for prediction of delivery within 14 days; > or =33 mIU/ml, 89%, 92%, 94%, 83%, 90%, 5.83 and, 11.55, respectively, for prediction of delivery before 35 weeks; and finally > or =27 mIU/ml, 76%, 50%, 85%, 37%, 71%, 1.34 and 1.52, respectively, for prediction of delivery before 37 weeks.
Cervical hCG expression seems to be rewarding in accurate diagnosis of preterm labor. This test has the advantage of low cost and wide availability.
我们计划确定宫颈分泌物中人绒毛膜促性腺激素（hCG）浓度是否可作为准确诊断早产的有用标志物，以及联合使用宫颈hCG检测和 Bishop 评分是否能改善对 7 天内分娩的预测，并确定在一组早产高危女性中，hCG 在预测 100 小时、7 天和 14 天内以及妊娠 35 周和 37 周前分娩时的临界值。
该研究于 2002 年 2 月至 2003 年 2 月在 Zeynep Kamil 妇女儿童医院围产医学科进行。102 名诊断为胎膜完整的先兆早产患者纳入研究。进行 hCG 检测时，将棉拭子插入宫颈内 10 秒以吸取液体。评估 Bishop 评分。对影响 hCG 值的变量进行相关性检验。采用 ROC 曲线分析确定宫颈 hCG 的最佳临界浓度和 Bishop 评分的最佳临界水平。连续变量采用不成对、独立、双尾 t 检验分析，分类数据采用卡方检验分析。
宫颈 hCG 浓度与 Bishop 评分之间存在显著正相关（r = 0.72，P < 0.0001），宫颈 hCG 浓度与采样时间至分娩的时间间隔之间存在高度负相关（r = -0.80，P < 0.0001）。宫颈 hCG 浓度的临界值及其在准确确定 100 小时内分娩的敏感性、特异性、阳性和阴性预测值、准确性、相对风险和似然比分别为≥32 mIU/ml、98%、55%、70%、96%、77%、19.68 和 2.18。然而，对于预测 7 天内分娩，这些值分别为≥32 mIU/ml、97%、84%、89%、95%、92%、17.37 和 6.06；对于预测 14 天内分娩，分别为≥30 mIU/ml、97%、79%、87%、94%、89%、15.15 和 4.62；对于预测 35 周前分娩，分别为≥33 mIU/ml、89%、92%、94%、83%、90%、5.83 和 11.55；最后，对于预测 37 周前分娩，分别为≥27 mIU/ml、76%、50%、85%、37%、71%、1.34 和 1.52。
宫颈 hCG 表达似乎有助于准确诊断早产。该检测具有成本低和易于获得的优点。
