初产妇分娩后血清TIMP-1和Fibulin-3水平变化及对产后盆底功能障碍的诊断价值  

Changes of Serum TIMP-1 and Fibulin-3 Levels after First Delivery and Their Diagnostic Value for Postpartum Pelvic Floor Dysfunction

作　　者：王利伶 张银 于波 WANG Liling;ZHANG Yin;YU Bo(Department of Obstetrics,Chengde Maternal and Child Health Hospital,Hebei Chengde 067000,China)

机构地区：[1]承德市妇幼保健院产科,河北承德067000

出　　处：《现代检验医学杂志》2024年第5期179-182,198,共5页Journal of Modern Laboratory Medicine

基　　金：2023年承德市科技计划自筹经费项目(项目编号:202301A006,202301A001)。

摘　　要：目的 探究初产妇分娩后血清金属蛋白酶抑制因子-1(tissue inhibitor of metalloproteinase-1,TIMP-1)、细胞外基质蛋白-3(extracellular matrix protein-3, Fibulin-3)水平变化及其对产后盆底功能障碍(pelvic floor dysfunction,PFD)的诊断价值,为PFD临床研究提供参考。方法 选取2021年6月~2022年6月在承德市妇幼保健院收治的PFD患者98例作为研究对象,将患者分为单纯盆腔脱垂(POP)组(n=34)、单纯压力性尿失禁(SUI)组(n=51)以及POP并发SUI组(n=13)。同期选取产后复查无PFD初产女性98例作为对照组。比较各组血清TIMP-1,Fibulin-3水平。受试者工作特征(ROC)曲线分析血清TIMP-1,Fibulin-3水平对PFD的预测效能。结果 PFD组第二产程时间延长患者比例比对照组高,差异具有统计学意义(χ^(2)=20.933,P <0.05)。PFD组血清TIMP-1(3.68±0.41ng/ml),Fibulin-3(20.18±2.29ng/ml)水平比对照组(4.25±0.53ng/ml,23.04±2.64ng/ml)低,差异具有统计学意义(t=8.421,8.101,均P <0.05)。POP并发SUI组血清TIMP-1,Fibulin-3水平低于单纯POP组和单纯SUI组,差异具有统计学意义(F=21.940,14.871,均P <0.05)。随着单纯POP组与单纯SUI组患者病情加重,血清TIMP-1,Fibulin-3水平逐渐降低(F=8.411,13.173,18.425,10.965,均P <0.05)。ROC曲线显示,血清TIMP-1,Fibulin-3预测发生PFD的AUC是0.770,0.784,二者联合预测的AUC为0.893,优于单独检测(Z=2.996,2.766,均P <0.05)。结论 PFD患者血清TIMP-1,Fibulin-3水平降低,且二者联合预测效能高于单独检测,可作为预测产后PFD的血清学指标。Objective To explore the changes of serum tissue inhibitor of metalloproteinase-1(TIMP-1)and extracellular matrix protein-3(Fibulin-3)levels after the first delivery,and their diagnostic value for postpartum pelvic floor dysfunction(PFD),and provide a reference for clinical research of PFD.Methods A total of 98 patients with PFD admitted to Chengde Maternal and Child Health Hospital from June 2021 to June 2022 were selected as study subjects,and the patients were categorized into the pure pelvic prolapse(POP)group(n=34),the pure stress urinary incontinence(SUI)group(n=51),and the POP-combined SUI group(n=13).In the same period,98 women who underwent postpartum review for primiparous delivery without PFD were selected as the control group.Serum TIMP-1 and Fibulin-3 levels were compared between the groups.The predictive efficacy of serum TIMP-1 and Fibulin-3 levels for PFD was analyzed by ROC.Results The proportion of patients with prolonged duration of the second stage of labor in the PFD group was higher than that in the control group,and the difference was statisticlly significant(t=20.933,P<0.05).Serum TIMP-1(3.68±0.41ng/ml)and Fibulin-3(28.18±2.29ng/ml)levels in the PFD group were lower than those in the control group(4.25±0.53ng/ml,23.04±2.64ng/ml),and the differenes were statistically significant(t=8.421,8.101,all P<0.05).Serum TIMP-1 and Fibulin-3 levels in the POP combined with SUI group were lower than those in the POP alone group and SUI-only group(F=21.940,14.871,all P<0.05).As the condition of the patients in the POP-only group and the SUIonly group worsened,the serum TIMP-1 and Fibulin-3 levels were gradually decreased(F=8.411,13.173,18.425,10.965,all P<0.05).ROC curves showed that the AUCs of serum TIMP-1 and Fibulin-3 alone and the combination of the two for the prediction of the occurrence of PFD were 0.770,0.784 and 0.893,respectively,which the AUC of combination detection was superior to that of the test alone(Z=2.996,2.766,all P<0.05).Conclusion Serum TIMP-1 and Fibulin-3 levels are reduced

关 键 词：盆底功能障碍 金属蛋白酶抑制因子-1 细胞外基质蛋白-3 

分 类 号：R714.69[医药卫生—妇产科学] R392.11[医药卫生—临床医学]