A COMPARATIVE-STUDY OF THE DIAGNOSTIC PERFORMANCE OF AMNIOTIC-FLUID GLUCOSE, WHITE BLOOD-CELL COUNT, INTERLEUKIN-6, AND GRAM STAIN IN THE DETECTION OF MICROBIAL INVASION IN PATIENTS WITH PRETERM PREMATURE RUPTURE OF MEMBRANES
A COMPARATIVE-STUDY OF THE DIAGNOSTIC PERFORMANCE OF AMNIOTIC-FLUID GLUCOSE, WHITE BLOOD-CELL COUNT, INTERLEUKIN-6, AND GRAM STAIN IN THE DETECTION OF MICROBIAL INVASION IN PATIENTS WITH PRETERM PREMATURE RUPTURE OF MEMBRANES
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DOI：
10.1016/0002-9378(93)90014-a
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发表时间：
1993-10-01
影响因子：
9.8
通讯作者：
SEHGAL, P
中科院分区：
文献类型：
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作者：
ROMERO, R;YOON, BH;SEHGAL, P
目的：我们的目的是比较羊水试验在羊膜早破患者羊膜穿刺至分娩间隔和新生儿并发症的检测羊膜腔微生物侵入和预测羊膜早破的价值。研究设计：通过经腹羊膜穿刺术从110例连续的胎膜早破患者中获得羊水。培养好氧细菌和厌氧细菌以及支原体。羊水分析包括革兰氏染色检查、白细胞计数、葡萄糖和白细胞介素-6测定。采用Logistic回归和生存技术（比例风险模型）进行统计分析。结果：(1)胎膜早破患者羊水培养阳性检出率为38% (42/110)；(2)微生物侵入患者羊膜穿刺术至分娩间隔较阴性患者短，新生儿并发症发生率较高；(3)羊水白细胞介素-6检测羊水微生物侵入最敏感（临界值为7.9 ng/ml） （IL-6敏感性为80.9%，白细胞计数敏感性为57.1%，葡萄糖敏感性为57.1%，革兰氏染色敏感性为23.8%,p < 0.05）；(4)羊水革兰氏染色检测微生物侵袭的特异性最高（革兰氏染色特异性为98.5%，白细胞计数特异性为77.9%，白细胞介素-6特异性为75%，葡萄糖特异性为73.5%,p < 0.01）；(5)在所有羊水试验中，白细胞介素-6测定是唯一对羊膜穿刺术至分娩间隔及新生儿并发症预测具有显著临床价值的试验。结论：羊水白细胞介素-6浓度比羊水革兰氏染色、葡萄糖或白细胞计数更能预测羊膜早破患者羊水微生物侵入羊膜腔、羊膜穿刺术至分娩间隔和新生儿并发症。
OBJECTIVE: Our aim was to compare the value of amniotic fluid tests for the detection of microbial invasion of the amniotic cavity and in the prediction of the amniocentesis-to-delivery interval and neonatal complications in patients with preterm premature rupture of membranes.STUDY DESIGN: Amniotic fluid was obtained by transabdominal amniocentesis from 110 consecutive patients with preterm premature rupture of membranes. Fluid was cultured for aerobic and anaerobic bacteria, as well as mycoplasmas. Amniotic fluid analysis included a Gram stain examination, white blood cell count, and glucose and interleukin-6 determinations. Logistic regression and survival techniques (proportional hazards model) were used for statistical analysis.RESULTS: (1) The prevalence of positive amniotic fluid cultures in patients with preterm premature rupture of membranes was 38% (42/110); (2) patients with microbial invasion had a shorter amniocentesis-to-delivery interval and a higher neonatal complication rate than patients with negative cultures; (3) the most sensitive test for the detection of microbial invasion of the amniotic cavity was amniotic fluid interleukin-6 determinations (cutoff 7.9 ng/ml) (sensitivity: for IL-6 80.9%; for white blood cell count 57.1 %; for glucose 57.1 %; for Gram stain 23.8%; p < 0.05 for all comparisons); (4) the most specific test for the detection of microbial invasion was the Gram stain of amniotic fluid (specificity: for Gram stain 98.5%; for white blood cell count 77.9%; for interleukin-6 75%; for glucose 73.5%; p < 0.01 for all); (5) of all amniotic fluid tests, interleukin-6 determination was the only test that had significant clinical value in the prediction of the amniocentesis-to-delivery interval and neonatal complications.CONCLUSION: Interleukin-6 concentrations in amniotic fluid are a better predictor of microbial invasion of the amniotic cavity, amniocentesis-to-delivery interval and neonatal complications than the amniotic fluid Gram stain, glucose, or white blood cell count in patients with preterm premature rupture of membranes.