Smith Erik J, Muller Corinna L, Sartorius Jennifer A, White David R, Maslow Arthur S
Department of Maternal Fetal Medicine, Danville, PA 17822-2920, USA.
J Am Osteopath Assoc. 2012 Oct;112(10):660-4.
Chorioamnionitis (CAM) affects many pregnancies complicated by preterm premature rupture of membranes (PPROM). Finding a serum factor that could accurately predict the presence of CAM could potentially lead to more efficient management of PPROM and improved neonatal outcomes.
To determine if C-reactive protein (CRP) is an effective early marker of CAM in patients with PPROM.
A retrospective evaluation of pregnant women with PPROM at Geisinger Medical Center in Danville, Pennsylvania, between January 2005 and January 2009. Nonparametric statistical tests (ie, Wilcoxon rank sum and Spearman rank correlation) were used to compare distributions that were skewed. Characteristics of the study population were compared using 2-sample t tests for continuous variables and Fisher exact tests for discrete variables. Logistic regression analysis was used to generate receiver operating characteristic curves and obtain area under the curve estimates in stepwise fashion for predicting histologic CAM. A secondary analysis compared the characteristics among patients with clinical CAM, histologic CAM, or non-CAM.
The total population of 73 women was subdivided into patients with histologic CAM (n=26) and patients without histologic CAM (ie, no evidence of CAM on placental pathology; n=47). There was no difference between groups in CRP levels, days of pregnancy latency, white blood cell count, smoking status, antibiotic administration, or steroid benefit. The group with histologic CAM delivered at earlier gestational ages: mean (standard deviation) age was 29.5 (4.4) weeks vs 31.9 (3.5) weeks (P=.02). For our primary analysis, we found no difference in CRP levels (P=.32). Receiver operating characteristic curve plots of CRP levels, temperature at delivery, and white blood cell count resulted in an area under the curve estimate of 0.696, which was 70% predictive of histologic CAM. In the secondary analysis, after adjusting for gestational age, the estimated hazard ratio for CRP change was 1.05 (95% confidence interval, 1.02-1.08; P=.001). Therefore, increasing CRP levels from PPROM was statistically significant in predicting clinical CAM development over time.
C-reactive protein levels were not effective independent predictors of clinical or histologic CAM, nor was sequential CRP testing statistically significant for the identification of clinical or histologic CAM in patients with PPROM.
绒毛膜羊膜炎（CAM）影响许多合并胎膜早破（PPROM）的妊娠。找到一种能准确预测CAM存在的血清因子可能会使PPROM的管理更有效，并改善新生儿结局。
确定C反应蛋白（CRP）是否为PPROM患者CAM的有效早期标志物。
对2005年1月至2009年1月在宾夕法尼亚州丹维尔的盖辛格医疗中心患有PPROM的孕妇进行回顾性评估。使用非参数统计检验（即Wilcoxon秩和检验和Spearman秩相关检验）比较偏态分布。对于连续变量，使用两样本t检验比较研究人群的特征；对于离散变量，使用Fisher精确检验。使用逻辑回归分析生成受试者工作特征曲线，并逐步获得曲线下面积估计值以预测组织学绒毛膜羊膜炎。二次分析比较了临床绒毛膜羊膜炎、组织学绒毛膜羊膜炎或非绒毛膜羊膜炎患者的特征。
73名女性的总人群被分为组织学绒毛膜羊膜炎患者（n = 26）和无组织学绒毛膜羊膜炎患者（即胎盘病理学上无绒毛膜羊膜炎证据；n = 47）。两组在CRP水平、妊娠潜伏期天数、白细胞计数、吸烟状况、抗生素使用或类固醇益处方面无差异。组织学绒毛膜羊膜炎组的分娩孕周更早：平均（标准差）年龄为29.5（4.4）周，而另一组为31.9（3.5）周（P = 0.02）。对于我们的主要分析，我们发现CRP水平无差异（P = 0.32）。CRP水平、分娩时体温和白细胞计数的受试者工作特征曲线绘制得出曲线下面积估计值为0.696，这对组织学绒毛膜羊膜炎的预测率为70%。在二次分析中，在调整孕周后，CRP变化的估计风险比为1.05（95%置信区间，1.02 - 1.08；P = 0.001）。因此，随着时间的推移，PPROM时CRP水平升高在预测临床绒毛膜羊膜炎发展方面具有统计学意义。
C反应蛋白水平不是临床或组织学绒毛膜羊膜炎的有效独立预测指标，连续CRP检测对于识别PPROM患者的临床或组织学绒毛膜羊膜炎也无统计学意义。
