血清YKL-40、sTREM-1、PTX3表达对剖宫产术后发生产褥感染的预测价值

Predictive values of preoperative expressions of YKL-40, sTREM-1 and PTX3 in serum for puerperal infection after cesarean section

摘要

目的 探究血清甲壳质酶蛋白-40(YKL-40)、可溶性髓系细胞触发受体-1(sTREM-1)、正五聚蛋白(PTX3)表达对剖宫产术后发生产褥感染的预测价值。方法 选取2019年1月至2023年12月邯郸市第一医院收治的剖宫产术后发生产褥感染孕妇106例为病例组,选取同一阶段剖宫产术后未发生产褥感染孕妇80例为对照组.采用ELISA法检测孕妇剖宫产术前清晨血清YKL-40、sTREM-1、PTX3表达水平;Logistic回归分析影响剖宫产术后发生产褥感染的相关因素;受试者工作特征(ROC)曲线分析血清YKL-40、sTREM-1、PTX3对剖宫产术后发生产褥感染的预测价值。结果 病例组产前生殖道感染史占比、胎膜早破占比、妊娠糖尿病占比显著高于对照组(χ²值介于4.204~6.239之间,P＜0.05).病例组血清YKL-40、sTREM-1、PTX3水平均显著高于对照组(t值介于7.167~7.864之间,P＜0.001).妊娠糖尿病、胎膜早破、产前生殖道感染史、血清YKL-40、sTREM-1、PTX3是剖宫产术后发生产褥感染的影响因素(OR值介于1.456~2.161之间,P＜0.05).血清YKL-40、sTREM-1、PTX3联合预测剖宫产术后发生产褥感染的ROC曲线下面积(AUC)为0.880,优于各自单独诊断(Z三者联合-YKL-40=3.788、Z三者联合-sTREM-1=3.065、Z三者联合-PTX3=3.160,P＜0.001、P=0.002、P=0.001),联合预测的灵敏度、特异度分别为80.19%、85.00%。结论 剖宫产术前孕妇血清YKL-40、sTREM-1、PTX3三者联合检测,对剖宫产术后产妇发生产褥感染情况有一定的预测价值.

Abstract

Objective To investigate predictive values of preoperative expressions of chitinase protein-40 (YKL-40), soluble triggering receptor expressed on myeloid cell-1 (sTREM-1), and pentraxin 3 (PTX3) in serum for puerperal infection after cesarean section. Methods A total of 106 pregnant women who would experience puerperal infection after cesarean section treated in our hospital from January 2019 to December 2023 were selected as case group, and 80 pregnant women who would haven't puerperal infection after cesarean section were as control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of YKL-40, sTREM-1 and PTX3 at the morning before cesarean section of the day of surgery. Logistic regression was used to analyze influencing factors for puerperal infection after cesarean section. Receptor operation characteristic (ROC) curve was used to analyze predictive values of serum YKL-40, sTREM-1 and PTX3 for puerperal infection cesarean section. Results The proportions of the pregnant women who had prenatal reproductive tract infection history, premature rupture of membranes and gestational diabetes mellitus (GDM) in the case group were significantly higher than those in the control group (χ² values ranged from 4.204 to 6.239, all P＜0.05). The serum levels of YKL-40, sTREM-1 and PTX3 of the pregnant women in the case group were significantly higher than those in the control group (t values ranged from 7.167 to 7.864, all P＜0.001). GDM, premature rupture of membranes, prenatal reproductive tract infection history, and serum YKL-40, sTREM-1 and PTX3 were all related factors affecting postpartum puerperal infection after cesarean section (ORs ranged from 1.456-2.161, all P＜0.05). The area under the curve (AUC) of the combination of serum YKL-40, sTREM-1 and PTX3 levels for predicting puerperal infection after cesarean section was 0.880, which was superior to individual diagnoses of the three indexes (Ztriple combination-YKL-40=3.788, P＜0.001; Ztriple combination-sSTREM-1=3.065, P=0.002; Ztriple combination-PTX3=3.160, P=0.001), and the sensitivity and the specificity of combined prediction were 80.19% and 85.00% respectively. Conclusion The combined detection of serum YKL-40, sTREM-1 and PTX3 levels before cesarean section for pregnant women has a certain predictive value for occurrence of puerperal infection after cesarean section.

关键词

甲壳质酶蛋白-40 / 可溶性髓系细胞触发受体-1 / 正五聚蛋白 / 剖宫产 / 产褥感染

Key words

chitinase potein-40 / soluble triggering receptor expressed on myeloid cell-1 / pentraxin 3 / cesarean section / puerperal infection

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基金资助

河北省2024年度医学科学研究课题计划项目(20240441)