| Objective: serum ferritin(SF)is a 24 subunit protein with large molecular weight,which is mainly distributed in liver,spleen,bone marrow and other tissues,secreted by liver cells,macrophages and Kupffer cells,and entered the blood circulation by classical secretion pathway.Currently,SF is mainly used as an indicator of iron storage in the body.With the development of research,serum ferritin is not only the most sensitive indicator of iron deficiency in the body,but also non-specific increased in acute phase reaction and acute and chronic inflammation.Octective chorioamnionitis leads to the lack of typical clinical manifestations in patients with premature rupture of membranes,and often has missed the best opportunity for clinical prophylactic application of antibiotics,making medical decisions more passive.At the same time,if poor prognosis of the mother and the child occurs,it is easy for the patient to not understand,resulting in medical disputes.Therefore,some sensitive diagnostic markers are urgently needed to identify and diagnose such patients early.However,there have been no reports on SF and occult chorioamnionitis leading to premature rupture of membranes.The purpose of this study was to investigate the diagnostic value of SF in occult chorioamnionitis leading to premature rupture of membranes,and to explore the significance of SF in predicting occult chorioamnionitis leading to premature rupture of membranes.Methods: all subjects were pregnant women who were hospitalized and gave birth in the maternity ward of the second affiliated hospital of dalian medical university between December 2017 and January 2019.Exclusion criteria were set to exclude the interfering factors affecting ferritin levels and to clarify that occult chorionic amnionitis leads to premature rupture of membranes.The normal pregnancy group was selected as the pregnant women who met the exclusion criteria,had a smooth and full-term pregnancy and had vaginal delivery.In exclusion criteria,hospital diagnosis of patients with premature rupture of membranes as premature rupture of membranes(PROM)group,which is divided into two groups,a and pathology confirmed as the research object of chorioamnionitis,for occult chorionic amniotic membrane inflammation(subclinical)group,pathology confirmed that no chorionic amniotic membrane inflammation of the object of study,premature rupture of membranes for unknown reason(unknown).Clinical data,serological specimens,reproductive tract secretions,pathological specimens and other indicators were collected.SPSS21.0software was used for statistical analysis of the data.ROC curve drawing,computer processing area under curve(AUC),obtained under different cutting value of sensitivity and the degree of specific indicators,and through the sensitivity and work out the corresponding specific degrees about(Youden index,Youden index,the experiments of the higher diagnostic value,point to find out their corresponding maximum Youden index of diagnosis,diagnostic point is the best.Results: a total of 1408 pregnant women were hospitalized and gave birth,352 of whom were diagnosed as premature rupture of membranes.48 cases in the normal pregnancy group and 74 cases in the PROM group met the exclusion criteria were selected.There was no statistically significant difference between the two groups in terms of age,number of pregnancies and number of births.Among them,59 cases had PROM and 15 cases had no PROM.Of the 74 subjects in the PROM group,41 could obtain histopathological results,including 28 patients diagnosed with chorionic amnionitis,13 patients diagnosed with non-chorionic amnionitis,and the unknown group.There were no statistically significant differences between Subclinical and unknown groups in age,number of pregnancies,number of births and hemoglobin levels.The AUC of ferritin in the diagnosis of chorionic amnionitis in patients with premature rupture of membranes was 0.626,and the Youden index was the highest(0.253)when ferritin was 17.18ng/m L.Finally,subclinical amnionitis and normal pregnancy were compared,and there was no significant difference in age,pregnancy,delivery and hemoglobin level between the two groups.There were significant differences in ferritin levels,30.33 22.66 ng/m L in the subclinical group and 16.8810.57 ng/m L in the normal group(P=0.006).The ROC curve was used to re-evaluate the diagnostic efficacy of serum ferritin in the normal population.AUC=0.775.Conclusion: ferritin is significantly increased in patients with occult chorioamnionitis leading to premature rupture of membranes,with good diagnostic efficacy,which is better than the infection indicators CRP and PCT,and can be further used and evaluated in clinical practice,so as to constantly correct its application range. |
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