产后出血因素及血清AT-Ⅲ、BNP及NO预测价值

The related factors of postpartum hemorrhage and the predictive value of serum levels of AT-Ⅲ, BNP and NO for postpartum hemorrhage

目的:分析产后出血的相关因素及血清抗凝血酶-Ⅲ(AT-Ⅲ)、脑钠肽(BNP)及一氧化氮(NO)预测价值。方法:本院2015年1月—2018年1月产科住院分娩的204例孕产妇资料,根据分娩后出血情况分为出血组69例及无产后出血者135例作为对照组,分析血清指标及产后出血的相关因素。结果:两组年龄、产次、妊娠周期比较无差异(P>0.05),妊娠期高血压疾病、妊娠期糖尿病、流产史、剖宫产史、前置胎盘、胎盘早剥、宫缩乏力、分娩方式、产程延长、软产道损伤、胎儿体质量、AT-Ⅲ、BNP及NO比较有差异(P<0.05)。多因素logistic回归分析显示,妊娠期高血压疾病、妊娠期糖尿病、流产史、剖宫产史、前置胎盘、胎盘早剥、宫缩乏力、分娩方式、产程延长、软产道损伤、胎儿体质量、BNP及NO为产后发生的独立危险因素,AT-Ⅲ为保护因素。AT-Ⅲ曲线下面积为0.698,敏感度和特异度分别为0.6%和0.7%;BNP曲线下面积为0.771,敏感度和特异度分别为0.9%和0.6%:NO曲线下面积为0.825,敏感度和特异度分别为0.7%和0.8%;联合检测曲线下面积为0.900,敏感度和特异度分别为0.8%和0.8%,联合检测最佳。结论:产后出血的发生与多种因素有关,AT-Ⅲ、BNP及NO有一定预测价值。

Objective: To analyze the related factors of postpartum hemorrhage, and to study the predictive value of serum levels of serum antithrombin Ⅲ(AT-Ⅲ), brain natriuretic peptide (BNP), and nitric oxide (NO) for postpartum hemorrhage. Methods: 204 pregnant women were divided into group A (69 women with postpartum hemorrhage) and group B (135 women without postpartum hemorrhage) according to the postpartum hemorrhage situation of women from January 2015 to January 2018. The related factors of postpartum hemorrhage and the levels of serum AT-III, BNP and NO were compared between the two groups. Results: There was no significant difference in age, number of births, and gestational weeks between the two groups ( P >0.05). The delivery model, the rates of gestational hypertension disease, gestational diabetes, history of abortion, cesarean delivery, placenta previa, placental abruption, contractions fatigue, prolonged labor, soft birth canal injury, and the fetal body quality, and the levels of AT -Ⅲ, BNP and NO of women in group A were significant different from those of women in group B ( P <0.05). Multiple Logistic regression analysis showed that delivery mode, rates of gestational hypertension disease, gestational diabetes, abortion history, cesarean delivery history, placenta previa, placental abruption, uterine inertia, prolonged labor, soft birth canal injury, and fetal body mass, levels of BNP and NO were independent risk factors of postpartum hemorrhage, and the level of AT-III was a protective factor of postpartum hemorrhage. The area under curve of the AT-III level was 0.698, and the sensitivity and specificity of the AT-III level were 0.6 and 0.7, respectively. The area under curve of the BNP level was 0.771, and the sensitivity and specificity of the BNP level were 0.9 and 0.6, respectively. And the area under curve of the NO level was 0.825, and the sensitivity and the specificities of the NO level were 0.7 and 0.8, respectively. The area under curve of the combined levels of AT-III, BNP and NO was 0.900, and the sensitivity and specificity were 0.8 and 0.8, respectively, which was significant higher than that of the AT-III level, BNP level, or NO level only. Conclusion: The occurrence of postpartum hemorrhage is related to a variety of factors, and among them, the levels of AT-III, BNP and NO have some predictive value for postpartum hemorrhage.