血清TSP-2联合PTX3水平对产后出血的预测价值

Predictive value of serum TSP-2 combined with PTX3 levels for postpartum hemorrhage

摘要

目的 探讨血小板反应蛋白2(TSP-2)与正五聚蛋白3(PTX3)在孕妇产后出血(PPH)患者血清中的表达,以及对PPH的预测价值。方法 选取2018年9月至2022年9月于我院分娩且发生PPH的126例孕妇作为研究组,另外选取同期126例于我院分娩的正常孕妇为对照组.采用ELISA法检测血清TSP-2、PTX3水平,采用ROC曲线分析TSP-2、PTX3对孕妇PPH的预测价值,采用多因素Logistic回归分析探究孕妇PPH的影响因素。结果 研究组血清钙水平(t=2.158)、不良孕产史(χ²=8.966)显著高于对照组(均P<0.05);研究组TSP-2、PTX3、凝血酶原时间(PT)、凝血酶时间(TT)、APTT显著高于对照组(t值介于2.339~8.414之间,P<0.05),而纤维蛋白原(FIB)水平显著低于对照组(t=2.413,P<0.05).TSP-2对孕妇PPH预测的AUC值为0.729(95%CI:0.666~0.793),PTX3预测的AUC值为0.732(95%CI:0.669~0.794),两者联合预测的AUC值为0.808(95%CI:0.754~0.863),优于两者单独预测(Z两者联合-TSP-2=1.858,P=0.032;Z两者联合-PTX3=1.787,P=0.037).多因素Logistic回归分析显示,TSP-2、PTX3、TT、FIB、PT、APTT、不良孕产史是孕妇PPH发生的影响因素(OR值介于1.131~2.249之间,P<0.05)。结论 TSP-2、PTX3在孕妇PPH患者血清中均呈高表达,两者联合对PPH的发生具有一定的预测价值,可成为辅助预测孕妇PPH的标志物.

Abstract

Objective To investigate the expression of thrombospondin-2 (TSP-2) and pentraxin 3 (PTX3) in the serum of pregnant women with postpartum hemorrhage (PPH) and predictive value for PPH. Methods 126 pregnant women who delivered in our hospital from September 2018 to September 2022 and experienced PPH were selected as the study group. Additionally, another 126 normal pregnant women who delivered at our hospital were chosen as the control group. The levels of serum TSP-2 and PTX3 were detected by enzyme-linked immunosorbent assay (ELISA), the predictive value of TSP-2 and PTX3 for maternal PPH was analyzed using receiver operating characteristic (ROC) curves. Multivariate logistic regression analysis was applied to analyze the influencing factors of PPH in pregnant women. Results The serum calcium levels (t=2.158) and adverse obstetric history (χ ²=8.966) in the study group were significantly higher than those in the control group (P<0.05); TSP-2, PTX3, prothrombin time (PT), thrombin time (TT) and activated partial thromboplastin time (APTT) in the study group were significantly higher than in the control group (t values ranging from 2.339 to 8.414, P<0.05), while the level of fibrinogen (FIB) was significantly lower than in the control group (t=2.413, P<0.05). The area under curve (AUC) value for predicting maternal PPH was 0.729 (95%CI: 0.666-0.793) for TSP-2, 0.732 (95%CI: 0.669-0.794) for PTX3, and 0.808 (95%CI: 0.754-0.863) for their combined prediction, which was superior to individual predictions (Zcombination-TSP-2=1.858, P=0.032; Zcombination-PTX3=1.787, P=0.037). Multivariate logistic regression analysis showed that TSP-2, PTX3, TT, FIB, PT, APTT and adverse obstetric history were the influencing factors for the occurrence of maternal PPH (OR values ranging from 1.131 to 2.249, P<0.05). Conclusion TSP-2 and PTX3 both exhibit high expression in the serum of pregnant women with PPH. Their combination has a certain predictive value for the occurrence of PPH and can be an auxiliary marker for predicting PPH in pregnant women.

关键词

孕妇 / 产后出血 / 血小板反应蛋白2 / 正五聚蛋白3

Key words

pregnant women / postpartum hemorrhage / thrombospondin-2 / pentraxin 3

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基金资助

天山创新团队计划项目(2021D14006)