摘要
目的 探讨系统性免疫炎症指数(systemic immune-inflammatory index,SII)与可溶性白细胞分化抗原14亚型(Presepsin)对未足月胎膜早破(premature rupture of membranes,PROM)孕妇并发组织型绒毛膜羊膜炎(histological chorioamnionitis,HCA)的诊断价值.方法 选取2021年6月～2023年6月宿迁市第一人民医院收治的未足月PROM孕妇146例,根据是否并发HCA将患者分为非HCA组(n=44)和HCA组(n=102),另根据HCA的组织学分期将未足月PROM并发HCA患者分为Ⅰ期组(n=39),Ⅱ期组(n=33),Ⅲ期组(n=30).检测所有研究对象的SⅡ,Presepsin,C 反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)水平,采用 Pearson 相关系数分析指标间的相关性,受试者工作特征(receiver operating characteristic,ROC)曲线分析SII,Presepsin等指标对未足月PROM孕妇并发HCA的诊断价值.结果 与非HCA组比较,HCA组的SⅡ(638.96±168.12 vs 421.65±153.84),血清 Presepsin(608.62±116.97 ng/L vs 453.84±102.15 ng/L),CRP(7.01±3.02 mg/L vs 4.35±1.86 mg/L),PCT(0.13±0.05 µg/L vs 0.08±0.03 µg/L)升高,差异具有统计学意义(t=7.347,7.611,5.410,6.165,均 P＜0.05).Ⅰ 期组、Ⅱ 期组、Ⅲ期组的SII以及血清Presepsin,CRP,PCT水平依次升高,差异具有统计学意义(F=25.794,54.230,9.459,16.774,均 P＜0.05).经 Pearson 分析显示,HCA 组孕妇 SII 与 Presepsin,CRP,PCT 呈正相关(r=0.485,0.312,0.353,均 P＜0.05),Presepsin 与 CRP,PCT 呈正相关(r=0.472,0.421,P＜0.05).经 ROC 曲线分析显示,SII,Presepsin诊断未足月PROM孕妇并发HCA的曲线下面积(95％置信区间)分别为0.859(95％CI:0.794～0.923),0.877(95％CI:0.820～0.934),明显大于 CRP(0.773,95％CI:0.699～0.847)和 PCT(0.774,95％CI:0.698～0.849).结论 未足月PROM并发HCA孕妇的SII,Presepsin水平升高,且两指标的水平与HCA的组织学分期密切相关,SII,Presepsin对未足月PROM孕妇并发HCA有较高的诊断价值.
Abstract
Objective To investigate the diagnostic value of systemic immune-inflammatory index(SII)and soluble leukocyte differentiation antigen 14 subtype(Presepsin)in women with preterm premature rupture of membranes(PROM)complicated with histological chorioamnionitis(HCA).Methods A total of 146 pregnant women with preterm PROM admitted to Suqian First Hospital from June 2021 to June 2023 were selected.They were divided into non HCA group(n=44)and HCA group(n=102)based on the presence or absence of HCA.Based on the histological staging of HCA,the preterm PROM complicated with HCA group was divided into stage Ⅰ group(n=39),stage Ⅱ group(n=33)and stage Ⅲ group(n=30).The SII,Presepsin,C-reactive protein(CRP)and procalcitonin(PCT)levels of all subjects were detected.Pearson correlation coefficient was used to analyze the correlation between these indicators.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of SII,Presepsin and other indicators for HCA in pregnant women with preterm PROM.Results Compared with the non HCA group,the SII(638.96±168.12 vs 421.65±153.84),serum Presepsin(608.62±116.97 ng/L vs 453.84±102.15 ng/L),CRP(7.01±3.02 mg/L vs 4.35±1.86 mg/L)and PCT(0.13±0.05 µg/L vs 0.08±0.03 µg/L)of the HCA group were increased,and the differences were statistically significant(t=7.347,7.611,5.410,6.165,all P＜0.05).The levels of SII and serum Presepsin,CRP and PCT in stage Ⅰ,Ⅱ and Ⅲ groups were increased successively,and the differences were significant(F=25.794,54.230,9.459,16.774,all P＜0.05).Pearson analysis showed that SII in the HCA group was positively correlated with Presepsin,CRP and PCT(r=0.485,0.312,0.353,all P＜0.05),and Presepsin in the HCA group was positively correlated with CRP and PCT(r=0.472,0.421,P＜0.05).ROC(95％CI)analysis showed that the areas under the curve of SII and Presepsin diagnosis of pregnant women with HCA was 0.859(95％CI:0.794～0.923)and 0.877(95％CI:0.820～0.934),respectively,which was significantly larger than those of CRP(0.773,95％CI:0.699～0.847),and PCT(0.774,95％CI:0.698-0.849).Conclusion The levels of SII and Presepsin in pregnant women with preterm PROM complicated with HCA were higher,and the levels of these two indicators were closely related to the histological staging of HCA.SII and Presepsin may have high diagnostic value for preterm PROM pregnant women complicated with HCA.
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