Coultrip L L, Lien J M, Gomez R, Kapernick P, Khoury A, Grossman J H
Fairfax Hospital, Falls Church, Virginia.
Am J Obstet Gynecol. 1994 Oct;171(4):901-11. doi: 10.1016/s0002-9378(94)70057-5.
Our purpose was to (1) determine the value of amniotic fluid interleukin-6 determination in the detection of microbial invasion of the amniotic cavity and (2) compare interleukin-6 to other rapid tests in the evaluation of preterm labor.
Amniotic fluid interleukin-6 was determined quantitatively by enzyme-linked immunosorbent assay in 91 amniotic fluid specimens obtained by amniocentesis in 89 patients with preterm labor. Amniotic fluid cultures for aerobes, anaerobes, and mycoplasma species were performed. Receiver-operator characteristic curve analysis, logistic regression analysis, and Cox's proportional-hazards model were used to explore the relationship between several explanatory and outcome variables. Diagnostic index values of interleukin-6, glucose level, Gram stain, leukocyte esterase, and limulus amebocyte lysate assay for prediction of a positive amniotic fluid culture, preterm delivery, clinical infection, and neonatal sepsis were calculated.
The prevalence of positive amniotic fluid cultures was 13% (12/89). The median interleukin-6 concentration in patients with positive cultures was 241.8 ng/ml, in contrast to 0.291 ng/ml in patients with negative cultures (p. < 0.005). Sensitivity and specificity of an interleukin-6 level > or = 6.17 ng/ml was 75% and 79%, in contrast to that of glucose, < or = 12 mg/dl (83% and 86%) for a positive amniotic fluid culture and sensitivity (p = 0.26, z test). All patients with an interleukin-6 level > 6.17 ng/ml were delivered preterm, in contrast to 85.2% of patients with a glucose level < or = 12 mg/dl. When all rapid tests and clinical parameters were considered simultaneously in the logistic model, only interleukin-6 maintained a significant relationship to preterm birth (odds ratio 35, p = 0.003). Cox's proportional analysis demonstrated a strong relationship between interleukin-6 and the amniocentesis-to-delivery interval after clinical variables were controlled for (hazard ratio 3.01, p < 0.00001).
Amniotic fluid interleukin-6 determination may be a useful adjunct to our armamentarium of rapid tests to exclude infection and predict delivery in patients with preterm labor and intact membranes.
我们的目的是（1）确定羊水白细胞介素-6检测在诊断羊膜腔微生物感染中的价值，以及（2）在早产评估中比较白细胞介素-6与其他快速检测方法。
采用酶联免疫吸附测定法定量检测89例早产患者羊膜穿刺获取的91份羊水标本中的羊水白细胞介素-6。对需氧菌、厌氧菌和支原体进行羊水培养。采用受试者工作特征曲线分析、逻辑回归分析和Cox比例风险模型来探讨几个解释变量和结果变量之间的关系。计算白细胞介素-6、葡萄糖水平、革兰氏染色、白细胞酯酶和鲎试剂检测对羊水培养阳性、早产、临床感染和新生儿败血症预测的诊断指标值。
羊水培养阳性率为13%（12/89）。培养阳性患者的白细胞介素-6浓度中位数为241.8 ng/ml，而培养阴性患者为0.291 ng/ml（p<0.005）。白细胞介素-6水平≥6.17 ng/ml时，羊水培养阳性的敏感性和特异性分别为75%和79%，而葡萄糖水平≤12 mg/dl时分别为83%和86%（p = 0.26，z检验）。所有白细胞介素-6水平>6.17 ng/ml的患者均早产，而葡萄糖水平≤12 mg/dl的患者中这一比例为85.2%。在逻辑模型中同时考虑所有快速检测和临床参数时，只有白细胞介素-6与早产保持显著关系（优势比35，p = 0.003）。Cox比例分析表明，在控制临床变量后，白细胞介素-6与羊膜穿刺至分娩间隔之间存在密切关系（风险比3.01，p<0.00001）。
羊水白细胞介素-6检测可能是我们用于排除感染和预测胎膜完整的早产患者分娩的快速检测手段中的一项有用辅助方法。
