血清降钙素原、基质金属蛋白酶-9和可溶性细胞间黏附分子-1联合检测对绒毛膜羊膜炎的诊断价值

doi:10.3877/cma.j.issn.1674-1358.2023.03.008

中华实验和临床感染病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 194 -199. doi: 10.3877/cma.j.issn.1674-1358.2023.03.008

论著

血清降钙素原、基质金属蛋白酶-9和可溶性细胞间黏附分子-1联合检测对绒毛膜羊膜炎的诊断价值

任琼^†(

), 吴东燕, 李中花, 石晶, 张静, 耿丽伟

050000　石家庄市，河北省优抚医院妇产科
050011　石家庄市，石家庄市第四医院妇产科
050000　石家庄市，长安区胜北社区卫生服务中心妇产科
050057　石家庄市，栾城人民医院妇产科

收稿日期:2022-06-16 出版日期:2023-06-15
通信作者: 任琼
基金资助:
河北省卫健委重点课题(No. 20171023)

Diagnostic value of combined detection of serum pro-calcitonin, matrix metalloproteinase-9 and soluble intercellular adhesion molecule 1 in chorioamnionitis

Qiong Ren^†(), Dongyan Wu, Zhonghua Li, Jing Shi, Jing Zhang, Liwei Geng

Department of Gynaecology and Obstetrics, Shijiazhuang Youfu Hospital, Shijiazhuang 050000, China
Department of Gynaecology and Obstetrics, Shijiazhuang the Fourth Hospital, Shijiazhuang 050011, China
Department of Gynaecology and Obstetrics, Shengbei Community Health Service Center, Chang'an District, Shijiazhuang 050000, China
Department of Gynaecology and Obstetrics, Luancheng People's Hospital, Shijiazhuang 050057, China

Received:2022-06-16 Published:2023-06-15
Corresponding author: Qiong Ren

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引用本文：

任琼, 吴东燕, 李中花, 石晶, 张静, 耿丽伟. 血清降钙素原、基质金属蛋白酶-9和可溶性细胞间黏附分子-1联合检测对绒毛膜羊膜炎的诊断价值[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(03): 194-199.

Qiong Ren, Dongyan Wu, Zhonghua Li, Jing Shi, Jing Zhang, Liwei Geng. Diagnostic value of combined detection of serum pro-calcitonin, matrix metalloproteinase-9 and soluble intercellular adhesion molecule 1 in chorioamnionitis[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2023, 17(03): 194-199.

目的

探讨血清降钙素原（PCT）、基质金属蛋白酶-9（MMP-9）和可溶性细胞间黏附分子-1（sICAM-1）联合检测对诊断绒毛膜羊膜炎的价值。

方法

选取2019年3月至2021年12月于河北省优抚医院就诊的83例单胎妊娠发生胎膜早破的产妇进行回顾性研究；根据胎盘病理及患者有无绒毛膜羊膜炎临床表现将患者分为4组，即临床表现和病理诊断均符合绒毛膜羊膜炎19例患者为临床+病理组；无明显临床表现但胎盘病理诊断为绒毛膜羊膜炎患者为病理组（17例）；具有一定临床表现但病理诊断为阴性的患者为临床组（20例）；其余27例患者临床表现和病理诊断均为阴性，为对照组。比较各组产妇血清PCT、MMP-9和ICAM-1水平，应用Spearman相关性分析绒毛膜羊膜炎产妇血清PCT、MMP-9和ICAM-1间的相关性；应用受试者工作特征曲线（ROC）分析3种指标单独使用和联合检测对绒毛膜羊膜炎的诊断价值。

结果

各组产妇血清PCT、MMP-9和sICAM-1水平差异有统计学意义（F = 35.907、75.807、44.363，P均< 0.001）。临床+病理组产妇PCT、MMP-9和sICAM-1水平均显著高于其他3组（P均< 0.001）。但病理组和临床组产妇PCT、MMP-9和sICAM-1水平差异无统计学意义（t = 0.328、P = 0.671，t = 0.449、P = 0.551，t = 0.173、P = 0.826）。Spearman相关性分析结果显示，绒毛膜羊膜炎产妇血清PCT与MMP-9、sICAM-1均呈正相关（r = 0.420、P = 0.001，r = 0.343、P = 0.010），血清MMP-9与sICAM-1呈显著正相关（r = 0.424、P = 0.001）。以胎盘病理诊断为金标准，评估血清PCT、MMP-9和sICAM-1水平对绒毛膜羊膜炎的诊断价值。PCT阈值设为61.020 pg/ml时，其特异度和灵敏度分别为87.2%和83.3%，ROC曲线下面积（AUC）为0.917（95%CI：0.825~0.955）；MMP-9阈值为111.412 ng/ml时，特异度和灵敏度分别为72.3%和97.2%，AUC为0.927（95%CI：0.837~0.962）；sICAM-1阈值为1 149.635 ng/ml时，特异度和灵敏度分别为83.0%和86.1%，AUC为0.879（95%CI：0.798~0.902）；联合检测特异度和灵敏度分别为93.1%和93.4%，AUC为0.951（95%CI：0.874~0.969），联合检测AUC较PCT、MMP-9和sICAM-1单独检测AUC差异无统计学意义（Z = 0.500、P = 0.617，Z = 0.901、P = 0.368），联合检测AUC显著高于sICAM-1单独检测AUC，差异具有统计学意义（Z = 3.158、P = 0.018）。

结论

血清PCT、MMP-9和sICAM-1联合检测辅助诊断绒毛膜羊膜炎有较好的灵敏度和特异性。

关键词: 绒毛膜羊膜炎, 降钙素原, 基质金属蛋白酶-9, 细胞间黏附分子-1

Objective

To investigate the value of combined detection of serum calcitonin (PCT), matrix metalloproteinase-9 (MMP-9) and soluble intercellular adhesion molecule 1 (sICAM-1) in the diagnosis of chorioamnionitis.

Methods

From March 2019 to December 2021, a total of 83 women with premature rupture of membranes (PROM) in single pregnancy in Hebei Youfu Hospital were selected, retrospectively. According to the placental pathology and clinical manifestations of chorioamnionitis, patients were divided into four groups; 19 patients with clinical and pathological findings consistent with chorioamnionitis were classified as clinical + pathological group, 17 patients without obvious clinical manifestations but with placental pathology diagnosed as chorioamnionitis were classified as pathological group, 20 patients with certain clinical manifestations but negative pathological diagnosis were classified as clinical group. The clinical manifestations and pathological diagnosis of the remaining 27 patients were negative, and they were enrolled in control group. The levels of serum PCT, MMP-9 and ICAM-1 among different groups of postpartum women were compared, and Spearman correlation analysis was used to analyze the correlations between serum PCT, MMP-9 and ICAM-1 among postpartum women with chorioamnionitis. The diagnostic value of chorioamnionitis of the three indicators alone and combination were analyzed by receiver operating characteristic curve (ROC).

Results

There were significant differences in the levels of serum PCT, MMP-9 and sICAM-1 in each group of postpartum women (F = 35.907, 75.807, 44.363, all P < 0.001). The levels of PCT, MMP-9 and sICAM-1 in the clinical + pathological group were significantly higher than those of the other three groups (all P < 0.001). However, there was no significant difference in the levels of PCT, MMP-9 and sICAM-1 between pathological group and clinical group (t = 0.328, P = 0.671; t = 0.449, P = 0.551; t = 0.173, P = 0.826). Spearman correlation analysis showed that serum PCT of cases with chorioamnionitis was positively correlated with MMP-9 and sICAM-1 (r = 0.420, P = 0.001; r = 0.343, P = 0.010), while serum MMP-9 was positively correlated with sICAM-1 (r = 0.424, P = 0.001), both with significant differences. The diagnostic values of serum PCT, MMP-9 and sICAM-1 levels for chorioamnionitis were analyzed by diagnosing placental pathology as the gold standard. When the PCT threshold was 61.020 pg/ml, its specificity and sensitivity were 87.2% and 83.3%, respectively, and the AUC was 0.917 (95%CI: 0.825-0.955); When the MMP-9 threshold was 111.412 ng/ml, the specificity and sensitivity were 72.3% and 97.2%, respectively, and the AUC was 0.927 (95%CI: 0.837-0.962); When the sICAM-1 threshold was 1 149.635 ng/ml, the specificity and sensitivity were 83.0% and 86.1%, respectively, and the AUC was 0.879 (95%CI: 0.798-0.902). The specificity and sensitivity of the combined detection of the above three indicators were 93.1% and 93.4%, respectively, with the AUC of 0.951 (95%CI: 0.874-0.969). The combined detection of AUC showed no significant difference compared with PCT and MMP-9 alone (Z = 0.500, P = 0.617; Z = 0.901, P = 0.368). The combined detection of AUC was significantly higher than that of sICAM-1 alone (Z = 3.158, P = 0.018).

Conclusions

Combined detection of serum PCT, MMP-9 and sICAM-1 has good sensitivity and specificity in assisting in diagnosis of chorioamnionitis.

Key words: Chorioamnionitis, Procalcitonin, Matrix metalloproteinase 9, Intercellular adhesion molecule -1

表1 各组产妇的一般资料

组别	例数	年龄（ ± s，岁）	孕次（ ± s，次）	产次（ ± s，次）	剖宫产[例（%）]	顺产[例（%）]	胎儿出生体重（ ± s，kg）
临床+病理组	19	33.02 ± 4.98	2.14 ± 0.46	1.56 ± 0.84	19（100.00）	0（0.00）	2.10 ± 0.32
病理组	17	32.57 ± 5.01	2.31 ± 0.59	1.49 ± 0.76	8（47.06）	9（52.94）	1.98 ± 0.23
临床组	20	32.05 ± 4.76	2.21 ± 0.48	1.51 ± 0.69	8（40.00）	12（60.00）	2.05 ± 0.33
对照组	27	32.87 ± 4.17	2.19 ± 0.51	1.53 ± 0.75	11（40.74）	16（59.26）	2.20 ± 0.28
统计量		F = 0.171	F = 0.351	F = 0.028	χ² = 20.045^a		F = 2.18
P值		0.916	0.789	0.994	< 0.001		0.097

表1 各组产妇的一般资料

组别	例数	年龄（ ± s，岁）	孕次（ ± s，次）	产次（ ± s，次）	剖宫产[例（%）]	顺产[例（%）]	胎儿出生体重（ ± s，kg）
临床+病理组	19	33.02 ± 4.98	2.14 ± 0.46	1.56 ± 0.84	19（100.00）	0（0.00）	2.10 ± 0.32
病理组	17	32.57 ± 5.01	2.31 ± 0.59	1.49 ± 0.76	8（47.06）	9（52.94）	1.98 ± 0.23
临床组	20	32.05 ± 4.76	2.21 ± 0.48	1.51 ± 0.69	8（40.00）	12（60.00）	2.05 ± 0.33
对照组	27	32.87 ± 4.17	2.19 ± 0.51	1.53 ± 0.75	11（40.74）	16（59.26）	2.20 ± 0.28
统计量		F = 0.171	F = 0.351	F = 0.028	χ² = 20.045^a		F = 2.18
P值		0.916	0.789	0.994	< 0.001		0.097

表2 各组产妇血清PCT、MMP-9和sICAM-1水平（ ± s）

组别	例数	PCT（pg/ml）	MMP-9（ng/mL）	sICAM-1（ng/ml）
临床+病理组	19	88.26 ± 15.20	178.59 ± 30.89	1468.38 ± 273.46
病理组	17	68.58 ± 19.56	125.41 ± 19.09	1176.32 ± 279.76
临床组	20	67.12 ± 10.58	120.84 ± 21.27	1042.73 ± 283.17
对照组	27	28.71 ± 9.07	84.38 ± 10.94	698.28 ± 31.28
F值		116.850	75.807	44.363
P值		< 0.001	< 0.001	< 0.001
t₁值		3.390	6.124	3.165
P₁值		0.002	< 0.001	0.003
t₂值		5.063	6.504	4.771
P₂值		< 0.001	< 0.001	< 0.001
t₃值		16.623	16.652	14.567
P₃值		< 0.001	< 0.001	< 0.001
t₄值		0.288	0.682	1.438
P₄值		0.775	0.500	0.159
t₅值		9.182	9.082	8.852
P₅值		< 0.001	< 0.001	< 0.001
t₆值		13.372	7.662	6.293
P₆值		< 0.001	< 0.001	< 0.001

表2 各组产妇血清PCT、MMP-9和sICAM-1水平（ ± s）

组别	例数	PCT（pg/ml）	MMP-9（ng/mL）	sICAM-1（ng/ml）
临床+病理组	19	88.26 ± 15.20	178.59 ± 30.89	1468.38 ± 273.46
病理组	17	68.58 ± 19.56	125.41 ± 19.09	1176.32 ± 279.76
临床组	20	67.12 ± 10.58	120.84 ± 21.27	1042.73 ± 283.17
对照组	27	28.71 ± 9.07	84.38 ± 10.94	698.28 ± 31.28
F值		116.850	75.807	44.363
P值		< 0.001	< 0.001	< 0.001
t₁值		3.390	6.124	3.165
P₁值		0.002	< 0.001	0.003
t₂值		5.063	6.504	4.771
P₂值		< 0.001	< 0.001	< 0.001
t₃值		16.623	16.652	14.567
P₃值		< 0.001	< 0.001	< 0.001
t₄值		0.288	0.682	1.438
P₄值		0.775	0.500	0.159
t₅值		9.182	9.082	8.852
P₅值		< 0.001	< 0.001	< 0.001
t₆值		13.372	7.662	6.293
P₆值		< 0.001	< 0.001	< 0.001

图1 绒毛膜羊膜炎产妇血清PCT、MMP-9、sICAM-1之间相关性注：A：PCT与MMP-9相关性；B：PCT与sICAM-1相关性；C：MMP-9与sICAM-1相关性

图2 PCT、MMP-9和sICAM-1诊断绒毛膜羊膜炎的ROC曲线

表3 血清PCT、MMP-9和sICAM-1水平对绒毛膜羊膜炎的诊断价值

检测指标	AUC	最佳阈值（pg/ml）	特异性（%）	灵敏度（%）	95%CI
PCT	0.917	61.020	87.2	83.3	0.825~0.955
MMP-9	0.927	111.412	72.3	97.2	0.837~0.962
sICAM-1	0.879	1149.635	83.0	86.1	0.798~0.902
联合检测	0.951	—	93.1	94.5	0.874~0.969

表3 血清PCT、MMP-9和sICAM-1水平对绒毛膜羊膜炎的诊断价值

检测指标	AUC	最佳阈值（pg/ml）	特异性（%）	灵敏度（%）	95%CI
PCT	0.917	61.020	87.2	83.3	0.825~0.955
MMP-9	0.927	111.412	72.3	97.2	0.837~0.962
sICAM-1	0.879	1149.635	83.0	86.1	0.798~0.902
联合检测	0.951	—	93.1	94.5	0.874~0.969

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Diagnostic value of combined detection of serum pro-calcitonin, matrix metalloproteinase-9 and soluble intercellular adhesion molecule 1 in chorioamnionitis

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Diagnostic value of combined detection of serum pro-calcitonin, matrix metalloproteinase-9 and soluble intercellular adhesion molecule 1 in chorioamnionitis