摘要
目的分析凶险性前置胎盘(pernicious placenta previa,PPP)孕产妇血清基质金属蛋白酶-2(matrix metalloproteinase-2,MMP-2)、胱甘肽过氧化物酶1(glutathione peroxidase 1,GPX1)、D-二聚体(D-dimer,D-D)变化与产后出血关系。方法回顾性收集许昌市中心医院2021年1月—2023年12月收治的118例PPP孕产妇临床资料,根据手术病理结果分为植入组与未植入组,其中植入组根据植入深度可分为粘连型亚组、植入型亚组、穿透型亚组,比较各组一般资料及分娩前血清MMP-2、GPX1、D-D水平差异,使用受试者工作特征(receiver operating characteristic,ROC)曲线评估分娩前血清MMP-2、GPX1、D-D对植入组产后出血的预测价值。结果各组间产后出血率存在显著差异(P<0.05),穿透型亚组产后出血率显著高于植入型亚组、粘连型亚组及未植入组(P<0.05),植入型亚组则高于粘连型亚组及未植入组(P<0.05)。植入组三个亚组分娩前血清MMP-2、D-D均显著高于未植入组(P<0.05),GPX1均低于未植入组(P<0.05);植入组中穿透型亚组血清MMP-2、D-D水平明显高于植入型亚组及粘连型亚组(P<0.05),植入型亚组则高于粘连型亚组(P<0.05);穿透型亚组血清GPX1明显低于植入型亚组及粘连型亚组(P<0.05),植入型亚组则低于粘连型亚组(P<0.05)。植入组产后出血者血清MMP-2、D-D明显高于未产后出血者(P<0.05),GPX1水平则低于未产后出血者(P<0.05)。ROC曲线分析,分娩前血清MMP-2、GPX1、D-D对预测植入组产后出血均具有统计学意义(P<0.05),其cut-off值分别为3.53 ng/m L、34.01 U/L、0.95 mg/L,且三项联合检测的预测价值最高,AUC值高达0.946(P<0.05)。结论血清MMP-2、GPX1、D-D波动与PPP孕产妇胎盘植入情况密切相关,且能辅助预测胎盘植入孕产妇产后出血风险,指导临床诊疗。
Objective To analyze the changes of serum matrix metalloproteinase-2(MMP-2),glutathione peroxidase 1(GPX1)and D-dimer(D-D)in pregnant and lying-in women with pernicious placenta previa(PPP)and the relationship with postpartum hemorrhage.Methods The clinical data of 118 pregnant and lying-in women with PPP in the hospital from January 2021 to December 2023 were retrospectively collected.According to the surgical pathological results,they were divided into implantation group and non-implantation group.The general data and serum levels of MMP-2,GPX1 and D-D before delivery were compared between the groups.According to the depth of implantation,the implantation group could be divided into adhesive subgroup,implant subgroup and penetrating subgroup.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum MMP-2,GPX1 and D-D before delivery on postpartum hemorrhage in the implantation group.Results There was a significant difference in the postpartum hemorrhage rate among the groups(P<0.05).The postpartum hemorrhage rate in the penetrating subgroup was significantly higher than that in the implant subgroup,adhesive subgroup and non-implantation group(P<0.05)and the rate in the implant subgroup was higher than that in the adhesive subgroup and non-implantation group(P<0.05).The levels of serum MMP-2 and D-D before delivery in the three subgroups of the implantation group were significantly higher than those in the non-implantation group(P<0.05)while the level of GPX1 was lower than that in the non-implantation group(P<0.05).The levels of serum MMP-2 and D-D in the penetrating subgroup of the implantation group were significantly higher than those in the implant subgroup and the adhesive subgroup(P<0.05),and the levels in the implant subgroup were higher than those in the adhesive subgroup(P<0.05).Serum GPX1 level in the penetrating subgroup was significantly lower than that in the implant and adhesive subgroups(P<0.05),and the level in the implant subgroup was significantly lower than that in the adhesive subgroup(P<0.05).Serum levels of MMP-2 and D-D in patients with postpartum hemorrhage in the implantation group were significantly higher than those in patients without postpartum hemorrhage(P<0.05)while the GPX1 level was lower than that in patients without postpartum hemorrhage(P<0.05).ROC curve analysis showed that serum MMP-2,GPX1,and D-D before delivery were statistically significant in predicting postpartum hemorrhage in the implantation group(P<0.05),and their cut-off values were 3.53 ng/mL,34.01 U/L and 0.95 mg/L respectively,and the combination of the three indicators had the highest predictive value,with an AUC value as high as 0.946(P<0.05).Conclusion The fluctuations of serum MMP-2,GPX1 and D-D are closely related to placenta implantation in pregnant and lying-in women with PPP,and can assist in predicting the risk of postpartum hemorrhage in pregnant and lying-in women with placenta implantation,and guide clinical diagnosis and treatment.
作者
苏宁
巩军
周利娟
SU Ning;GONG Jun;ZHOU Li-juan(Department of Obstetrics and Gynecology,Xuchang Central Hospital,Xuchang,Henan 461000,China)
出处
《医药论坛杂志》
2025年第21期2328-2332,共5页
Journal of Medical Forum
