摘要
目的 探明妊娠期糖尿病(GDM)孕妇分娩期宫内感染(IAI)的相关因素,并分析相关因素对IAI的预测价值。方法 回顾性收集360例GDM孕妇,其中发生IAI孕妇120例(IAI组),未发生IAI的GDM孕妇240例(对照组)。收集2组孕妇一般临床资料、产时胎心监护情况、胎盘病理、妊娠结局及糖化血红蛋白(HbA1c)结果,采用多因素Logistic回归探究GDM患者发生IAI的影响因素。应用受试者工作特征(ROC)曲线评估联合HbA1c水平、产次、破膜时间对GDM患者发生IAI的预测价值,计算ROC曲线下面积(AUC)。结果 IAI组首次妊娠比例、初产妇比例、人工破膜比例、使用催产素比例、破膜时间、HbA1c均高于对照组(P<0.05);IAI组分娩孕周小,产钳助产及剖宫产率、羊水污染发生率均较高(P<0.05);IAI组产时异常基线胎心比例及变异减速发生率较对照组升高(P<0.05)、而胎心晚期减速发生率及Ⅱ类胎心监护比例较对照组降低(P<0.05);2组间产时基线变异情况及加速情况差异无统计学意义(P>0.05)。IAI组轻度新生儿窒息比例及新生儿转科率高(P<0.05)。多因素Logistic回归示HbA1c水平升高(OR=3.342,95%CI:1.539~7.257)和破膜时间延长(OR=1.001,95%CI:1.000~1.001)是GDM孕妇发生IAI的独立危险因素,经产妇则是保护因素(OR=0.113,95%CI:0.046~0.278);联合HbA1c、产次、破膜时间预测分娩期IAI的AUC为0.819(95%CI:0.772~0.865),敏感度为0.742,特异度为0.767。结论 HbA1c水平、破膜时间、产次是GDM患者产时IAI的独立影响因素,联合3种因素对预测GDM孕妇IAI具有较高临床价值。
Objective To explore related factors of intra-amniotic infection(IAI)during the delivery period in pregnant women with gestational diabetes mellitus(GDM),and to analyze the predictive value of these related factors for IAI.Methods A retrospective study was conducted on 360 GDM pregnant women,including 120 cases with IAI(IAI group)and 240 pregnant women with GDM who did not develop IAI(control group).Clinical data,fetal monitoring during labor,placental pathology,pregnancy outcomes and glycosylated hemoglobin(HbA1c)results were collected for both groups.Multivariate Logistic regression was used to investigate influencing factors of IAI.The predictive value of combined HbA1c levels,parity and rupture time for IAI was evaluated using receiver operating characteristic(ROC)curves,and the area under the curve(AUC)was calculated.Results In the IAI group,the proportion of primigravida,first-time delivery,artificial rupture of membranes,oxytocin use,rupture time and HbA1c levels were significantly higher than those in the control group(P<0.05).The IAI group had a smaller gestational age at delivery,higher rates of forceps-assisted delivery,cesarean section and amniotic fluid contamination(P<0.05).In the IAI group,the proportion of abnormal intrapartum baseline fetal heart rate and the incidence of late decelerations were higher than those in the control group(P<0.05),while the incidence of variable deceleration and the proportion of categoryⅡfetal heart rate monitoring were lower in the IAI group than those in the control group(P<0.05).There were no significant differences in baseline variability or acceleration of fetal heart rate between the two groups (P>0.05). The proportions of mild neonatal asphyxia and neonatal transfer to intensive care were high in the IAI group than those of the control group (P<0.05). Multivariate Logistic regression showed that elevated HbA1c levels (OR = 3.342, 95%CI: 1.539-7.257) and prolonged rupture time (OR=1.001, 95%CI: 1.000-1.001) were independent risk factors for IAI in GDM pregnant women, while multiparity was a protective factor (OR=0.113, 95%CI: 0.046-0.278). The AUC for predicting IAI during labor by combining HbA1c, parity and rupture time was 0.819 (95%CI: 0.772-0.865), with a sensitivity of 0.742 and specificity of 0.767. Conclusion HbA1c levels, rupture time and parity are independent influencing factors for IAI during labor in pregnant women with GDM. The combination of these three factors has high clinical value in predicting IAI in GDM patients.
作者
陈璐
张瑞家
陈国庆
CHEN Lu;ZHANG Ruijia;CHEN Guoqing(Shenzhen School of Clinical Medicine,Southern Medical University,Shenzhen 518110,China;Department of Obstetrics,Shenzhen Maternity and Child Healthcare Hospital,Southern Medical University)
出处
《天津医药》
2025年第12期1258-1262,共5页
Tianjin Medical Journal
基金
广东省自然科学基金面上项目(2020A1515010099)。
关键词
糖尿病
妊娠
影响因素分析
糖基化血红蛋白A
产次
宫内感染
破膜时间
diabetes,gestational
root cause analysis
glycated hemoglobin A
parity
intra-amniotic infection
membrane rupture time
