产时发热合并宫内感染临床特点及miR-182、WBC、PCT、LBP对其诊断价值

Clinical characteristics and diagnostic values of miR-182, WBC, PCT and LBP in intrapartum fever parturients with concurrent intrauterine infection

    摘要
  • 摘要:
    目的 探讨产时发热产妇宫内感染的临床特点及微小核糖核酸(miR)-182、白细胞计数(WBC)、降钙素原(PCT)、脂多糖结合蛋白(LBP)对其诊断价值。
    方法 选取2021年1月-2023年1月舟山市妇女儿童医院收治的产时发热合并宫内感染产妇99例作为研究组, 另选产时发热未合并宫内感染产妇116例作为对照组。分析两组临床资料和妊娠结局, 统计产时发热产妇宫内感染的病原菌分布情况; 分别采用实时荧光定量聚合酶链式反应、流式细胞术和酶联免疫吸附试验检测血清miR-182、PCT、LBP、外周血WBC水平。比较研究组和对照组血清miR-182、PCT、LBP、外周血WBC水平; 受试者工作特征(ROC)曲线分析四者联合检测的诊断价值。
    结果 99例产时发热产妇宫内感染患者共分离出107株病原菌, 大肠埃希菌(27株, 25.23%)、无乳链球菌(20株, 18.69%)、巨细胞病毒(17株, 15.89%)、白假丝酵母(16株, 14.95%)占比较高。研究组围产期脑损伤、新生儿死亡、新生儿宫内感染、新生儿宫内感染性肺炎、新生儿呼吸窘迫综合征发生率较对照组高(P＜0.05)。研究组血清miR-182、PCT、LBP、外周血WBC水平均较对照组高(P＜0.05)。四者联合检测诊断产时发热产妇宫内感染的曲线下面积(AUC)较单独高(P＜0.05), 敏感度82.70%, 特异度88.30%。
    结论 产时发热产妇宫内感染多为大肠埃希菌、无乳链球菌、巨细胞病毒、白假丝酵母感染, 且会影响妊娠结局。产时发热产妇宫内感染后miR-182、WBC、PCT、LBP呈高表达, 联合检测miR-182、WBC、PCT、LBP有助于诊断产时发热产妇宫内感染。

     

    Abstract:
    OBJECTIVE To investigate the clinical characteristics of intrauterine infection in parturients with fever during childbirth and the diagnostic value of microRNA (miR) -182, white blood cell count (WBC), procalcitonin (PCT) and lipopolysaccharide-binding protein (LBP).
    METHODS A total of 99 parturients with intrapartum fever combined with intrauterine infection treated in Zhoushan Women and Children′s Hospital from Jan. 2021 to Jan. 2023 were selected as the study group, and another 116 parturients with intrapartum fever and non-intrauterine infection were selected as control. Clinical data and pregnancy outcomes of the two groups and the distribution of pathogenic bacteria in intrauterine infection were analyzed. Real-time fluorescence quantitative polymerase chain reaction, flow cytometry and enzyme-linked immunosorbent assay were used to detect serum levels of miR-182, PCT, LBP and peripheral blood WBC, respectively, which were compared between the two groups. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of the four combined indices.
    RESULTS A total of 107 strains of pathogenic bacteria were found in the study group, including Escherichia coli (27 strains, 25.23%), Streptococcus agalactiae (20 strains, 18.69%), cytomegalovirus (17 strains, 15.89%) and Candida albicans (16 strains, 14.95%). The incidences of perinatal brain injury, neonatal death, intrauterine infection, intrauterine pneumonia and neonatal respiratory distress syndrome in the study group were higher than those in the control group (P < 0.05). The levels of miR-182, PCT, LBP and WBC in the study group were higher than those in the control group (P < 0.05). The area under the curve (AUC) of the four indices combined was higher than that of the index alone (P < 0.05), with the sensitivity 82.70% and specificity 88.30%.
    CONCLUSIONS Most cases of intrauterine infection in women with fever during childbirth are infected with E. coli, S. agalactiae, cytomegalovirus and C. albicans, which can affect the pregnancy outcomes. The levels of miR-182, WBC, PCT and LBP are high after intrauterine infection, and their combination is helpful for the diagnosis of intrauterine infection in parturients with intrapartum fever.

     

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