羊水白细胞计数、葡萄糖、白细胞介素-6及革兰氏染色在胎膜完整的早产患者中的诊断及预后价值
The diagnostic and prognostic value of amniotic fluid white blood cell count, glucose, interleukin-6, and gram stain in patients with preterm labor and intact membranes.
作者信息
Romero R, Yoon B H, Mazor M, Gomez R, Diamond M P, Kenney J S, Ramirez M, Fidel P L, Sorokin Y, Cotton D
机构信息
Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48201.
出版信息
Am J Obstet Gynecol. 1993 Oct;169(4):805-16. doi: 10.1016/0002-9378(93)90009-8.
OBJECTIVE
Our goal was to compare the value of amniotic fluid tests in the detection of microbial invasion of the amniotic cavity and in the relationship with the amniocentesis-to-delivery interval and neonatal complications in patients with preterm labor and intact membranes.
STUDY DESIGN
Amniotic fluid was retrieved by transabdominal amniocentesis from 120 patients with preterm labor and intact membranes. Fluid was cultured for aerobic and anaerobic bacteria and for mycoplasmas. Amniotic fluid analysis included a Gram stain, white blood cell count, glucose and interleukin-6 determinations. Logistic regression and Cox's proportional hazards model were used for analysis.
RESULTS
(1) The prevalence of positive amniotic fluid cultures was 9.2% (11/120); (2) patients with microbial invasion had a shorter amniocentesis-to-delivery interval and a higher neonatal complications rate than patients with a negative culture; (3) the most sensitive test for the detection of microbial invasion of the amniotic cavity was amniotic fluid interleukin-6 determinations (cutoff 11.3 ng/ml) (sensitivity; for interleukin-6 100%, for glucose 81.8%, for white blood cell count 63.6%, and for Gram stain 63.6%; p < 0.05 for all comparisons); (4) the most specific test was the Gram stain of amniotic fluid (specificity: for Gram stain 99.1%, for white blood cell count 94.5%, for interleukin-6 82.6%, and for glucose 81.6%; p < 0.01 for all); (5) of all amniotic fluid tests, interleukin-6 determinations were the only ones that had significant relationship with the amniocentesis-to-delivery interval and neonatal complications.
CONCLUSION
Interleukin-6 concentrations in amniotic fluid are better indicators of microbial invasion of the amniotic cavity, amniocentesis-to-delivery interval, and neonatal complications than the amniotic fluid Gram stain, glucose concentration, or white blood cell count.
目的
我们的目标是比较羊水检测在检测羊膜腔微生物入侵方面的价值，以及其与早产且胎膜完整患者的羊膜腔穿刺至分娩间隔和新生儿并发症之间的关系。
研究设计
通过经腹羊膜腔穿刺术从120例早产且胎膜完整的患者中获取羊水。对羊水进行需氧菌、厌氧菌和支原体培养。羊水分析包括革兰氏染色、白细胞计数、葡萄糖和白细胞介素-6测定。采用逻辑回归和Cox比例风险模型进行分析。
结果
（1）羊水培养阳性率为9.2%（11/120）；（2）与培养阴性的患者相比，微生物入侵患者的羊膜腔穿刺至分娩间隔更短，新生儿并发症发生率更高；（3）检测羊膜腔微生物入侵最敏感的检测方法是羊水白细胞介素-6测定（临界值为11.3 ng/ml）（敏感性：白细胞介素-6为100%，葡萄糖为81.8%，白细胞计数为63.6%，革兰氏染色为63.6%；所有比较p<0.05）；（4）最具特异性的检测方法是羊水革兰氏染色（特异性：革兰氏染色为99.1%，白细胞计数为94.5%，白细胞介素-6为82.6%，葡萄糖为81.6%；所有p<0.01）；（5）在所有羊水检测中，白细胞介素-6测定是唯一与羊膜腔穿刺至分娩间隔和新生儿并发症有显著关系的检测方法。
结论
与羊水革兰氏染色、葡萄糖浓度或白细胞计数相比，羊水中白细胞介素-6浓度是羊膜腔微生物入侵、羊膜腔穿刺至分娩间隔和新生儿并发症的更好指标。
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