Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
BJOG. 2023 Aug;130(9):1072-1079. doi: 10.1111/1471-0528.17431. Epub 2023 Mar 13.
To investigate reliable biomarkers for predicting histological chorioamnionitis (HCA) in women with preterm prelabour rupture of membranes (PPROM).
A retrospective study.
A maternity care hospital in Shanghai.
Women with PPROM before 34 weeks of gestation.
Mean values of biomarkers were compared by two-way analysis of variance (ANOVA). Log-binomial regression models were used to assess the association between biomarkers and risk of HCA. A stepwise logistic regression model was used to develop a multi-biomarker prediction model and identify the independent predictors. The area under the receiver operating characteristic curve (AUC) was used to assess prediction performance.
The ability of the individual biomarker and the combination of multiple biomarkers to predict HCA.
In 157 mothers with PPROM, 98 (62.42%) women had HCA and 59 (37.58%) women did not have HCA. No significant differences were observed between the two groups in white blood cell, neutrophil or lymphocyte counts, whereas both high-sensitivity C-reactive protein (hsCRP) and procalcitonin (PCT) were significantly higher in the HCA group. HsCRP and PCT were found to be independently associated with the risk of HCA, and PCT had a larger AUC value than hsCRP (p < 0.05). The optimal multi-biomarker prediction model for HCA (AUC = 93.61%) included hsCRP at 72 hours and PCT at 48 and 72 hours, and PCT had a stronger prediction capacity than hsCRP.
PCT could be a reliable biomarker for the early prediction of HCA in women with PPROM within 72 hours of dexamethasone treatment.
研究预测胎膜早破早产（PPROM）孕妇发生组织学绒毛膜羊膜炎（HCA）的可靠生物标志物。
回顾性研究。
上海一家产科医院。
妊娠 34 周前发生 PPROM 的孕妇。
采用双因素方差分析（ANOVA）比较生物标志物的均值。采用对数二项式回归模型评估生物标志物与 HCA 风险之间的关联。采用逐步逻辑回归模型建立多生物标志物预测模型并识别独立预测因子。采用受试者工作特征曲线（ROC）下面积（AUC）评估预测性能。
单个生物标志物和多个生物标志物联合预测 HCA 的能力。
在 157 例 PPROM 孕妇中，98 例（62.42%）孕妇发生 HCA，59 例（37.58%）孕妇未发生 HCA。两组间白细胞、中性粒细胞或淋巴细胞计数无显著差异，而 HCA 组高敏 C 反应蛋白（hsCRP）和降钙素原（PCT）均显著升高。hsCRP 和 PCT 被发现与 HCA 风险独立相关，且 PCT 的 AUC 值大于 hsCRP（p<0.05）。HCA 的最佳多生物标志物预测模型（AUC=93.61%）包括 72 小时 hsCRP 和 48、72 小时 PCT，且 PCT 的预测能力强于 hsCRP。
在接受地塞米松治疗 72 小时内，PCT 可能是预测 PPROM 孕妇发生 HCA 的可靠生物标志物。
