[1]李相杰,任艳芳,王玉红,等.孕晚期血清血小板反应蛋白-1、D-二聚体及金属蛋白酶组织抑制物-1水平对瘢痕子宫再次妊娠患者产后出血的预测价值[J].新乡医学院学报,2024,(2):138-142.[doi:10.7683/xxyxyxb.2024.02.007]
　LI Xiangjie,REN Yanfang,WANG Yuhong,et al.Predictive value of serum thrombospondin-1,D-dimer and tissue inhibitor of metalloproteinase-1 levels in late pregnancy for postpartum hemorrhage in re-pregnant women with scarred uterus[J].Journal of Xinxiang Medical University,2024,(2):138-142.[doi:10.7683/xxyxyxb.2024.02.007]
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孕晚期血清血小板反应蛋白-1、D-二聚体及金属蛋白酶组织抑制物-1水平对瘢痕子宫再次妊娠患者产后出血的预测价值
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
期数:
2024年2
页码:
138-142
栏目:
临床研究
出版日期:
2024-02-05

文章信息/Info

Title:
Predictive value of serum thrombospondin-1,D-dimer and tissue inhibitor of metalloproteinase-1 levels in late pregnancy for postpartum hemorrhage in re-pregnant women with scarred uterus
作者:
李相杰; 任艳芳; 王玉红; 张全华; 管文莉
（新乡医学院第一附属医院产科，河南　卫辉　453100）
Author(s):
LI Xiangjie; REN Yanfang; WANG Yuhong; ZHANG Quanhua; GUAN Wenli
(Department of Obstetrics,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
关键词:
产后出血; 血小板反应蛋白-1; D-二聚体; 金属蛋白酶组织抑制物-1; 瘢痕子宫
Keywords:
postpartum hemorrhage; thrombospondin-1; D-dimer; tissue inhibitor of metalloproteinase-1; scarred uterus
分类号:
R714.46
DOI:
10.7683/xxyxyxb.2024.02.007
文献标志码:
A
摘要:
目的　探讨孕晚期血清血小板反应蛋白-1（THBS-1）、D-二聚体（D-D）及金属蛋白酶组织抑制物-1（TIMP-1）水平对瘢痕子宫再次妊娠患者产后出血（PPH）的预测价值。
方法　选择2020年6月至2022年8月新乡医学院第一附属医院收治的108例瘢痕子宫再次妊娠孕妇为研究对象，根据孕妇分娩后是否发生PPH分为PPH组（n=21）和非PPH组（n=87）。采集2组孕妇入院当天肘静脉血5 mL，应用酶联免疫吸附法检测2组孕妇血清THBS-1、D-D、TIMP-1水平。比较2组孕妇的基本临床资料及血清THBS-1、D-D、TIMP-1水平。采用多因素logistic回归分析瘢痕子宫再次妊娠孕妇发生PPH的影响因素，受试者操作特征（ROC）曲线分析血清THBS-1、D-D、TIMP-1水平对瘢痕子宫再次妊娠孕妇发生PPH的预测价值。
结果　PPH组人工流产次数≥2次、胎盘早剥、子宫切口撕裂、宫缩乏力、瘢痕厚度<0.3 cm占比及孕晚期血清THBS-1、D-D水平显著高于非PPH组，血清TIMP-1水平显著低于非PPH组（P<0.05）。宫缩乏力、D-D和THBS-1水平升高是瘢痕子宫再次妊娠孕妇PPH的独立危险因素(P<0.05)，TIMP-1水平降低是瘢痕子宫再次妊娠孕妇PPH的保护因素（P<0.05）。血清THBS-1、D-D、TIMP-1联合预测瘢痕子宫再次妊娠孕妇PPH的曲线下面积大于三者单独预测（P<0.05）。
结论　孕晚期血清THBS-1、D-D、TIMP-1水平均可作为预测瘢痕子宫再次妊娠孕妇发生PPH的参考指标，且三者联合对瘢痕子宫再次妊娠孕妇发生PPH的预测效能更高。
Abstract:
Objective　To investigate the predictive value of serum thrombospondin-1 (THBS-1),D-dimer (D-D) and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels in late pregnancy for postpartum hemorrhage (PPH) in re-pregnant women with scarred uterus.
Methods　Totally 108 re-pregnant women with scarred uterus admitted to the First Affiliated Hospital of Xinxiang Medical University from June 2020 to August 2022 were selected and divided into the PPH group (n=21) and the non-PPH group (n=87) according to whether PPH occurred after delivery.On the day of admission,5 mL elbow venous blood was collected from re-pregnant women in the two groups,and the levels of serum THBS-1,D-D and TIMP-1 of pregnant women in the two groups were detected by enzyme-linked immunosorbent assay.The serum THBS-1,D-D TIMP-1 levels and clinical data of pregnant women between the two groups were compared.The influencing factors on the occurrence of PPH in re-pregnant women with scarred uterus were analyzed by multivariate logistic regression,and the predictive value of serum THBS-1,D-D and TIMP-1 levels on the occurrence of PPH in re-pregnant women with scarred uterus was evaluated by receiver operating characteristic curve.
Results　The percentage of patients with ≥ 2 induced abortions,placental abruption,uterine incision laceration,uterine inertia or scar thickness < 0.3 cm,as well as serum THBS-1 and D-D levels in late pregnancy in the PPH group were significantly higher than those in the non-PPH group,and serum TIMP-1 level in late pregnancy were significantly lower than that in the non-PPH group (P<0.05).The uterine inertia,as well as high D-D and THBS-1 levels,were independent risk factors for PPH in re-pregnant women with scarred uterus (P<0.05),and low TIMP-1 level was a protective factor (P<0.05).The area under the curve of combined serum THBS-1,D-D and TIMP-1 levels to predict PPH in re-pregnant women with scarred uterus was greater than that predicted by the three factors alone (P<0.05).
Conclusion　Serum THBS-1,D-D and TIMP-1 levels in late pregnancy can be used as reference indicators for predicting the occurrence of PPH in re-pregnant women with scarred uterus,and the combination of the three indexes is more effective in predicting the occurrence of PPH.

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更新日期/Last Update: 2024-02-05