剖宫产产妇产褥感染危险因素及血清IFN-γ与TGF-β变化

Risk factors for puerperal infection in caesarean section women and changes of serum IFN-γ and TGF-β

目的探究剖宫产产妇产褥感染的危险因素及血清降钙素原(PCT)、干扰素-γ(IFN-γ)、转化生长因子-β(TGF-β)的变化。方法选取2015年6月-2019年6月于河南大学淮河医院妇产科行剖宫产手术并发产褥感染的产妇100例为感染组,选取同期行剖宫产手术未发生产褥感染的产妇100例为非感染组。对感染组病原分布进行调查;检测两组血清PCT、IFN-γ、TGF-β的水平;分析剖宫产产褥期感染的相关危险因素;采用受试者工作特征曲线(ROC)评价三种指标对剖宫产产妇产褥感染的诊断价值。结果感染组感染病原以大肠埃希菌(49.3%)为主;感染组产妇血清PCT、IFN-γ、TGF-β水平均升高(P<0.01);多因素Logistic回归分析显示,手术时长、生殖道感染史、胎膜早破、产后出血、会阴侧切或撕裂是剖宫产产褥感染的独立危险因素,ROC曲线结果血清PCT、IFN-γ、TGF-β以及联合指标的ROC曲线下面积(AUC)分别为0.879、0.769、0.890以及0.973。结论大肠埃希菌是导致剖宫产产妇产褥感染的最主要致病菌;剖宫产产妇的手术时长、生殖道感染史、胎膜早破、产后出血、会阴侧切或撕裂均是剖宫产产妇发生产褥感染的危险因素;血清PCT、TGF-β均有着较好的诊断效能,三指标联合的诊断效能最佳。

OBJECTIVE To explore the risk factors for puerperal infection in caesarean section women and observe the changes of serum procalcitonin(PCT), interferon-γ(IFN-γ) and transforming growth factor-β(TGF-β). METHODS From Jun. 2015 to Jun. 2019, totally 100 puerpera who underwent cesarean section in department of obstetrics and gynecology of Huaihe Hospital, Henan University and were complicated with puerperal infection were chosen as the infection group, meanwhile, 100 puerpera who underwent cesarean section but were not complicated with puerperal infection were assigned as the non-infection group. The distribution of pathogens of the infection group was investigated, the levels of serum PCT, IFN-γ and TGF-β of the two groups were detected, the related risk factors for the puerperal infection were analyzed, and the values of the three indexes in diagnosis of puerperal infection were evaluated by using receiver operating characteristic(ROC) curve. RESULTS Escherichia coli(49.3%) was the predominant species of pathogen isolated from the infection group;the levels of serum PCT, IFN-γ and TGF-β of the infection group were significantly elevated(P<0.01). Multivariate logistic regression analysis showed that operation duration, history of genital tract infection, premature rupture of fetal membranes, postpartum hemorrhage and episiotomy or laceration of perineum were the independent risk factors for the puerperal infection in the cesarean section women. The result of ROC curve analysis indicated that the areas under ROC curve(AUC) of the serum PCT, IFN-γ, TGF-β and the joint detection of the indexes were 0.879, 0.769, 0.890 and 0.973, respectively. CONCLUSION E.coli is the predominant species of pathogen causing the puerperal infection in the cesarean section women. The operation duration, history of genital tract infection, premature rupture of fetal membranes, postpartum hemorrhage and episiotomy or laceration of perineum are the risk factors for the puerperal infection in the cesarean section women. Serum PCT and TGF-β have high diagnostic efficiency, and the joint detection of the three indexes has the optimal diagnostic efficiency.