血清AT-Ⅲ、sCD40L、TIMP-1水平对妊娠期高血压疾病产后出血的预测价值  

Predictive value of serum AT-Ⅲ,sCD40L and TIMP-1 combined detection for postpartum hemorrhage in patients with hypertensive diseases during pregnancy

作　　者：朱卫红 徐海燕 王欢 ZHU Weihong;XU Haiyan;WANG Huan(Department of Blood Transfusion,The Orthopaedic Hospital of Zhoukou City,Henan 466000,China)

机构地区：[1]河南省周口骨科医院输血科,466000 [2]河南省周口市中心医院妇产科,466000

出　　处：《淮海医药》2025年第1期9-12,共4页Journal of Huaihai Medicine

基　　金：周口市2022年科技发展计划(2022GG02435)。

摘　　要：目的:分析血清抗凝血酶Ⅲ(AT-Ⅲ)、可溶性CD40配体(sCD40L)、金属蛋白酶组织抑制因子-1(TIMP-1)对妊娠期高血压疾病(HDP)产后出血的预测价值。方法:回顾性选取2020年5月—2023年5月某院诊治的108例HDP患者为研究对象,依据产后24 h是否发生出血分为发生组(29例)和未发生组(79例)。比较2组临床资料及分娩前血清AT-Ⅲ、sCD40L、TIMP-1水平;多因素Logistic回归分析产后出血的影响因素;受试者工作特征曲线(ROC)评价分娩前血清AT-Ⅲ、sCD40L、TIMP-1水平对产后出血的预测效能。结果:发生组胎盘早剥、前置胎盘、瘢痕子宫、软产道损伤占比均高于未发生组(P<0.05);发生组血清AT-Ⅲ水平低于未发生组,血清sCD40L、TIMP-1水平高于未发生组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,胎盘早剥(OR=2.204,95%CI1.158~4.195)、软产道损伤(OR=2.250,95%CI 1.632~3.102)及分娩前sCD40L(OR=2.627,95%CI 2.235~3.087)、TIMP-1(OR=2.204,95%CI 1.158~4.195)水平为产后出血的独立危险因素(P<0.05),分娩前血清AT-Ⅲ(OR=0.439,95%CI 0.226~0.854)水平为产后出血的独立保护因素(P<0.05);ROC分析显示,分娩前血清AT-Ⅲ、sCD40L、TIMP-1单项及联合预测产后出血的AUC分别为0.735、0.746、0.795、0.903。结论:HDP产后出血患者血清AT-Ⅲ水平降低,血清sCD40L、TIMP-1水平升高,联合检测对产后出血具有一定预测价值。Objective:To analyze the predictive value of serum antithrombin III(AT-Ⅲ),soluble CD40 ligand(sCD40L),and tissue inhibitor of metalloproteinase-1(TIMP-1)in postpartum hemorrhage in patients with hypertensive disorders of pregnancy(HDP).Methods:A retrospective study was conducted on 108 patients with HDP who were treated in a hospital from May 2020 to May 2023.They were divided into a group of 29 patients who experienced bleeding within 24 hours after delivery and a group of 79 patients who did not.Clinical data and levels of serum AT-Ⅲ,sCD40L,and TIMP-1 before delivery were compared between the two groups.Multivariate logistic regression analysis was used to analyze the influencing factors of postpartum hemorrhage.The predictive efficacy of serum AT-Ⅲ,sCD40L,and TIMP-1 levels before delivery for postpartum(24 h)hemorrhage was evaluated using receiver operating characteristic(ROC)curve analysis.Results:The proportions of placental abruption,placenta previa,scarred uterus,and soft birth canal injury in the occurrence group were higher than those in the non-occurrence group(P<0.05).The serum AT-Ⅲlevel in the occurrence group was lower than that in the non-occurrence group,while the serum sCD40L and TIMP-1 levels were higher than those in the non-occurrence group(P<0.05).Multivariate logistic regression analysis showed that placental abruption(95%CI 1.265~2.228,P=0.020),soft birth canal injury(95%CI 1.632~3.102,P=0.024),and prepartum sCD40L(95%CI 2.235~3.087,P=0.016)and TIMP-1(95%CI 1.158~4.195,P=0.001)levels were independent risk factors for postpartum hemorrhage,while prepartum serum AT-Ⅲ(95%CI 0.226~0.854,P=0.002)level was an independent protective factor for postpartum hemorrhage(P<0.05).ROC analysis showed that the AUC of serum AT-Ⅲ,sCD40L,TIMP-1,and their combination for predicting postpartum hemorrhage before delivery were 0.735,0.746,0.795,and 0.903,respectively,and the AUC of the combination was greater than that of individual indicators(P<0.05).Conclusion:The serum AT-Ⅲlevel of HDP patients wi

关 键 词：高血压 妊娠性 产后出血 抗凝血酶Ⅲ 可溶性CD40配体 金属蛋白酶组织抑制因子-1 

分 类 号：R714.246[医药卫生—妇产科学]