A Combination of Cervicovaginal Fluid Glutamate, Acetate and D-Lactate Identified Asymptomatic Low-Risk Women Destined to Deliver Preterm: a Prospective Cohort Study.
A Combination of Cervicovaginal Fluid Glutamate, Acetate and D-Lactate Identified Asymptomatic Low-Risk Women Destined to Deliver Preterm: a Prospective Cohort Study.
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DOI：
10.1007/s43032-021-00711-2
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Anumba DOC
中科院分区：
文献类型：
--
作者：
Amabebe E;Anumba DOC
由于经阴道超声宫颈长度 (CL) 和定量胎儿纤连蛋白 (qfFN) 对早产 (PTB) 风险较低的孕妇的预测能力有限且临床应用有限，我们试图确定宫颈阴道液 (CVF) 代谢物（宿主微生物代谢的副产品）在预测自发性 PTB 中的效用 妊娠中期无症状的低风险女性。这是 ECCLIPPx 研究队列的一项前瞻性亚队列研究。通过基于酶的分光光度法对无 PTB 病史的无症状单身女性（20-22 周，n = 168）的 CVF 进行代谢物分析。还测量了 CL、阴道 pH 值和 qfFN。分别通过斯皮尔曼相关性、二元逻辑回归和受试者工作特征曲线下面积（AUC）进行相关性和预测分析。在纳入的 168 名女性中，仅分析了 135 名 (80.4%) 女性的 CVF 样本。有 6/135 (4.4%) 例自发性 PTB (sPTB)，其中两次妊娠在妊娠 28 周内结束。单独来看（AUC，95% CI），只有谷氨酸（0.72，0.64-0.80）和 CL（0.69，0.60-0.77）可以预测 PTB。然而，还确定了五种更准确预测 sPTB 的多变量模型，即：谷氨酸、乙酸盐和 D-乳酸的组合（GAD，0.82、0.74–0.89）；仅 CL 和 qfFN（0.78、0.70–0.85）； CL、qfFN、谷氨酸盐和乙酸盐（0.88、0.81–0.93）； CL、qfFN 和 GAD（0.94、0.88–0.98）；以及 GAD 和 pH（0.86、0.79–0.92）。还观察到 CL、pH 和 qfFN 与代谢物之间的相关性。在该队列中，CVF 谷氨酸、乙酸盐和 D-乳酸的中期组合比单独的代谢物、宫颈长度和胎儿纤连蛋白更准确地预测早产，且假阳性率非常低，阳性预测值很高。需要对早产率较高的人群进行进一步测试。在线版本包含可在 10.1007/s43032-021-00711-2 获取的补充材料。
Due to the modest predictive capacities and limited clinical application of transvaginal ultrasonographic cervical length (CL) and quantitative fetal fibronectin (qfFN) in pregnant women at low risk of preterm birth (PTB), we sought to determine the utility of cervicovaginal fluid (CVF) metabolites (by-products of host-microbial metabolism) for prediction of spontaneous PTB in asymptomatic low-risk women at mid-gestation. This was a prospective sub-cohort study from the ECCLIPPx study cohort. CVF from asymptomatic singleton women (20–22 weeks, n = 168) without a prior history of PTB were analysed for metabolites by enzyme-based spectrophotometry. CL, vaginal pH and qfFN were also measured. Correlation and predictive analyses were performed by Spearman’s correlation, and binary logistic regression and area under receiver operating characteristic curve (AUC), respectively. Of the 168 women enrolled, only CVF samples from 135 (80.4%) women were analysed. There were 6/135 (4.4%) spontaneous PTB (sPTBs), with two of these pregnancies ending ≤ 28 weeks’ gestation. Individually (AUC, 95% CI), only glutamate (0.72, 0.64–0.80) and CL (0.69, 0.60–0.77) were predictive of PTB. However, five multivariable models that more accurately predicted sPTB were also identified, i.e. a combination of: glutamate, acetate and D-lactate (GAD, 0.82, 0.74–0.89); CL and qfFN only (0.78, 0.70–0.85); CL, qfFN, glutamate and acetate (0.88, 0.81–0.93); CL, qfFN and GAD (0.94, 0.88–0.98); and GAD and pH (0.86, 0.79–0.92). Correlations between CL, pH and qfFN and metabolites were also observed. In this cohort, a midtrimester combination of CVF glutamate, acetate and D-lactate predicted preterm birth more accurately than individual metabolites, cervical length and fetal fibronectin with a very low false-positive rate and high positive predictive value. Further testing in populations with higher preterm birth rates is required. The online version contains supplementary material available at 10.1007/s43032-021-00711-2.
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