血清TIMP-1联合elafin水平对自然分娩初产妇产后压力性尿失禁的预测价值  

Predictive value of serum TIMP-1 combined with elafin level for postpartum stress incontinence in natural delivery primiparas

作　　者：林婕 白丽娟 沈秋妮 傅晓冬 LIN Jie;BAI Li-juan;SHEN Qiu-ni(Department of Obstetrical,The Affiliated Hospital of Southwest Medical Universit,Luzhou Sichuan 646000,China)

机构地区：[1]西南医科大学附属医院产科,四川泸州646000

出　　处：《临床和实验医学杂志》2023年第15期1628-1632,共5页Journal of Clinical and Experimental Medicine

基　　金：四川省科技厅项目(编号:2021JDR0185)。

摘　　要：目的探讨血清组织金属蛋白酶抑制因子(TIMP-1)联合弹性蛋白酶抑制剂(elafin)水平对初产妇产后压力性尿失禁的预测价值。方法回顾性选取2021年1月至2022年12月在西南医科大学附属医院自然分娩的294例初产妇作为研究对象。根据产后42 d产妇是否出现压力性尿失禁将其分为观察组(n=78)与对照组(n=216)。根据不同病情严重程度将78例压力性尿失禁产妇分为轻度组(n=35)、中度组(n=30)、重度组(n=13)。比较观察组、对照组的一般资料情况(包括年龄、产前体重指数、使用助产器、无痛分娩、第二产程时间、胎儿体重和胎儿头围)。比较观察组与对照组,不同病情严重程度压力性尿失禁产妇妊娠晚期血清TIMP-1、elafin水平差异。应用Logistic回归分析对压力性尿失禁的影响因素进行分析,并应用受试者工作特征(ROC)曲线评价TIMP-1、elafin对压力性尿失禁的预测价值。结果观察组第二产程时间>1 h的比例、胎儿体重和胎儿头围均高于对照组,差异均有统计学意义(P<0.05)。观察组血清TIMP-1、elafin水平分别为(101.78±28.65)、(7.67±2.18)pg/mL,均低于对照组[(136.12±34.59)、(12.84±3.47)pg/mL],差异均有统计学意义(P<0.05),且随着病情程度加重,血清TIMP-1、elafin水平逐渐降低,差异均有统计学意义(P<0.05)。Logistic回归分析表明,第二产程时间、胎儿体重和血清TIMP-1、elafin水平是自然分娩初产妇压力性尿失禁发生的影响因素(P<0.05)。ROC曲线分析显示,TIMP-1、elafin水平预测压力性尿失禁的曲线下面积(AUC)分别为0.818、0.841,二者比较差异无统计学意义(P>0.05);二者联合的AUC为0.914,相比单一指标均提高,差异有统计学意义(P<0.05)。结论血清TIMP-1、elafin与自然分娩初产妇压力性尿失禁的发生及病情严重程度相关,可作为压力性尿失禁的早期预测指标,二者联合可提高预测效能。Objective To investigate the predictive value of serum tissue inhibitor of metalloproteinase-1(TIMP-1)combined with elastase inhibitor(elafin)level for postpartum stress incontinence in primipara.Methods A total of 294 primiparas who delivered natural childbirth in the Affiliated Hospital of Southwest Medical University from January 2021 to December 2022 were selected retrospectively as the study subjects.They were divided into observation group(n=78)and control group(n=216)according to whether stress incontinence occurred 42 days after delivery.A total of 78 stress incontinence pregnant women were divided into mild group(n=35),moderate group(n=30),and severe group(n=13)based on the severity of the condition.The general information of the stress incontinence group and non-stress incontinence groups,including age,prenatal body mass index,use of birth aids,painless delivery,second stage of labor,fetal weight,and fetal head circumference were compared.The differences of serum TIMP-1 and elafin levels in late pregnancy among stress incontinence group,non-stress incontinence group,and stress incontinence pregnant women with different severity levels were compared.Logistic regression was used to analyze the influencing factors of stress incontinence,and receiver operating characteristic(ROC)curve was used to evaluate the predictive value of TIMP-1 and elafin for stress incontinence.Results The proportion of second stage labor time>1 hour,fetal weight,and fetal head circumference in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The levels of serum TIMP-1 and elafin in the observation group were(101.78±28.65),(7.67±2.18)pg/mL,which were lower than those in the control group[(136.12±34.59),(12.84±3.47)pg/mL],the differences were statistically significant(P<0.05),and the levels of serum TIMP-1 and elafin decreased gradually with the aggravation of the disease,the differences were statistically significant(P<0.05).Logistic regression analysis

关 键 词：压力性尿失禁 盆底功能障碍 组织金属蛋白酶抑制因子 弹性蛋白酶抑制剂 

分 类 号：R714.6[医药卫生—妇产科学] R711.59[医药卫生—临床医学]