采用 CCL2 和 CXCL10 对有症状高危孕妇血清进行预测：一项前瞻性队列研究。
Prediction of spontaneous preterm birth using CCL2 and CXCL10 in maternal serum of symptomatic high-risk pregnant women: a prospective cohort study.
机构信息
Department of Obstetrics and Gynecology, Rostock University Medical Centre, Rostock, Germany.
Department of Obstetrics and Gynecology, HELIOS Hospital Schwerin, Schwerin, Germany.
出版信息
BMC Pregnancy Childbirth. 2023 Sep 28;23(1):697. doi: 10.1186/s12884-023-06016-3.
INTRODUCTION
CCL2 and CXCL10 are putative biomarkers for the prediction of spontaneous preterm birth. This study evaluates these markers in a cohort of pregnant high-risk women.
MATERIAL AND METHODS
In our prospective study, we included 109 women with signs of preterm labor between 20 + 0 and 31 + 6 weeks of gestation. Inclusion criteria were regular (< 3/30 min) or painful contractions, cervical length < 25 mm or a history of previous preterm birth (PTB). Blood samples were obtained upon first admission to our clinic. Biomarker concentrations were measured using pre-coated sandwich immunoassays (ELISA). Primary study outcome was spontaneous preterm birth < 34 weeks, secondary outcome was delivery < 37 weeks or within seven days after study inclusion.
RESULTS
Sixteen women (14.7%) delivered < 34 weeks and twenty women between 34 + 0 and 36 + 6 weeks (18.4%). Six patients (5.5%) gave birth within seven days after study admission. CXCL10 showed higher medium serum levels in women with PTB < 34 weeks (115 pg/ml compared to 61 pg/ml ≥ 34 weeks; p < 0.001) and < 37 weeks (103 pg/ml vs. 53 pg/ml; p < 0.001). In contrary, lower CCL2 serum levels were associated with PTB < 34 weeks (46 pg/ml vs. 73 pg/ml; p = 0.032) and birth within 7 days (25 pg/ml vs. 73 pg/ml; p = 0.008). The CXCL10/CCL2-ratio further improved the predictive model with a ROC-AUC of 0.83 (95% CI 0.73-0.93, p < 0.001) for delivery < 34 weeks. These corresponds to a sensitivity, specificity and positive predictive value of 0.67, 0.86 and 0.43 at a cut-off of 2.2.
CONCLUSION
Low maternal serum CCL2 levels are associated with a higher risk of preterm delivery within seven days. High CXCL10 serum levels are more associated with a high risk for preterm birth < 34 weeks. Elevated CXCL10/CCL2-ratio is showing the best predictive performance.
TRIAL REGISTRATION NUMBER (DRKS-ID): DRKS00010763, Registration date: September 02, 2016.
简介
CCL2 和 CXCL10 是预测自发性早产的潜在生物标志物。本研究评估了这些标志物在高危孕妇队列中的表现。
材料与方法
在我们的前瞻性研究中，纳入了 109 名在 20+0 至 31+6 周妊娠时出现早产迹象的孕妇。纳入标准为规律（<3/30 分钟）或疼痛性宫缩、宫颈长度<25 毫米或有早产史（PTB）。第一次就诊时采集血样。使用预包被的夹心免疫测定法（ELISA）测量生物标志物浓度。主要研究结局为自发性早产<34 周，次要结局为<37 周或研究纳入后 7 天内分娩。
结果
16 名妇女（14.7%）在<34 周分娩，20 名妇女在 34+0 至 36+6 周分娩（18.4%）。6 名患者（5.5%）在研究入院后 7 天内分娩。CXCL10 在<34 周早产（115pg/ml 比≥34 周早产（61pg/ml；p<0.001）和<37 周早产（103pg/ml 比 53pg/ml；p<0.001）的妇女中血清水平更高。相反，较低的 CCL2 血清水平与<34 周早产（46pg/ml 比 73pg/ml；p=0.032）和 7 天内分娩（25pg/ml 比 73pg/ml；p=0.008）相关。CXCL10/CCL2 比值进一步改善了预测模型，ROC-AUC 为 0.83（95%CI 0.73-0.93，p<0.001），用于预测<34 周分娩。这对应于 0.67 的灵敏度、0.86 的特异性和 0.43 的阳性预测值，截止值为 2.2。
结论
孕妇血清 CCL2 水平较低与 7 天内早产风险增加相关。高 CXCL10 血清水平与<34 周早产风险增加更为相关。升高的 CXCL10/CCL2 比值显示出最佳的预测性能。
试验注册号（DRKS-ID）：DRKS00010763，登记日期：2016 年 9 月 2 日。
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