بررسی حساسیت، ویژگی و صحت تست کراتینین و گنادوتروپین جفتی انسانی (βHCG) ترشحات سرویکوواژینال جهت تشخیص پارگی زودرس کیسه آمنیونتیک

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استادیار گروه زنان و مامایی، فلوشیپ پریناتولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی زنجان، زنجان، ایران.

2 دکتری تخصصی زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی زنجان، زنجان، ایران.

3 دانشیار گروه پزشکی اجتماعی، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشکده پزشکی، دانشگاه علوم پزشکی زنجان، زنجان، ایران.

4 دانشیار گروه آسیب‌شناسی، دانشکده پزشکی، دانشگاه علوم پزشکی زنجان، زنجان، ایران.

5 مربی گروه مامایی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی زنجان، زنجان، ایران.

6 دانشجوی دکتری بهداشت باروری، کمیته‌ تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

چکیده

مقدمه: پارگی زودرس کیسه آب از مشکلات شایع مامایی است که تشخیص صحیح آن امری ضروری در روند درمان و پیشگیری پیامدهای نامطلوب بارداری است. مطالعه حاضر با هدف بررسی صحت تشخیصی کراتینین و گنادوتروپین (βHCG) ترشحات موکوس سرویکس در شناسایی آبریزش زنان باردار انجام شد.
روش‌کار: این مطالعه آینده­نگر در سال 96-1367 بر روی 150 زنان باردار 37-24 هفته مشکوک به PPROM انجام گرفت. افراد در دو گروه کیسه آب پاره (تست پولینگ و فرن هر دو مثبت) و گروه کنترل (تست پولینگ و فرن هر دو منفی و AFI نرمال) قرار گرفتند. جهت اندازه‌گیری میزان کراتینین از روش Automated Analyzer و با دستگاه Prestige و برای اندازه‌گیری میزان βHCG از روش Chemi-luminescence Signal Band و با دستگاه Abbott استفاده شد. با استفاده از منحنی راک، نقطه برش و صحت تشخیصی برای دو تست اندازه‌گیری شد. میزان p کمتر از 05/0 معنادار در نظر گرفته شد.
یافته‌ها: در تشخیص پارگی کیسه آب بیشترین حساسیت و ویژگی کراتینین در نقطه برش 135/0 و برای βHCG در نقطه برش 78/26 به‌دست آمد که حساسیت، ویژگی، ارزش اخباری مثبت و منفی و دقت کلی برای کراتینین به‌ترتیب 7/91%، 1/56%، 75/39%، 52/95% و 66/64% با میزان توافق 33/0 (001/0>p) و برای βHCG برابر با 3/58%، 2/63%، 33/33%، 75/82% و 62% با میزان توافق 171/0 (023/0=p) به‌دست آمد.
نتیجه­گیری: حساسیت و قدرت تشخیصی کراتینین در زنان پره‌ترم بالاتر از βHCG بود. قیمت مناسب، سادگی و ایمنی از مزایای هر دو روش است. صحت تشخیصی به‌دست آمده در این مطالعه پایین بود، ولی با توجه محدود بودن مطالعات در افراد پره‌ترم، نمی‌توان استفاده بالینی از این مارکرها را رد یا توصیه کرد؛ لذا مطالعات وسیع‌تری پیشنهاد می‌شود.

کلیدواژه‌ها

عنوان مقاله [English]

The sensitivity, specificity, and accuracy of Creatinine test and human chorionic gonadotropin (HCG) test of cervical mucus discharge to diagnose preterm premature rupture of membranes (PPROM)

نویسندگان [English]

  • Atousa Dabiri 1
  • Somayeh Rafiee 2
  • Nima Motamed 3
  • Ahmad Jalilvand 4
  • Mahnaz Keshavarz Afshar 5
  • Fatemeh Bayat 6
1 Assistant Professor, Department of Obstetrics and Gynecology, Fellowship of Perinatology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
2 Gynecologist, Department of Obstetrics and Gynecology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
3 Associate Professor, Department of Community Medicine, Research Center for Social Factors Affecting Health, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
4 Associate Professor, Department of Pathology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
5 Instructor, Department of Midwifery, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran.
6 PhD Student of Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
چکیده [English]

Introduction: Premature Rupture of Membranes (PROM) is one of the common problems of midwifery, which its early diagnosis is essential in the process of treatment and prevention of pregnancy adverse outcomes. Therefore, this study was performed with aim to evaluate the diagnostic accuracy of Creatinine and human chorionic Gonadotropin (HCG) test of cervical mucusdischarge to diagnose PROM in pregnant women.
Methods: This prospective study was conducted in 2017-2018 on 150 pregnant women with gestational age of 24 to 37 weeks and suspected to PROM. The subjects were divided into two groups of Rupture Membranes (Pooling and Fern test both of them were positive) and control group (Pooling and Fern test both of them were negative and AFI was normal). Creatinine was measured with Automated Analyzer method (Prestige device) and βHCG with Chemi-luminescence Signal Band method (Abbott device). Cut-off point and diagnostic accuracy were measured for two tests by rock curve. P-value<0.05 was considered statistically significant.
Results: The highest sensitivity and specificity for creatinine in the diagnosis of PPROM was obtained at cut-off point 0.135 and for βHCG at cut-off point 26.78, with sensitivity of 91.7% and specificity 56.1%, and positive predictive value of 39.75% and negative predictive value of 95.52% and overall accuracy was 64.66% and the agreement rate was 0.33 (P <0.001). For βHCG, the sensitivity 58.3% and specificity 63.2%, and positive predictive value 33.33%, and negative predictive value of 82.75% and overall accuracy was 62% and the agreement rate was 0.171 (P=0.023).
Conclusion: The sensitivity and diagnostic power of Creatinine in preterm women was higher than βHCG. Reasonable price, simplicity, and safety are the advantages of both methods. The diagnostic accuracy obtained in this study was low, but due to the limited studies in preterm patients, the clinical use of these markers cannot be recommended or rejected; therefore, more studies are suggested.

کلیدواژه‌ها [English]

  • Cervical Mucus
  • Creatinine
  • Gonadotropin
  • PPROM
  • Sensitivity and Specificity

مراجع

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مجله زنان، مامایی و نازایی ایران
دوره 24، شماره 5
مرداد 1400
صفحه 31-39

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