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目的探讨孕妇羊水中可溶性人白细胞抗原G(sHLA-G)的水平与胎膜早破合并绒毛膜羊膜炎的关系。方法运用双抗体夹心酶联免疫吸附(ELISA)法测定89例胎膜早破孕产妇(包括足月胎膜早破60例和未足月胎膜早破29例)及40例正常足月分娩孕产妇羊水中sHLA-G的水平,同时用散射比浊法测定上述研究对象分娩前血清中CRP的含量,最后对所有产后胎膜进行病理检查,判断有无绒毛膜羊膜炎。结果①胎膜早破患者羊水中sHLA-G的水平和血清中CRP中水平均显著高于正常足月孕妇(P<0.05);②胎膜早破并发绒毛膜羊膜炎的患者羊水中sHLA-G的水平显著高于未发生绒毛膜羊膜炎者(P<0.05);③以羊水sHLA-G≥53.46U/ml作为绒毛膜羊膜炎的诊断阈值,其敏感性、特异性及ROC曲线下面积分别为88%、89.7%、0.89,明显优于血清C-反应蛋白指标(70.0%,69.2%,0.74,诊断阈值为3.5mg/L)。结论发生绒毛膜羊膜炎时,羊水中sHLA-G的水平升高,与血清CRP相比,其诊断价值更高,可作为胎膜早破合并绒毛膜羊膜炎的可靠的辅助诊断指标。
Objective To investigate the relationship between soluble human leukocyte antigen G (sHLA-G) and premature rupture of membranes and chorioamnionitis in pregnant women. Methods Eighty-nine pregnant women with premature rupture of membranes (including 60 cases of premature rupture of membranes and 29 cases of premature rupture of membranes) and 40 normal full-term labor were measured by double antibody sandwich enzyme-linked immunosorbent assay (ELISA) The sHLA-G level in pregnant women’s amniotic fluid was measured. The levels of CRP in serum before delivery were measured by nephelometry. Finally, all the postnatal membranes were examined for pathology to determine if there was chorioamnionitis. Results ① The level of sHLA-G in amniotic fluid and the level of serum CRP in premature rupture of membranes were significantly higher than those in normal full-term pregnant women (P <0.05). ② In patients with premature rupture of membranes, amniotic fluid sHLA- G was significantly higher than that without chorioamnionitis (P <0.05); ③In the amniotic fluid sHLA-G≥53.46U / ml as the diagnostic threshold of chorioamnionitis, the sensitivity, specificity and area under the ROC curve 88%, 89.7% and 0.89 respectively, which were significantly better than those of serum C-reactive protein (70.0%, 69.2%, 0.74, the diagnostic threshold was 3.5 mg / L). Conclusions When chorioamnionitis occurs, the level of sHLA-G in amniotic fluid increases. Compared with serum CRP, it has higher diagnostic value. It can be used as a reliable diagnostic index for premature rupture of membranes and chorioamnionitis.