【作者】 周密；

【导师】 郑九生；

【作者基本信息】 南昌大学 ， 妇产科学（专业学位）， 2017， 硕士

【摘要】 目的探讨联合检测血清C-反应蛋白(CRP)和降钙素原(PCT)对未足月胎膜早破合并绒毛膜羊膜炎的诊断价值,血清CRP和PCT水平与胎膜早破时间及绒毛膜羊膜炎发生率的相关性。方法选择200例未足月胎膜早破孕妇为观察组,其中破膜至分娩时间≥24h为长时组110例,破膜至分娩时间<24h为短时组90例,正常未足月孕妇120例为对照组。检测产前各组血清CRP、PCT水平,产后通过病理学检测胎盘组织中中性粒细胞/淋巴细胞量诊断绒毛膜羊膜炎,计算血清CRP、PCT、CRP+PCT诊断绒毛膜羊膜炎的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比及阴性似然比。结果观察组中长时组应用抗生素前血清CRP、PCT水平均高于短时组及对照2组入院2h内,长时、短时2组入院2h内血清PCT水平均高于对照组入院2h内(均p<0.05)。胎膜早破时间(t)与血清CRP水平之间呈直线正相关(r=0.533,p<0.05)。胎膜早破时间(t)与血清PCT水平之间呈直线正相关(r=0.649,p<0.05)。血清PCT诊断绒毛膜羊膜炎的敏感性、特异性、阳性预测值及阴性预测值与血清CRP诊断比较差异无统计学意义(p>0.05)。血清CRP+PCT联合诊断绒毛膜羊膜炎的敏感性、特异性、阳性预测值及阴性预测值均高于血清CRP、PCT诊断(均p<0.05);血清CRP+PCT联合诊断绒毛膜羊膜炎的阳性似然比高于血清CRP、PCT诊断,阴性似然比低于血清CRP、PCT诊断。结论血清CRP、PCT联合检测对未足月胎膜早破并发绒毛膜羊膜炎的有重要的诊断价值。胎膜早破时间越长,血清CRP、PCT水平越高,绒毛膜羊膜炎的发生率也越高。更多还原

【Abstract】 Objective:To investigate the diagnostic value of combined detection of serum C-reactive protein(CRP)and procalcitonin(PCT)in patients with preterm premature rupture of membranes(PPROM)complicated with chorioamnionitis,And the correlation between the length of premature rupture of membranes with serum CRP and PCT levels and the incidence of chorioamnionitis.Methods:200 cases of preterm premature rupture of membranes patients were selected as observation group,which 110 cases rupture of membranes to delivery time ≥ 24 h for the long-term group,90 cases rupture of membranes to delivery time <24h for the short-term group,120 normal not-full-term pregnant women were selected as control group.The levels of serum CRP and PCT were detected in each group.The levels of serum CRP and PCT were inferred whether the level of the two is related to the change of time.The diagnosis of chorioamnionitis with pathology as the gold standard,and to calculate the sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio of serum CRP,PCT,CRP + PCT in diagnosis of chorioamnionitis.Results:The serum CRP and PCT levels 2h admission before the application of antibiotics in the long time group were higher than those in the same group and short term group,and the control group was 2h admission.The levels of serum PCT in the long time group and short term group 2h admission were higher than those in the control group 2h admission(p<0.05).The serum CRP levels of PPROM were linearly positive correlation.The serum PCT levels of PPROM were linearly positive correlation.The sensitivity,specificity,positive predictive value and negative predictive value of serum PCT in the diagnosis of chorioamnionitis were not significantly different from those of serum CRP(p>0.05).The sensitivity,specificity,positive predictive value and negative predictive value of serum CRP+PCT in the diagnosis of chorioamnionitis were higher than those of serum CRP and PCT(p<0.05);The positive likelihood ratio of CRP+PCT in the diagnosis of chorioamnionitis was higher than that of serum CRP and PCT,and the negative likelihood ratio was lower than that of serum CRP and PCT.Conclusion:Combined detection of serum CRP and PCT has important value in diagnosis of chorioamnionitis in preterm premature rupture of membranes.The time longer the premature rupture of membranes,The higher serum CRP and PCT levels,The higher incidence of chorioamnionitis.更多还原