Tekesin Ismail, Wallwiener Diethelm, Schmidt Stephan
Department of Gynecology and Obstetrics, University of Tuebingen, Germany.
J Perinat Med. 2005;33(5):383-91. doi: 10.1515/JPM.2005.070.
To evaluate clinical risk factors, cervical fetal fibronectin (fFN), cervical length, and mean gray value assessment in predicting of preterm delivery (PTD) in patients with signs and/or symptoms of preterm labor (PTL).
One hundred and seventeen women with PTL between 24 and 34 weeks of gestation were included. Cervical swabs were tested for fFN using the rapid fFN assay. When 2-dimensional transvaginal ultrasound measurement of cervical length was completed, a region of interest (ROI) of constant size was defined in the midsection of the posterior wall, and the tissue-specific gray scale was determined. The end point were PTDs at <34 and <37 weeks of gestation.
In univariate analysis, the three strongest predictors of spontaneous preterm birth <34 weeks were positive fFN (relative risk [RR] 8.9; 95% confidence interval [CI] 2.6-30.1), cervical length < or =2.5 cm (RR 6.9; 95% CI 1.6-29.7), and a low mean gray value of < or =5.97 (RR 7.9; 95% CI 2.3-27.2). Predictors significantly associated with spontaneous PTD at less than 37 weeks of gestation included previous PTD in multiparas (RR 3.9; 95% CI 1.6-9.5), positive fFN (RR 7.6; 95% CI 3.8-15.3), cervical length < or =2.5 cm (RR 2.6; 95% CI 1.4-5.1) and a low gray scale value of < or =6.54 (RR 4.5; 95% CI 2.3-8.9). In the final regression models used to predict spontaneous PTD <34 weeks and <37 weeks of gestation, both a positive fetal fibronectin (odds ratio [OR] 13.4; 95% CI, 2.5-72.1, P=0.003 vs. OR, 17.3; 95% CI 4.9-61.8, P<0.001) and a low gray scale value (OR 6.3 95% CI 1.3-29.4, P=0.02 vs. OR, 7.1; 95% CI 2-25.2, P=0.003) remained powerful predictors. The RRs of spontaneous PTD <37 weeks has been analyzed by a combination of these significant parameters. Low mean gray value < or =6.54 and negative fFN had a 10.3-fold (95% CI 2-74.5) increased risk of spontaneous preterm birth at <37 weeks. Combination of positive fFN and normal gray level (>6.54), had a higher increase risk of PTD (RR 18.1; 95% CI 4.4-76.7). When both factors were positive, the RR increases to 24.8 (95% CI 6.2-98.7).
Combined use of rapid fFN and cervical gray value analysis improves the diagnostic efficiency and allows identification of women at risk for preterm delivery and in need for further prophylactic/therapeutic intervention.
评估临床风险因素、宫颈胎儿纤维连接蛋白（fFN）、宫颈长度及平均灰度值评估对早产迹象和/或症状患者早产（PTD）的预测价值。
纳入117例妊娠24至34周有早产迹象的妇女。采用快速fFN检测法对宫颈拭子进行fFN检测。完成经阴道二维超声测量宫颈长度后，在宫颈后壁中段定义一个固定大小的感兴趣区域（ROI），并测定组织特异性灰度。终点为妊娠<34周和<37周的早产。
单因素分析中，妊娠<34周自然早产的三个最强预测因素为fFN阳性（相对危险度[RR] 8.9；95%置信区间[CI] 2.6 - 30.1）、宫颈长度≤2.5 cm（RR 6.9；95% CI 1.6 - 29.7）以及平均灰度值≤5.97（RR 7.9；95% CI 2.3 - 27.2）。与妊娠<37周自然早产显著相关的预测因素包括经产妇既往早产史（RR 3.9；95% CI 1.6 - 9.5）、fFN阳性（RR 7.6；95% CI 2；3.8 - 15.3）、宫颈长度≤2.5 cm（RR 2.6；95% CI 1.4 - 5.1）以及灰度值≤6.54（RR 4.5；95% CI 2.3 - 8.9）。在用于预测妊娠<34周和<37周自然早产的最终回归模型中，胎儿纤维连接蛋白阳性（比值比[OR] 13.4；95% CI，2.5 - 72.1，P = 0.003；与OR 17.3；95% CI 4.9 - 61.8，P < 0.001相比）和低灰度值（OR 6.3，95% CI 1.3 - 29.4，P = 0.02；与OR 7.1；95% CI 2 - 25.2，P = 0.003相比）仍是有力的预测因素。对妊娠<37周自然早产的RR通过这些显著参数进行了综合分析。平均灰度值≤6.54且fFN阴性时，妊娠<37周自然早产风险增加10.3倍（95% CI 2 - 74.5）。fFN阳性与正常灰度水平（>6.54）组合时，早产风险增加更高（RR 18.1；95% CI 4.4 - 76.7）。当两个因素均为阳性时，RR增至24.8（95% CI 6.2 - 98.7）。
快速fFN与宫颈灰度值分析联合应用可提高诊断效率，有助于识别有早产风险且需要进一步预防性/治疗性干预的妇女。
