摘要
目的探究子宫创伤后胎盘植入发生的高危因素,分析其对妊娠结局产生的影响。方法选取于2020年1月至2024年12月期间,在唐山市妇幼保健院进行分娩的118例有子宫创伤史的患者进行研究,按患者有无发生胎盘植入分为观察组和对照组,每组59例。比较两组孕妇的一般临床资料,测量子宫动脉血流动力学参数[搏动指数(PI)、阻力指数(RI)、收缩期峰值血流速度/舒张末期血流速度(S/D)]及血管新生指标[可溶性血管内皮生长因子受体-1(sFlt-1)、血管内皮生长因子(VEGF)]。对观察组的子宫动脉血流动力学参数和血管新生指标进行局部加权散点平滑法(Lowess)分析。通过随机森林算法分析胎盘植入发生的影响因素。运用Logistic多因素回归分析胎盘植入的高危因素。评估危险因素对胎盘植入的预测价值,建立预测模型,绘制受试者操作特征(ROC)曲线。对比两组孕妇的妊娠结局,分析胎盘植入与妊娠结局之间的关联。结果两组孕妇在年龄、孕次、产次、前置胎盘、人工流产史、剖宫产史等临床特征,血流动力学指数PI、RI、S/D,以及血管新生指标sFlt-1、VEGF的水平上,差异均存在统计学意义(P<0.05);观察组PI和RI与sFlt-1呈正相关,与VEGF呈负相关,S/D与sFlt-1呈负相关,与VEGF呈正相关;随机森林算法分析显示VEGF、前置胎盘、PI、sFlt-1、RI、剖宫产史、S/D、孕次可能是影响胎盘植入的因素;Logistic回归分析显示,前置胎盘(OR=9.819)、剖宫产史(OR=6.885)及VEGF(OR=1.018)是构成胎盘植入的独立危险因素,RI(OR=0.029)是保护因素;前置胎盘、剖宫产史、VEGF、RI单独及联合预测胎盘植入的ROC曲线下面积(AUC)分别为0.797、0.771、0.781、0.808、0.968;构建的胎盘植入风险评估模型的AUC为0.968,模型诊断效能良好;观察组不良妊娠结局发生风险高于对照组(RR>1,P<0.05)。结论前置胎盘、剖宫产史、VEGF是子宫创伤后胎盘植入的高危因素,RI是保护因素。胎盘植入会增加不良妊娠结局,需引起高度重视。
Objective To explore the high-risk factors influencing the occurrence of placenta accreta after uterine trauma and discuss their impacts on pregnancy outcomes.Methods A total of 118 patients with a history of uterine trauma who gave birth in Tangshan Maternal and Children Health Hospital from January 2020 to December 2024 were selected for the study.They were divided into an observation group and a control group according to whether they had placental implantation,with 59 cases in each group.The general clinical data of the two groups of pregnant women were compared.The hemodynamic parameters of the uterine artery[pulsatility index(PI),resistance index(RI),peak systolic velocity/end diastolic velocity(S/D)]and angiogenesis indexes[soluble fms-like tyrosine kinase-1(sFlt-1),vascular endothelial growth factor(VEGF)]were measured.The hemodynamic parameters of the uterine artery and angiogenesis indexes of the observation group were analyzed by the locally weighted scatterplot smoothing method(Lowess).The influencing factors of placenta accreta spectrum were analyzed by the random forest algorithm.Independent predictors of placenta accreta were evaluated via Logistic regression analysis,evaluate the predictive value of risk factors for placenta accreta,establish a prediction model,and draw the receiver operating characteristic(ROC)curve.The pregnancy outcomes of the two groups were compared,and the correlation between placenta accreta spectrum and pregnancy outcomes was analyzed.Results When compared,the two groups of pregnant women demonstrated notable differences.Significantly,discrepancies were evident in clinical characteristics,namely age,parity,gravidity,placenta previa status,history of induced abortion,and cesarean section history.Moreover,disparities existed in hemodynamic indices,specifically PI,RI,and S/D,and in the levels of angiogenesis-related indices sFlt-1 and VEGF(P<0.05).In the observation group,positive associations were detected between PI,RI and sFlt-1,while negative correlations were identified between PI,RI and VEGF.Conversely,S/D demonstrated an inverse relationship with sFlt-1 but a positive correlation with VEGF.Analysis by the random forest algorithm showed that VEGF,placenta previa,PI,sFlt-1,RI,history of cesarean section,S/D,and number of pregnancies might be factors influencing placenta accreta spectrum.Multivariate Logistic regression analysis showed that placenta previa(OR=9.819),history of cesarean section(OR=6.885),and VEGF(OR=1.018)were independent risk factors for placenta accreta spectrum,and RI(OR=0.029)was a protective factor.The areas under the ROC curves(AUC)for predicting placenta accreta of placenta previa,history of cesarean section,VEGF,RI alone and in combination were 0.797,0.771,0.781,0.808 and 0.968 respectively.The AUC of the constructed risk assessment model for placental implantation is 0.968,and the model has good diagnostic performance.The risk of adverse pregnancy outcomes in the observation group was higher than that in the control group(RR>1,P<0.05).Conclusion Placenta previa,history of cesarean section,and VEGF are high-risk factors for placenta accreta spectrum after uterine trauma,and RI is a protective factor.Placenta accreta spectrum will increase the risk of adverse pregnancy outcomes and requires great attention.
作者
曹佳宇
曹淑新
李妍
付丽君
张春梅
CAO Jiayu;CAO Shuxin;LI Yan;FU Lijun;ZHANG Chunmei(Department of Obstetrics,Tangshan Maternal and Children Health Hospital,Tangshan,Hebei O63000,China;Department of Hysteroscopy,Tangshan Maternal and Children Health Hospital,Tangshan,Hebei O63000,China)
出处
《中国优生与遗传杂志》
2025年第10期2211-2219,共9页
Chinese Journal of Birth Health & Heredity
基金
河北省2024年度医学科学研究课题计划(20241293)。
关键词
胎盘植入
子宫创伤
高危因素
妊娠结局
placenta accreta spectrum
uterine trauma
high-risk factors
pregnancy outcomes
