Hussey M J, Levy E S, Pombar X, Meyer P, Strassner H T
Department of Obstetrics and Gynecology, Rush-Presbyterian-St Luke's Medical Center, Chicago, Illinois 60612, USA.
Am J Obstet Gynecol. 1998 Sep;179(3 Pt 1):650-6. doi: 10.1016/s0002-9378(98)70059-6.
The aim of the study was to compare the diagnostic utility of the Gram stain, the amniotic fluid glucose level, and the ratio of amniotic fluid glucose level to serum glucose level in detecting intra-amniotic infection.
We conducted a prospective study of 127 patients with preterm labor and 26 patients with preterm premature rupture of the membranes (153 total). All patients underwent amniocentesis to diagnose intra-amniotic infection. The diagnostic criterion for intra-amniotic infection was a positive amniotic fluid culture result.
The Gram stain is 80% sensitive and 91% specific when a positive is considered the presence of white blood cells or bacteria. Amniotic fluid glucose level and the ratio of amniotic fluid glucose level to serum glucose level are significantly lower when amniotic fluid culture results are positive, but as diagnostic tests they are inferior to the Gram stain. Logistic regression models that combine predictors yield superior accuracy with respect to individual tests. The most accurate combination was amniotic fluid glucose level and Gram stain with white blood cells or bacteria. Although the number of patients with preterm premature rupture of the membranes was small in this study (n = 26), analysis of our data suggests that the diagnostic performance levels of these tests were similar when used in patients with preterm labor and intact membranes and in patients with premature rupture of the membranes.
The amniotic fluid glucose level and the ratio of amniotic fluid to serum glucose level have equivalent diagnostic utility and are inferior to the Gram stain. The combination of Gram stain with amniotic fluid glucose level is superior to any individual test.
本研究旨在比较革兰氏染色、羊水葡萄糖水平以及羊水葡萄糖水平与血清葡萄糖水平的比值在检测羊膜腔内感染方面的诊断效用。
我们对127例早产患者和26例胎膜早破早产患者（共153例）进行了一项前瞻性研究。所有患者均接受羊膜腔穿刺术以诊断羊膜腔内感染。羊膜腔内感染的诊断标准为羊水培养结果呈阳性。
当将白细胞或细菌的存在视为阳性时，革兰氏染色的敏感性为80%，特异性为91%。羊水培养结果呈阳性时，羊水葡萄糖水平以及羊水葡萄糖水平与血清葡萄糖水平的比值显著降低，但作为诊断测试，它们不如革兰氏染色。结合预测指标的逻辑回归模型在个体测试方面具有更高的准确性。最准确的组合是羊水葡萄糖水平与存在白细胞或细菌的革兰氏染色。尽管本研究中胎膜早破早产患者的数量较少（n = 26），但对我们数据的分析表明，这些测试在早产且胎膜完整的患者和胎膜早破患者中使用时，诊断性能水平相似。
羊水葡萄糖水平以及羊水与血清葡萄糖水平的比值具有同等的诊断效用，且不如革兰氏染色。革兰氏染色与羊水葡萄糖水平的组合优于任何单项测试。
