THE VALUE OF AMNIOTIC-FLUID INTERLEUKIN-6 DETERMINATION IN PATIENTS WITH PRETERM LABOR AND INTACT MEMBRANES IN THE DETECTION OF MICROBIAL INVASION OF THE AMNIOTIC CAVITY
THE VALUE OF AMNIOTIC-FLUID INTERLEUKIN-6 DETERMINATION IN PATIENTS WITH PRETERM LABOR AND INTACT MEMBRANES IN THE DETECTION OF MICROBIAL INVASION OF THE AMNIOTIC CAVITY
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DOI：
10.1016/s0002-9378(94)70057-5
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发表时间：
1994-10-01
影响因子：
9.8
通讯作者：
GROSSMAN, JH
中科院分区：
文献类型：
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作者：
COULTRIP, LL;LIEN, JM;GROSSMAN, JH
目的：我们的目的是 (1) 确定羊水白细胞介素 6 测定在检测羊膜腔微生物入侵方面的价值，以及 (2) 将白细胞介素 6 与其他快速检测方法在评估早产方面进行比较。 研究设计：通过酶联免疫吸附测定法对 89 名早产患者通过羊膜穿刺术获得的 91 份羊水样本中的羊水白细胞介素 6 进行定量测定劳动。对需氧菌、厌氧菌和支原体进行羊水培养。使用接受者-操作者特征曲线分析、逻辑回归分析和Cox比例风险模型来探索几个解释变量和结果变量之间的关系。计算白细胞介素6、葡萄糖水平、革兰氏染色、白细胞酯酶和鲎阿米巴细胞裂解物检测预测羊水培养阳性、早产、临床感染和新生儿败血症的诊断指标值。结果：羊水培养阳性率为13%（12/89）。培养阳性患者的白细胞介素 6 浓度中位数为 241.8 ng/ml，而培养阴性患者的中位白细胞介素 6 浓度为 0.291 ng/ml (p. < 0.005)。对于羊水培养阳性和敏感性而言，白细胞介素 6 水平大于或等于 6.17 ng/ml 的敏感性和特异性分别为 75% 和 79%，而葡萄糖的水平小于或等于 12 mg/dl（83% 和 86%）（p = 0.26，z 检验）。所有白介素 6 水平 > 6.17 ng/ml 的患者均早产，而葡萄糖水平低于或等于 12 mg/dl 的患者则有 85.2% 早产。当在逻辑模型中同时考虑所有快速检测和临床参数时，只有白介素 6 与早产保持显着关系（比值比 35，p = 0.003）。 Cox 的比例分析表明，在控制临床变量后，白细胞介素 6 与羊膜穿刺至分娩间隔之间存在密切关系（风险比 3.01，p < 0.00001）。 结论：羊水白细胞介素 6 测定可能是我们快速检测设备的有用辅助手段，可排除感染并预测早产且胎膜完整的患者的分娩。
OBJECTIVES: Our purpose was to (1) determine the value of amniotic fluid interleukin-6 determination in the detection of microbial invasion of the amniotic cavity and (2) compare interleukin-6 to other rapid tests in the evaluation of preterm labor.STUDY DESIGN: Amniotic fluid interleukin-6 was determined quantitatively by enzyme-linked immunosorbent assay in 91 amniotic fluid specimens obtained by amniocentesis in 89 patients with preterm labor. Amniotic fluid cultures for aerobes, anaerobes, and mycoplasma species were performed. Receiver-operator characteristic curve analysis, logistic regression analysis, and Cox's proportional-hazards model were used to explore the relationship between several explanatory and outcome variables. Diagnostic index values of interleukin-6, glucose level, Gram stain, leukocyte esterase, and limulus amebocyte lysate assay for prediction of a positive amniotic fluid culture, preterm delivery, clinical infection, and neonatal sepsis were calculated.RESULTS: The prevalence of positive amniotic fluid cultures was 13% (12/89). The median interleukin-6 concentration in patients with positive cultures was 241.8 ng/ml, in contrast to 0.291 ng/ml in patients with negative cultures (p. < 0.005). Sensitivity and specificity of an interleukin-6 level greater than or equal to 6.17 ng/ml was 75% and 79%, in contrast to that of glucose, less than or equal to 12 mg/dl (83% and 86%) for a positive amniotic fluid culture and sensitivity (p = 0.26, z test). All patients with an interleukin-6 level > 6.17 ng/ml were delivered preterm, in contrast to 85.2% of patients with a glucose level less than or equal to 12 mg/dl. When all rapid tests and clinical parameters were considered simultaneously in the logistic model, only interleukin-6 maintained a significant relationship to preterm birth (odds ratio 35, p = 0.003). Cox's proportional analysis demonstrated a strong relationship between interleukin-6 and the amniocentesis-to-delivery interval after clinical variables were controlled for (hazard ratio 3.01, p < 0.00001).CONCLUSION: Amniotic fluid interleukin-6 determination may be a useful adjunct to our armamentarium of rapid tests to exclude infection and predict delivery in patients with preterm labor and intact membranes.