Bittar R E, Yamasaki A A, Sasaki S, Zugaib M
Obstetric Clinic, University of Säo Paulo Medical School, Brazil.
Am J Obstet Gynecol. 1996 Jul;175(1):178-81. doi: 10.1016/s0002-9378(96)70271-5.
This study aimed to evaluate fetal fibronectin concentrations in cervical secretions measured by either a rapid immunoassay or an enzyme-linked immunosorbent assay as a tool for the screening of premature delivery in otherwise asymptomatic pregnant women at high risk for prematurity.
One hundred two pregnant women at high risk for premature delivery were followed up. Samples of the cervical secretion were taken every 2 weeks between the twenty-fourth and the thirty-fourth weeks of pregnancy. The samples were obtained from the ectocervix with two swabs. One cervical sample was used for the immediate-reading membrane test, and the other one for the immunoenzyme test. The correlation between the presence of fetal fibronectin in the cervical secretions and preterm birth was evaluated. In addition, a comparison between tests was made.
The rate of preterm birth was 37.25% (38/102). Membrane tests revealed a sensitivity of 73.68% and a specificity of 92.18%; its positive predictive value was 84.84% and the negative predictive value was 85.50%. The enzyme-linked immunosorbent assays revealed a sensitivity of 78.94% and a specificity of 85.93%; its positive predictive value was 76.92%, and the negative predictive value was 87.30%. When compared with each other, the tests were found essentially concordant (p < 0.05). The elapsed time between the last sampling and the occurrence of preterm birth was 2.9 +/- 1.8 weeks.
The rapid result membrane test is comparable to the standard fetal fibronectin enzyme-linked immunosorbent assays for the detection of fetal fibronectin in cervical secretions between the twenty-fourth and thirty-fourth weeks of gestation. Moreover, both assays were found to be good tools for the prediction of premature delivery in asymptomatic pregnant women at high risk for prematurity. The availability of a rapid search for the presence of cervical fetal fibronectin should improve our ability to efficiently identify patients at risk for preterm delivery to discriminate between such patients and those with benign Braxton Hicks contractions.
本研究旨在评估通过快速免疫测定法或酶联免疫吸附测定法检测宫颈分泌物中胎儿纤连蛋白浓度，以此作为筛查无症状但早产风险较高的孕妇早产的一种工具。
对102名早产风险较高的孕妇进行随访。在妊娠第24周至第34周期间，每2周采集一次宫颈分泌物样本。用两根拭子从宫颈外口获取样本。一份宫颈样本用于即时读数膜试验，另一份用于免疫酶试验。评估宫颈分泌物中胎儿纤连蛋白的存在与早产之间的相关性。此外，还对两种检测方法进行了比较。
早产率为37.25%（38/102）。膜试验显示敏感性为73.68%，特异性为92.18%；其阳性预测值为84.84%，阴性预测值为85.50%。酶联免疫吸附测定显示敏感性为78.94%，特异性为85.93%；其阳性预测值为76.92%，阴性预测值为87.30%。相互比较时，发现两种检测方法基本一致（p<0.05）。最后一次采样至早产发生的时间间隔为2.9±1.8周。
快速结果膜试验与标准的胎儿纤连蛋白酶联免疫吸附测定法在检测妊娠第24周至第34周宫颈分泌物中的胎儿纤连蛋白方面具有可比性。此外，两种检测方法均被发现是预测无症状但早产风险较高的孕妇早产的良好工具。快速检测宫颈胎儿纤连蛋白的可用性应能提高我们有效识别早产风险患者的能力，以便区分此类患者与良性布拉克斯顿希克斯宫缩患者。
