PDF(Pubmed)
Abstract：
Studies on noninvasive factors and predicting the maintenance of pregnancy, and those comparing the usefulness of these factors with invasive amniotic fluid markers in predicting the maintenance of pregnancy following rescue cerclage, are lacking. Therefore, this study aimed to determine whether C-reactive protein (CRP) levels, White blood cell (WBC) count, absolute neutrophil count (ANC), and platelet-to-lymphocyte ratio (PLR) in maternal blood, which are noninvasive and readily available clinical markers, can predict the maintenance of pregnancy following rescue cerclage in patients with cervical insufficiency (CI). A total of 142 singleton pregnant women (15-28 wk) who underwent rescue cerclage for CI were retrospectively evaluated. The interleukin (IL)-6 concentration in the amniotic fluid; CRP levels, WBC count, ANC, and PLR in the maternal peripheral blood; and degree of cervical dilatation were evaluated before cerclage. The primary outcome was whether the pregnancy was maintained for >4 weeks after rescue cerclage. Among the 142 patients, prolonged pregnancy for >4 weeks following emergent cerclage was observed in 107 (75.35%), while 35 (24.65%) gave birth within 4 weeks. This study demonstrated that the degree of cervical dilatation at diagnosis; WBC count, ANC, and CRP levels in the maternal peripheral blood; and IL-6 concentration in the amniotic fluid significantly differed between the successful and failure groups (all P < .05). The area under the curve (AUC) of the amniotic fluid IL-6 concentration was .795 for the prediction of spontaneous preterm birth within 4 weeks after rescue cerclage. Additionally, the AUC of the CRP level, cervical dilatation, WBC count, ANC, and PLR were .795, .703, .695, .682, and .625, respectively. These findings suggest that the preoperative CRP levels can be considered a useful noninvasive marker comparable to amniotic fluid IL-6 concentration for identifying pregnant women with CI at high risk of spontaneous preterm birth following rescue cerclage.
摘要：
研究无创因素和预测维持妊娠，以及那些将这些因素与侵入性羊水标志物在预测抢救环扎后妊娠维持中的有用性进行比较的人，缺乏。因此,这项研究旨在确定C反应蛋白（CRP）水平，白细胞（WBC）计数，中性粒细胞绝对计数（ANC），和母亲血液中的血小板与淋巴细胞比率（PLR），它们是无创的和容易获得的临床标志物，可以预测宫颈功能不全（CI）患者抢救环扎术后的妊娠维持情况。回顾性评估了142例接受CI抢救环扎的单胎孕妇（15-28周）。羊水白细胞介素(IL)-6浓度;CRP水平,白细胞计数,ANC,母亲外周血中的PLR；并在环扎前评估宫颈扩张程度。主要结果是抢救环扎术后妊娠是否维持>4周。在142名患者中，在107例（75.35%）中观察到紧急环扎后>4周的延长妊娠，而35人(24.65%)在4周内分娩。这项研究表明，诊断时宫颈扩张的程度；白细胞计数，ANC,成功组和失败组孕妇外周血CRP水平和羊水IL-6浓度差异有统计学意义(P均<0.05)。羊水IL-6浓度的曲线下面积（AUC）为0.795，用于预测抢救环扎后4周内的自发性早产。此外,CRP水平的AUC，宫颈扩张,白细胞计数,ANC,PLR分别为.795、.703、.695、.682和.625。这些发现表明，术前CRP水平可被认为是与羊水IL-6浓度相当的有用的非侵入性标志物，可用于识别处于抢救环扎后自发性早产高危CI的孕妇。
