C反应蛋白指导胎膜早破患者合理预防性应用抗生素的可行性研究

发布时间：2018-01-27 23:52

本文关键词： C反应蛋白降钙素原白细胞介素- 白细胞介素- 胎膜早破抗生素感染　出处：《川北医学院学报》2016年06期 　论文类型：期刊论文

【摘要】：目的:探讨C反应蛋白(C-reactive protein,CRP)指导胎膜早破患者合理预防性应用抗生素的可行性。方法:选取138例入院时未临产且距破膜时间12 h的胎膜早破患者,检测血清中CRP水平,CRP8 mg/L的患者,随机分为A组(n=34)、B组(n=36),CRP8 mg/L的患者,随机分为C组(n=42)、D组(n=26)。A、C组预防性使用抗生素,B、D组不予预防性抗生素治疗,各组均在破膜24 h内分娩。观察4组孕妇胎盘组织学绒毛膜羊膜炎发生率,入院时、分娩后血CRP、降钙素原(PCT)水平、白细胞计数(WBC)数量、血白介素(IL)-6、IL-8水平变化。结果:B组胎盘组织学绒毛膜羊膜炎发生率为94.44%(34/36),高于D组的26.92%(7/26)及A组的41.18%(14/34),差异有统计学意义(P0.01);C组胎盘组织学绒毛膜羊膜炎发生率与D组比较无统计学差异(P0.05)。4组分娩后血CRP、PCT水平及WBC数量均高于入院时,差异有统计学意义(P0.05)。B组分娩后血CRP、PCT水平及WBC数量高于A组、C组、D组,差异有统计学意义(P0.01)。A、C组分娩后血清IL-6、IL-8水平均较入院时降低,差异有统计学意义(P0.01),B组较入院时增高,差异有统计学意义(P0.01)。结论:CRP水平升高与绒毛膜羊膜炎的发生明显相关,CRP正常者是否抗生素治疗对胎盘组织学绒毛膜羊膜炎发生率、产后血CRP、PCT、WBC水平变化无明显影响,对于CRP升高者经抗生素抗感染治疗后能有效降低胎盘组织学绒毛膜羊膜炎发生率,并在一定程度上抑制分娩后血CRP、PCT、WBC水平升高及抗炎性细胞因子IL-6、IL-8水平的升高。
[Abstract]:Objective: to investigate C-reactive protein (C-reactive protein). Methods: 138 patients with premature rupture of membranes who were not in labor at the time of admission and 12 hours from the time of rupture of membranes were selected. The patients whose serum CRP level was measured were randomly divided into A group (n = 34) and B group (n = 36) with CRP8 mg/L. They were randomly divided into group C (n = 42) and group D (n = 26). The incidence of placental histologic chorioamnionitis and the levels of serum CRP and procalcitonin PCT were observed in each group within 24 hours after rupture. WBC count and IL-8 level were measured. Results the incidence of placental histopathological chorioamnionitis in group B was 94.44 / 36). It was significantly higher than that in group D (26.92 / 26) and group A (41.18 / 14 / 34), the difference being statistically significant (P 0.01). The incidence of placental histopathological chorioamnionitis in group C was not significantly different from that in group D. The levels of serum CRPP-PCT and the number of WBC in group C were higher than those in group D after delivery. There was a significant difference in the levels of CRPP-PCT and the number of WBC after delivery in group P0.05. B was higher than that in group A and group C, and the difference was statistically significant (P 0.01). The serum levels of IL-6 and IL-8 in group C were significantly lower than those in group C after delivery, and the difference was statistically significant (P 0.01) and the level of IL-8 in group B was higher than that in group B at admission. The difference was significant (P 0.01). Conclusion there is a significant correlation between the increase of the level of CRP and the occurrence of chorioamnionitis. The incidence of placental histologic chorioamnionitis is obviously related to the antibiotic treatment of patients with normal CRP. There was no significant change in the level of CRP in postpartum blood, and the incidence of placental histopathological chorioamnionitis could be effectively reduced after antibiotics and anti-infection treatment. To some extent, the level of WBC and the level of IL-6 and IL-8 were inhibited after delivery.
【作者单位】：南京医科大学附属江宁医院妇产科;
【基金】：江苏省南京市卫生局医学科技发展项目(YKK13212)
【分类号】：R714.433
【正文快照】： 胎膜早破是指临产前发生的胎膜破裂,若发生于妊娠37周后为足月胎膜早破,临床症状多为不伴有疼痛的阴道流液[1]。胎膜早破的主要发生原因为细菌、支原体感染,感染造成的胎膜早破又增加了孕妇宫内感染的机率[2]。因此,胎膜早破发生后,抗感染治疗可以很大程度地减少对母婴的危害,

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