穿透性凶险性前置胎盘患者剖宫产术前外周血FAR、CD40L及MMP-9水平对产后出血的预测价值  

Prediction Value of FAR,CD40L and MMP⁃9 Levels in Peripheral Blood of Patients with Penetrating and Dangerous Placenta Previa before Cesare⁃an Section for Postpartum Hemorrhage

作　　者：桑雪梅[1] 甄慧 肖凤艳[2] SANG Xuemei;ZHEN hui;XIAO Fengyan(Department of gynaecology and obstetrics,Maternal and Child Health Hospital TangS-han,TangShan,HeiBei 063000,China;Department of clinical laboratory,Maternal and Child Health Hospital TangS-han,TangShan,HeiBei 063000,China)

机构地区：[1]唐山市妇幼保健院妇产科,河北唐山063000 [2]唐山市妇幼保健院检验科,河北唐山063000

出　　处：《转化医学杂志》2024年第7期1045-1050,共6页Translational Medicine Journal

基　　金：河北省重点研发计划自筹项目(172777165)。

摘　　要：目的探讨穿透性凶险性前置胎盘(PPP)患者剖宫产术前白细胞分化抗原40配体(CD40L)、纤维蛋白原与白蛋白比值(FAR)、基质金属蛋白酶-9(MMP-9)水平对产后出血的预测价值。方法选取2017年1月至2023年12月唐山市妇幼保健院收治的115例穿透性PPP患者作为研究对象,根据产后出血情况分为出血组(62例)与未出血组(53例)。比较2组基线资料、剖宫产术前FAR、CD40L及MMP-9水平,分析患者产后出血的影响因素及关系,ROC评价FAR、CD40L及MMP-9水平对产后出血的预测价值。结果2组剖宫产次数、年龄、前置胎盘类型比较,差异有统计学意义(P<0.05);出血组FAR低于未出血组,CD40L、MMP-9水平高于未出血组,差异有统计学意义(P<0.05);年龄、中央型前置胎盘、FAR、剖宫产次数、CD40L、MMP-9水平均为穿透性PPP患者产后出血的危险因素(P<0.05);FAR、CD40L、MMP-9水平仍与穿透性PPP患者产后出血显著相关(P<0.05);FAR、CD40L、MMP-9单独及联合预测穿透性PPP患者产后出血的AUC分别为0.795、0.768、0.803、0.935,FAR、CD40L、MMP-9联合预测的AUC高于FAR、CD40L、MMP-9单独预测(P<0.05)。结论穿透性PPP患者FAR、CD40L、MMP-9与产后出血有关,三者联合检测预测患者产后出血具有较高的价值,有望成为预测穿透性PPP产后出血的标志物。Objective To investigate the predictive value of fibrinogen to albumin ratio(FAR),leukocyte differenti⁃ation antigen 40 ligand(CD40L)and matrix metalloproteinase⁃9(MMP⁃9)levels in postpartum hemorrhage in patients with penetrating and dangerous placenta previa(PPP)before cesarean section.Methods A total of 115 patients with penetrating PPP in maternal and child health hospital TangShan,from January 2017 to December 2023 were selected as the study objects,and were divided into bleeding group(n=62)and non⁃bleeding group(n=53)according to postpartum hemorrhage.Base⁃line data,FAR,CD40L and MMP⁃9 levels before cesarean section were compared between the two groups,and the influencing factors and relationships of postpartum hemorrhage in penetrating PPP patients were analyzed.The predictive value of FAR,CD40L and MMP⁃9 levels on postpartum hemorrhage was evaluated using ROC.Results There were significant differences in age,proportion of central placenta previa type and number of cesarean section between the two groups(P<0.05).The levels of CD40L and MMP⁃9 in bleeding group were higher than those in non⁃bleeding group(P<0.05).Age,central placenta pre⁃via,number of cesarean section,FAR,CD40L and MMP⁃9 levels were the influencing factors of postpartum hemorrhage in penetrating PPP patients(P<0.05).The levels of FAR,CD40L and MMP⁃9 were still significantly correlated with postpar⁃tum hemorrhage in penetrating PPP patients(P<0.05).The AUC predicted by FAR,CD40L and MMP⁃9 alone and in com⁃bination were 0.795,0.768,0.803 and 0.935,respectively,and the AUC predicted by FAR,CD40L and MMP⁃9 combined was higher than that predicted by FAR,CD40L and MMP⁃9 alone(P<0.05).Conclusion FAR,CD40L and MMP⁃9 are associated with postpartum hemorrhage in penetrating PPP patients.Combined detection has high predictive value for postpar⁃tum hemorrhage in patients,and it is expected to become a marker for predicting postpartum hemorrhage in penetrating PPP patients.

关 键 词：凶险性前置胎盘 剖宫产 纤维蛋白原与白蛋白比值 分化抗原40配体 基质金属蛋白酶-9 产后出血 

分 类 号：R719.8[医药卫生—妇产科学]