Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
J Korean Med Sci. 2012 Jun;27(6):674-80. doi: 10.3346/jkms.2012.27.6.674. Epub 2012 May 26.
The aim of this study was to determine whether maternal serum C-reactive protein (CRP) is of value in predicting funisitis and early-onset neonatal sepsis (EONS) in women with preterm labor or preterm premature rupture of membranes (PROM). This retrospective cohort study included 306 consecutive women with preterm labor or preterm PROM who delivered preterm singleton neonates (23-35 weeks gestation) within 72 hr of CRP measurement. The CRP level was measured with a highly sensitive immunoassay. The sensitivity, specificity, positive predictive value, and negative predictive value of an elevated serum CRP level (≥ 8 mg/L) were 74.1%, 67.5%, 32.8%, and 92.4% for funisitis, and 67.7%, 63.3%, 17.2%, and 94.6% for EONS, respectively. Logistic regression analysis demonstrated that elevated levels of serum CRP were significantly associated with funisitis and EONS, even after adjusting gestational age. The maternal serum CRP level obtained up to 72 hr before delivery is an independent predictor of funisitis and EONS in women with preterm labor or preterm PROM. A low serum CRP level (< 8 mg/L) has good negative predictive value in excluding funisitis and EONS, and may therefore be used as a non-invasive adjunct to clinical judgment to identify low-risk patients.
本研究旨在确定母体血清 C 反应蛋白 (CRP) 是否可用于预测早产或早产胎膜早破孕妇的胎儿炎症和早发型新生儿败血症 (EONS)。这是一项回顾性队列研究，纳入了 306 例在 CRP 检测后 72 小时内分娩的有早产或早产胎膜早破且分娩早产儿 (23-35 孕周) 的连续孕妇。采用高敏免疫分析法检测 CRP 水平。对于胎儿炎症，CRP 水平升高 (≥8mg/L) 的灵敏度、特异度、阳性预测值和阴性预测值分别为 74.1%、67.5%、32.8%和 92.4%；对于 EONS，分别为 67.7%、63.3%、17.2%和 94.6%。Logistic 回归分析表明，即使在调整了胎龄后，血清 CRP 水平升高与胎儿炎症和 EONS 显著相关。在分娩前 72 小时内获得的母体血清 CRP 水平是早产或早产胎膜早破孕妇发生胎儿炎症和 EONS 的独立预测因素。低水平的血清 CRP(<8mg/L) 对排除胎儿炎症和 EONS 具有良好的阴性预测值，因此可作为临床判断的非侵入性辅助手段，以识别低危患者。
