血清25-羟基维生素D3水平对妊娠晚期B族链球菌感染孕妇发生胎膜早破的影响

Influence of serum 25-hydroxyvitamin D3 level on premature rupture of membranes in pregnant women with group B streptococcus infection in the third trimester of pregnancy

目的探究血清25-羟基维生素D3[25-(OH)D3]水平与妊娠晚期B族链球菌(GBS)感染孕妇并发胎膜早破(PROM)的关系。方法选取2018年5月-2021年11月绵阳市第三人民医院妇产科收治的198例GBS感染孕妇为研究对象,根据是否并发PROM分为非PROM组162例和PROM组36例。并根据孕妇的平均血清25-(OH)D3水平将其分为25-(OH)D3高水平组(n=101)和25-(OH)D3低水平组(n=97)。比较两组受试者一般资料及血清25-(OH)D3、干扰素-γ(INF-γ)、白介素-10(IL-10)水平,同时分析各指标与GBS感染并发PROM的关系。结果PROM组孕妇血清25-(OH)D3[(28.39±9.46)ng/mL vs.(52.16±17.39)ng/mL]、IL-10[(2.18±0.55)ng/mL vs.(2.96±0.74)ng/mL]水平低于非PROM组,血清INF-γ[(15.46±5.15)ng/mL vs.(9.13±3.04)ng/mL]水平高于非PROM组,差异均有统计学意义(t=7.934、5.964、9.785,P均<0.05)。25-(OH)D3低水平组孕妇血清INF-γ[(11.02±3.67)ng/mL vs.(9.57±3.17)ng/mL]水平及发生PROM者占比[30.93%vs.5.94%]高于25-(OH)D3高水平组(t=2.979,χ2=20.767,P均<0.05),血清IL-10[(2.64±0.66)ng/mL vs.(2.99±0.75)ng/mL]水平低于25-(OH)D3高水平组(t=3.481,P<0.05),差异均有统计学意义。GBS感染并发PROM孕妇血清25-(OH)D3水平与INF-γ成负相关(r=-0.488,P<0.05),与IL-10成正相关(r=0.463,P<0.05)。血清25-(OH)D3、INF-γ、IL-10与GBS感染并发PROM相关(OR=0.556、2.342、0.768、P均<0.05)。25-(OH)D3、INF-γ联合预测GBS感染并发PROM的曲线下面积(AUC)为0.940,高于血清25-(OH)D3、INF-γ、IL-10单独预测(AUC分别为0.860、0.866、0.658)。结论血清25-(OH)D3水平在妊娠晚期GBS感染孕妇并发PROM患者中下降,是妊娠晚期GBS感染孕妇并发PROM的影响因素,25-(OH)D3、INF-γ联合更有助于临床预测GBS感染并发PROM。

Objective To investigate the relationship between serum 25-hydroxyvitamin D3[25-(OH)D3]levels and pregnant women with group B streptococcus(GBS)infection complicated with premature rupture of membranes(PROM)in the third trimester of pregnancy.Methods A total of 198 pregnant women with GBS infection who were admitted to department of obstetrics and gynecology of the Mianyang Third People's Hospital from May 2018 to November 2021 were gathered as the research objects.According to whether pregnant women with GBS infection and complicated with PROM,they were grouped into 162 cases non-PROM group and 36 cases PROM group;according to the mean serum 25-(OH)D3 level of GBS-infected pregnant women,they were divided into 101 cases 25-(OH)D3 high level group and 97 cases 25-(OH)D3 low level group.The general data and serum 25-(OH)D3,interferon-gamma(INF-γ)and interleukin-10(IL-10)levels of the subjects in the two groups were compared,and the relationship between each index and GBS infection complicated with PROM was also analyzed.Results The serum levels of 25-(OH)D3[(28.39±9.46)ng/mL vs.(52.16±17.39)ng/mL]and IL-10[(2.18±0.55)ng/mL vs.(2.96±0.74)ng/mL]in pregnant women in the PROM group were lower than those in the non-PROM group;the serum level of INF-γ[(15.46±5.15)ng/mL vs.(9.13±3.04)ng/mL]was higher than that in the non-PROM group,and the differences were statistically significant(t=7.934,5.964,9.785,all P<0.05);the serum INF-γ[(11.02±3.67)ng/mL vs.(9.57±3.17)ng/mL]level of pregnant women in the 25-(OH)D3 low level group and the proportion of those who developed PROM[30.93%vs.5.94%]were higher than those in the 25-(OH)D3 high level group,and the differences were statistically significant(t=2.979,χ2=20.767,all P<0.05);the serum IL-10[(2.64±0.66)ng/mL vs.(2.99±0.75)ng/mL]level was lower than that of the 25-(OH)D3 high level group,and the differences were statistically significant(t=3.481,P<0.05);the serum level of 25-(OH)D3 in pregnant women with GBS infection complicated with PROM was negatively correlated with INF-γ(r=-0.488,P<0.05),and positively correlated with IL-10(r=0.463,P<0.05);serum 25-(OH)D3,INF-γ,and IL-10 were associated with GBS infection complicated with PROM(OR=0.556,2.342,0.768,all P<0.05).The area under the curve(AUC)of 25-(OH)D3 and INF-γcombined to predict GBS infection complicated with PROM was higher than the AUC predicted by serum 25-(OH)D3,INF-γ,and IL-10 alone.Conclusions Serum 25-(OH)D3 level was decreased in pregnant women with GBS infection complicated with PROM in late pregnancy and was an influencing factor of PROM in pregnant women with GBS infection in the third trimester.The combination of 25-(OH)D3 and INF-γwas more helpful for clinical prediction of GBS infection complicated with PROM.