早产女性中胎儿纤连蛋白检测和宫颈长度测量的临时应用。
Contingent use of fetal fibronectin testing and cervical length measurement in women with preterm labour.
作者信息
Audibert François, Fortin Suzanne, Delvin Edgard, Djemli Anissa, Brunet Suzanne, Dubé Johanne, Fraser William D
机构信息
Département d'Obstétrique Gynécologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal (Quebec).
出版信息
J Obstet Gynaecol Can. 2010 Apr;32(4):307-12. doi: 10.1016/s1701-2163(16)34473-5.
OBJECTIVE
To evaluate the contingent use of fetal fibronectin (fFN) testing and cervical length (CL) measurement to predict preterm delivery, and to validate the use of phosphorylated IGFBP-1 as a predictor of preterm delivery.
METHODS
We recruited 71 women with a clinical diagnosis of preterm labour between 24 and 34 weeks, and tested for the presence of fFN and IGFBP-1 in the cervicovaginal secretions of all women immediately before CL measurement.
RESULTS
Among the 66 women with complete outcome, four were excluded from the final analysis as two had assessment for fFN but no CL measurement, and another two had CL measured but no screening for fFN. Among 62 women with complete results, the mean gestational age at recruitment was 29.4 +/- 2.5 weeks. Six women (9.6%) delivered within two weeks of assessment, and 14 (22.5%) delivered before 34 weeks. A positive fFN test resulted in a sensitivity of 83%, a specificity of 84%, a positive predictive value of 36%, and a negative predictive value of 98% for delivery within two weeks; for CL < 25 mm, these figures were 50%, 52%, 10%, and 91%, respectively, and for a positive IGFBP-1, they were 17%, 93%, 20%, and 91%, respectively. A policy of contingent use of fFN (in which the test was assumed to be positive if CL < or = 15 mm, and fFN was only measured if the CL was between 16 and 30 mm) gave sensitivity, specificity, positive and negative predictive values of 80%, 61%, 17%, and 97%, respectively for delivery within two weeks. Using this contingent use protocol, only one third of women needed fFN screening after CL measurement.
CONCLUSION
In this study, IGFBP-1 screening did not predict preterm delivery and fFN screening provided the best predictive capacity. A policy of contingent use of testing for fFN after CL measurement, or contingent use of CL measurement after fFN screening (depending on available resources) is a promising approach to limit use of resources.
目的
评估使用胎儿纤连蛋白（fFN）检测和宫颈长度（CL）测量来预测早产的情况，并验证磷酸化胰岛素样生长因子结合蛋白-1（pIGFBP-1）作为早产预测指标的应用。
方法
我们招募了71名临床诊断为24至34周早产的女性，在测量CL之前，立即检测所有女性宫颈阴道分泌物中fFN和IGFBP-1的存在情况。
结果
在66名结局完整的女性中，4名被排除在最终分析之外，其中2名进行了fFN评估但未测量CL，另外2名测量了CL但未进行fFN筛查。在62名结果完整的女性中，招募时的平均孕周为29.4±2.5周。6名女性（9.6%）在评估后两周内分娩，14名（22.5%）在34周前分娩。fFN检测呈阳性对两周内分娩的敏感性为83%，特异性为84%，阳性预测值为36%，阴性预测值为98%；对于CL<25mm，这些数字分别为50%、52%、10%和91%，对于pIGFBP-1呈阳性，分别为17%、93%、20%和91%。一种fFN的应急使用策略（即如果CL≤15mm，则假定检测为阳性，只有当CL在16至30mm之间时才测量fFN）对两周内分娩的敏感性、特异性、阳性和阴性预测值分别为80%、61%、17%和97%。使用这种应急使用方案，CL测量后只有三分之一的女性需要进行fFN筛查。
结论
在本研究中，IGFBP-1筛查不能预测早产，而fFN筛查具有最佳的预测能力。CL测量后进行fFN检测的应急使用策略，或fFN筛查后进行CL测量的应急使用策略（取决于可用资源）是一种有前景的限制资源使用的方法。
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