Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
Gynecol Obstet Invest. 2010;70(1):40-6. doi: 10.1159/000284949. Epub 2010 Feb 17.
BACKGROUND/AIMS: To examine the relationship of biological mediators (cytokines, stress hormones), psychosocial, obstetric history, and demographic factors in the early prediction of preterm birth (PTB) using a comprehensive logistic regression model incorporating diverse risk factors.
In this prospective case-control study, maternal serum biomarkers were quantified at 9-23 weeks' gestation in 60 women delivering at <37 weeks compared to 123 women delivering at term. Biomarker data were combined with maternal sociodemographic factors and stress data into regression models encompassing 22 preterm risk factors and 1st-order interactions.
Among individual biomarkers, we found that macrophage migration inhibitory factor (MIF), interleukin-10, C-reactive protein (CRP), and tumor necrosis factor-alpha were statistically significant predictors of PTB at all cutoff levels tested (75th, 85th, and 90th percentiles). We fit multifactor models for PTB prediction at each biomarker cutoff. Our best models revealed that MIF, CRP, risk-taking behavior, and low educational attainment were consistent predictors of PTB at all biomarker cutoffs. The 75th percentile cutoff yielded the best predicting model with an area under the ROC curve of 0.808 (95% CI 0.743-0.874).
Our comprehensive models highlight the prominence of behavioral risk factors for PTB and point to MIF as a possible psychobiological mediator.
背景/目的：使用综合逻辑回归模型纳入多种危险因素，探讨生物介质（细胞因子、应激激素）、心理社会、产科史和人口统计学因素与早产（PTB）早期预测的关系。
在这项前瞻性病例对照研究中，在 9-23 孕周对 60 名在<37 孕周分娩的妇女和 123 名在足月分娩的妇女进行了母血清生物标志物定量检测。将生物标志物数据与母亲的社会人口统计学因素和应激数据结合到回归模型中，该模型包含 22 个早产危险因素和一阶交互作用。
在单个生物标志物中，我们发现巨噬细胞移动抑制因子（MIF）、白细胞介素-10、C 反应蛋白（CRP）和肿瘤坏死因子-α在所有测试的截止水平（75%、85%和 90%分位数）均为统计学上的早产预测指标。我们为每个生物标志物截止值拟合了多因素早产预测模型。我们的最佳模型表明，MIF、CRP、冒险行为和低教育程度是所有生物标志物截止值的一致早产预测指标。75%分位数截止值产生了最佳预测模型，ROC 曲线下面积为 0.808（95%CI 0.743-0.874）。
我们的综合模型强调了行为危险因素在早产中的重要性，并指出 MIF 可能是一种心理生物学介质。
