红细胞分布宽度/血小板计数比值对瘢痕子宫再次妊娠产妇产后出血的预测价值  

The Predictive Value of Red Blood Cell Distribution Width/Platelet Count Ratio for Postpartum Hemorrhage in Patients with a Second Pregnancy in a Scarred Uterus

作　　者：张霞 牟霞 高鹏[2] 刘正飞[1] ZHANG Xia;MOU Xia;GAO Peng;LIU Zhengfei(Department of Obstetrics,Yibin First People's Hospital,Yibin,Sichuan 644600,China;Department of Laboratory Medicine,Yibin First People's Hospital,Yibin,Sichuan 644600,China)

机构地区：[1]四川省宜宾市第一人民医院产科,四川宜宾644600 [2]四川省宜宾市第一人民医院检验科,四川宜宾644600

出　　处：《转化医学杂志》2024年第10期1670-1674,共5页Translational Medicine Journal

摘　　要：目的探讨红细胞分布宽度(RDW)/血小板计数(PLT)比值(RPR)对瘢痕子宫再次妊娠产妇产后出血的预测价值。方法选取2021年8月至2024年8月在宜宾市第一人民医院分娩的122例瘢痕子宫再次妊娠产妇作为研究对象,将产后出血者纳入产后出血组(n=23),产后未出血者纳入产后未出血组(n=99)。收集所有研究对象的临床资料。采用血细胞分析仪测定所有研究对象的RDW、PLT计数,并计算RPR。采用受试者工作特征(ROC)曲线分析RPR预测产后出血的效能,采用多因素Logistic回归分析产后出血的影响因素。结果产后出血组患者RDW、RPR水平均高于产后未出血组(P<0.05),PLT计数低于产后未出血组(P<0.05)。ROC曲线结果显示,RDW、PLT及RPR预测瘢痕子宫再次妊娠产妇产后出血的曲线下面积(AUC)(95%CI)分别为0.803(0.758~0.853)、0.729(0.684~0.779)、0.901(0.851~0.946)。产后出血组子宫瘢痕厚度≤3 mm、刮宫次数≥2次、子宫切口撕裂、新生儿出生时体质量≥4000 g的占比均高于产后未出血组(P<0.05)。多因素Logistic回归分析显示,子宫瘢痕厚度≤3 mm(OR=2.239,95%CI:1.350~3.712)、新生儿出生时体质量≥4000 g(OR=2.502,95%CI:1.318~4.749)、RPR≥0.08(OR=3.773,95%CI:1.893~7.523)是瘢痕子宫再次妊娠产妇产后出血的影响因素(P<0.05)。结论高RPR值与瘢痕子宫再次妊娠产妇发生产后出血密切相关,可用于预测瘢痕子宫再次妊娠产妇产后出血发生的生物标志物。Objective To explore the predictive value of red blood cell distribution width(RDW)/platelet count(PLT)ratio(RPR)for postpartum hemorrhage in patients with a second pregnancy in a scarred uterus.Methods A total of 122 patients with a second pregnancy in a scarred uterus who delivered at Yibin First People's Hospital from August 2021 to August 2024 were selected.Postpartum hemorrhage cases were included in the postpartum hemorrhage group(n=23),while non-hemorrhage cases were included in the postpartum non-hemorrhage group(n=99).Clinical data were collected for all subjects.RDW and PLT were measured using a blood cell analyzer,and RPR was calculated.Receiver operating characteristic(ROC)curves were used to analyze the predictive performance of RPR for postpartum hemorrhage,while multivariate Logistic regression was employed to identify influencing factors.Results The RDW and RPR levels were higher,while PLT was lower in the postpartum hemorrhage group compared to the non-hemorrhage group(P<0.05).The area under the ROC curve(AUC,95%confidence interval[CI])for predicting postpartum hemorrhage was 0.803(0.758-0.853)for RDW,0.729(0.684-0.779)for PLT,and 0.901(0.851-0.946)for RPR.The proportions of uterine scar thickness≤3 mm,curettage≥2 times,uterine incision tear,and newborn birth weight≥4000g were higher in the postpartum hemorrhage group(P<0.05).Multivariate Logistic regression showed that uterine scar thickness≤3 mm(odds ratio[OR]=2.239,95%CI:1.350-3.712),newborn birth weight≥4000 g(OR=2.502,95%CI:1.318-4.749),and RPR≥0.08(OR=3.773,95%CI:1.893-7.523)were significant influencing factors for postpartum hemorrhage(P<0.05).Conclusion A high RPR value is closely associated with postpartum hemorrhage in patients with a second pregnancy in a scarred uterus and can serve as a biomarker for its prediction.

关 键 词：瘢痕子宫 再次妊娠产妇 产后出血 红细胞分布宽度/血小板计数比值 ROC曲线 

分 类 号：R719.8[医药卫生—妇产科学] R714.461[医药卫生—临床医学] R446.111