妊娠中期胎盘α微球蛋白1联合宫颈长度对自发性早产的预测价值

Predictive value of placental alpha-microglobulin-1 combined with cervical length in mid pregnancy for spontaneous preterm birth and pregnancy outcomes

摘要

目的 评价妊娠中期胎盘α微球蛋白1(PAMG-1)联合宫颈长度(CL)对自发性早产(sPTB)的预测价值。方法 回顾性分析2022年3月~2024年3月在徐州市中心医院规律产检并分娩的87例sPTB孕产妇(sPTB组)和100例健康足月分娩孕产妇(足月产组)的临床资料。比较两组妊娠中期经阴道超声测量的CL以及阴道分泌物检测的PAMG-1阳性率的差异,并采用受试者工作特征(ROC)曲线分析两指标单独及联合对sPTB的预测效能。结果 sPTB组PAMG-1阳性率明显高于足月产组(χ²=20.075,P<0.001),CL显著低于足月产组(t=9.529,P<0.001)。Logistic多因素回归分析结果显示:妊娠中期PAMG-1阳性[OR=24.095(95%CI:16.377~35.450)]和CL值[OR=0.065(95%CI:0.017~0.254)]是sPTB的独立预测因子(P<0.05);ROC曲线结果表明:PAMG-1预测sPTB的曲线下面积(AUC)为0.653(95%CI:0.573~0.733),灵敏度、特异度分别为43.68%和87.00%;CL预测的AUC为0.835(95%CI:0.779~0.891),最佳预测值为29.2mm,灵敏度和特异度分别为80.46%和77.00%;以妊娠中期PAMG-1阳性、CL<29.2mm联合预测的AUC为0.839(95%CI:0.780~0.899),灵敏度为98.85%,特异度为69.00%;联合预测的效果优于单独PAMG-1预测(Z_{联合/PAMG-1}=5.625,P<0.05),与单独CL预测效果无差异(Z_联合/CL=0.156,P=0.876);单独CL预测效果优于单独PAMG-1预测(Z_CL/PAMG-1=4.061,P<0.05)。结论 妊娠中期CL缩短、PAMG-1阳性是孕妇sPTB的高发风险因素,二者联合可辅助sPTB预测。

Abstract

Objective To evaluate predictive value of placental alpha-microglobulin-1 (PAMG-1) combined with cervical length (CL) in mid pregnancy for spontaneous preterm birth (sPTB) and pregnancy outcomes. Methods The clinical data of 87 sPTB pregnant women (sPTB group) and 100 healthy full-term delivery women (full-term delivery group) who received regular prenatal examination and delivered in Xuzhou Municipal Central Hospital from March 2022 to March 2024 were retrospectively analyzed. The CL obtained by transviginal sonography (TVS) and positive rate of PAMG-1 in the vaginal secretions of the pregnant women in mid pregnancy were compared between the two groups, and receiver operating characteristic (ROC) curve was used to analyze efficacy of individual prediction and combined prediction of the two indexes for sPTB. Results The positive rate of PAMG-1 in the sPTB group was significantly higher than that in the full-term delivery group (χ²=20.075, P<0.001), while the CL was significantly shorter than that in the full-term delivery group (t=9.529, P<0.001). Multivariate Logistic regression analysis showed that positive rate of PAMG-1 [OR=24.095 (95%CI: 16.377-35.450)] and CL value [OR=0.065 (95%CI: 0.017-0.254)] in mid pregnancy were independent predictors of sPTB (both P<0.05). The ROC curve analysis showed that the area under the curve (AUC) of PAMG-1 for predicting sPTB was 0.653 (95%CI: 0.573-0.733), when the sensitivity was 43.68% and the specificity was 87.00%. The AUC of CL for predicting sPTB was 0.835 (95%CI: 0.779-0.891), the best predicted value was 29.2mm, when the sensitivity was 80.46% and the specificity was 77.00%. The AUC of combination of positive PAMG-1 and CL<29.2mm in mid pregnancy for predicting sPTB was 0.839 (95%CI: 0.780-0.899), the sensitivity was 98.85% and the specificity was 69.00%. The efficacy of the combined prediction of the two indexes was better than that of individual positive PAMG-1 (Z_{combined/PAMG-1}=5.625, P<0.05), and there was no difference in predictive efficacy between the combined prediction of the two indexes and the individual CL prediction (Z_combined/CL=0.156, P=0.876). And the efficacy of the individual CL prediction was better than that of the individual positive PAMG-1 (Z_CL/PAMG-1=4.061, P<0.05). Conclusion The shortened CL and positive PAMG-1 in mid pregnancy are high risk factors for sPTB in pregnant women, and combination of the two indexes can assist in predicting sPTB.

关键词

自发性早产 / 妊娠中期 / 胎盘α微球蛋白-1 / 宫颈长度 / 预测效能

Key words

spontaneous premature birth / mid pregnancy / placental alpha-microglobulin-1 / cervical length / predictive efficacy

参考文献

[1] 蒋湘, 应豪. 子宫颈手术史孕妇自发性早产的预测和预防[J]. 中国实用妇科与产科杂志, 2023, 39(6): 597-601.

[2] Feduniw S, Pruc M, Ciebiera M, et al. Biomarkers for Pregnancy Latency Prediction after Preterm Premature Rupture of Membranes-A Systematic Review[J]. Int J Mol Sci, 2023, 24(9): 8027.

[3] 唐瑶, 龚小会, 刘海燕, 等. 自发性早产孕妇血清中子宫平滑肌功能相关miRNA的表达及生物学功能分析[J]. 复旦学报(医学版), 2022, 49(2): 168-174.

[4] EPPPIC Group. Evaluating Progestogens for Preventing Preterm birth International Collaborative (EPPPIC):meta-analysis of individual participant data from randomised controlled trials[J]. Lancet, 2021, 397(10280): 1183-1194.

[5] 吴茜, 陈俊雅, 张潇潇, 等. 早中孕期经阴道超声测量子宫颈长度对单胎孕妇自发性早产的预测价值[J]. 中华围产医学杂志, 2022, 25(5): 326-331.

[6] Kashanian M, Eshraghi N, Rahimi M, et al. Evaluation of placental alpha microglobulin-1 (PAMG1) accuracy for prediction of preterm delivery in women with the symptoms of spontaneous preterm labor:a comparison with cervical length and number of contractions[J]. J Matern Fetal Neonatal Med, 2022, 35(3): 534-540.

[7] 中华医学会妇产科学分会产科学组. 早产临床诊断与治疗指南(2014)[J]. 中华围产医学杂志, 2015, 18(4): 241-245.

[8] Gomez-Lopez N, Galaz J, Miller D, et al. The immunobiology of preterm labor and birth:intra-amniotic inflammation or breakdown of maternal-fetal homeostasis[J]. Reproduction, 2022, 164(2): R11-R45.

[9] Cao G, Liu J, Liu M. Global,Regional,and National Incidence and Mortality of Neonatal Preterm Birth,1990-2019[J]. JAMA Pediatr, 2022, 176(8): 787-796.

[10] 刘明霞, 花静, 柯李, 等. 早产和早期出生与中国城市儿童发育性协调障碍的相关性研究[J]. 中国妇幼健康研究, 2022, 33(3): 28-35.

[11] Hoffman M K. Prediction and Prevention of Spontaneous Preterm Birth:ACOG Practice Bulletin,Number 234[J]. Obstet Gynecol, 2021, 138(6): 945-946.

[12] D'Antonio F, Eltaweel N, Prasad S, et al. Cervical cerclage for prevention of preterm birth and adverse perinatal outcome in twin pregnancies with short cervical length or cervical dilatation:A systematic review and meta-analysis[J]. PLoS Med, 2023, 20(8): e1004266.

[13] 曲首辉, 时春艳, 陈倩, 等. 孕中,晚期孕妇子宫颈长度测量对早产的预测价值[J]. 中华妇产科杂志, 2011, 46(10): 748-752.

[14] Wu T, Li S, Gong X, et al. Longitudinal cervical length measurements and spontaneous preterm birth in singleton and twin pregnancies[J]. JAMA Netw Open, 2024, 7(4): e244592.

[15] 詹佐令, 彭格红. 经阴道超声测量子宫宫颈前角和宫颈长度对双胎早产的预测价值[J]. 宁夏医科大学学报, 2023, 45(11): 1137-1142.

[16] 黄颖敏, 廖剑艺, 李映桃, 等. 经阴道超声测量宫颈前角与宫颈长度预测宫颈环扎术后早产的对比研究[J]. 中国医学影像学杂志, 2021, 29(5): 498-502.

[17] Eleje G U, Ezugwu E C, Ezebialu I U, et al. Performance indices of AmnioQuick Duo+ versus placental α-microglobulin-1 tests for women with prolonged premature rupture of membranes[J]. Int J Gynaecol Obstet, 2019, 144(2): 180-186.

[18] 马蔷, 艾玲, 曹云飞, 等. 宫颈分泌物胎盘α-1微球蛋白联合宫颈长度预测自发性早产的可行性分析[J]. 中国妇幼保健, 2024, 39(11): 1953-1957.

[19] Chawanpaiboon S, Titapant V, Pooliam J. Placental α-microglobulin-1 in cervicovaginal fluid and cervical length to predict preterm birth by Thai women with symptoms of labor[J]. Asian Biomed (Res Rev News), 2021, 15(3): 119-127.

[20] 裴菲, 张媛媛, 李青. 先兆早产孕妇的临床特征及自发性早产发生风险模型的构建与验证[J]. 中国妇幼健康研究, 2023, 34(11): 1-10.