摘要
目的研究胎膜早破患者外周血降钙素原（procalcitonin,PCT）水平,以了解细菌感染情况和指导抗生素治疗。方法选取龙华新区人民医院2012年12月至2015年1月收治的118例孕35~41周胎膜早破（premature rupture of membranes,PROM）孕妇作为观察组,同期孕检的40名健康孕妇作为对照组。采用电化学发光法（electrochemical luminescence,ECLIA）测定血清PCT,结合白细胞计数和胎盘病理检查,比较各组PCT水平和感染情况及使用抗生素时间。将观察组患者按照PCT水平分为A组38例（〈0.25 ng/m L）、B组45例（0.25~0.50 ng/m L）、C组35例（〉0.50 ng/m L）。结果对照组PCT均值为（0.14±0.06）ng/m L,A、B、C 3组均值分别为（0.17±0.09）ng/m L、（0.35±0.10）ng/m L和（4.34±3.35）ng/m L。A组血清PCT水平与对照组比较差异无统计学意义（t=0.520,P〉0.05）;B组较A组PCT水平升高（t=4.187,P〈0.01）,C组较B组PCT水平升高（t=4.996,P〈0.01）。经抗生素治疗1 d后,A组治疗前后PCT水平比较差异无统计学意义（t=0.730,P〉0.05）,B组治疗后较治疗前有下降趋势,但差异无统计学意义（t=2.357,P〉0.05）,C组治疗前后比较,差异有统计学意义（t=3.598,P〈0.05）;出院前比较,各组间PCT水平差异均无统计学意义（P〉0.05）。但以血清PCT 0.50 ng/m L为基线,PCT〉0.5 ng/m L为阳性,PROM患者组织学绒毛膜羊膜炎检查比较,3组间差异有统计学意义（P〈0.05）。通过动态监测PCT水平,A组较B、C两组抗生素使用时间短（t=7.840、10.971,P均〈0.01）;B组短于C组（t=4.992,P〈0.01）。结论血清PCT水平是细菌感染的重要指标,其诊断效率高。本研究中3个等级组有明确的基线界限,分为正常、可疑感染和明确感染,推荐对应治疗分别为不使用抗菌药物、可使用抗菌药物和强烈建议使用抗菌药物。血清PCT检测对胎膜早破患者治疗期间的早期临床诊治、合理用药具有指导意义。
Objective To investigate the procalcitonin（ PCT） levels of peripheral blood of pregnant women with premature rupture of membrane（ PROM）,so as to understand the situation of bacterial infections and guide the antibiotics therapy. Methods118 women with 35 ~ 41 pregnancy weeks and premature rupture of membranes（ PROM） hospitalized in Longhua People＇s Hospital of Shenzhen City from December 2012 to January 2015 were chosen as study group,selected 40 healthy pregnant women who had physical checks at the same period as control group, and were retrospectively analyzed. The levels of serum PCT were evaluated by electrochemical luminescence method and white blood cell counts and hematoxylin eosin（ HE） staining of placenta were performed after delivery. The level of PCT、bacterial infection and time of antibiotics were compared respectively. The patients of study group were divided into three groups according to the levels of PCT： group A,consisted of 38 cases（ PCT 〈0. 25 ng / m L）; group B,consisted of45 cases（ PCT = 0. 25 ~ 0. 5 ng / m L）; group C,consisted of 35 cases（ PCT 〉0. 5 ng / m L）. Results The mean level of PCT in the control group was（ 0. 14 ± 0. 06） ng / m L,the mean levels of PCT in group A,B,C were（ 0. 17 ± 0. 09） ng / m L,（ 0. 35 ± 0. 10） ng /m L and（ 4. 34 ± 3. 35） ng / m L. The difference of PCT levels between group A and control group was not statistically significant（ t =0. 520,P〉0. 05）. Compared with group A,the PCT level in group B increased significantly,the difference was statistically significant（ t = 4. 187,P〈0. 01）. Compared with group B,group C had a higher level of PCT,the difference was statistically significant（ t = 4. 996,P〈0. 01）. After one day＇s antibiotics therapy,there were no significant differences in group A and group B（ t= 0. 730,2. 357,P〉0. 05）,but there was significant difference in group C（ t = 3. 598,P〈0. 05）. When the serum PCT baseline was 0. 5 ng / m L,then PCT 0. 5 ng / m L was positive,compared the chorioamnionitis,there were significant differences among the three groups. Through dynamic supervision of PCT,the time of using antibiotics was shorter in group A than group B and group C,the differences were statistically significant,and there was significant difference between group B and group C. Conclusion The level of serum PCT was an important indicator of bacterial infections,with high diagnostic efficiency. In this study,group A,B,C had clear baseline boundaries： normal,suspected infection and clear infection,and were respectively recommended no use of antibiotics,could use and strongly recommend the use of antibiotics. It is instructive for the early clinical diagnosis and treatment of patients with PROM.
出处
《中国计划生育和妇产科》
2016年第3期28-31,共4页
Chinese Journal of Family Planning & Gynecotokology
关键词
胎膜早破
降钙素原
绒毛膜羊膜炎
抗生素使用
premature rupture of membranes
procalcitonin
chorioamnionitis
use of antibiotics
