血清中糖化血红蛋白和白蛋白水平预测妊娠期糖尿病产妇剖宫产术后感染风险的临床价值

Clinical Value of Serum Glycosylated Hemoglobin and Albumin Levels in Predicting the Risk of Infection After Cesarean Section in Puerperae with Gestational Diabetes Mellitus

目的:探究影响妊娠期糖尿病(GDM)产妇剖宫产术后感染的危险因素及血清糖化血红蛋白(HbA1c)、白蛋白(Alb)对术后感染的预测价值。方法:回顾性分析2017年9月至2020年9月收治的110例GDM产妇临床资料,所有产妇拟行剖宫产前一日清晨,检测空腹血糖(FPG)、HbA1c、血红蛋白(Hb)、糖化白蛋白(GA)、Alb、总胆固醇(TC)等血清生化指标水平。统计剖宫产术后感染发生情况,并收集产妇一般资料、手术资料、妊娠相关合并症情况等可能影响术后感染因素。采用单因素分析、多因素Logistic回归分析探究影响术后感染的危险因素,并绘制受试者工作特征(ROC)曲线探究血清指标对术后感染预测价值。结果:110例GDM剖宫产产妇术后感染发生率26.36%(29/110),其中切口感染10.00%(11/110),尿路感染11.82%(13/110),肺部感染4.55%(5/110)。GDM产妇剖宫产术后感染组与非感染组在手术切口长度、术中出血量、是否预防性应用抗生素、是否合并生殖道炎症、是否合并羊水污染、是否合并胎膜早破及血清FPG、HbA1c、GA、Alb水平上比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,预防性应用抗生素是GDM产妇剖宫产术后感染的保护因素(P<0.05),生殖道炎症、羊水污染、胎膜早破、HbA1c>6.5%、Alb<40g/L是术后感染的独立危险因素(P<0.05)。血清HbA1c、Alb及二者联合预测GDM产妇剖宫产术后感染的ROC曲线下面积分别为0.733、0.700、0.797(P<0.05)。结论:GDM剖宫产产妇术后感染有一定发生率,其中预防性应用抗生素是其保护因素,合并生殖道炎症、羊水污染、胎膜早破及血清高HbA1c、低Alb水平是其危险因素,且术前联合检测血清HbA1c、Alb对术后感染有一定预测价值。

Objective:To explore the risk factors of infection after cesarean section in puerperae with gestational diabetes mellitus(GDM)and the predictive value of serum glycosylated hemoglobin(HbA1c)and albumin(Alb)on postoperative infection.Methods:The clinical data of 110 puerperae with GDM admitted from September 2017 to September 2020 were retrospectively analyzed.The levels of serum biochemical indicators such as fasting plasma glucose(FPG),HbA1c,hemoglobin(Hb),glycated albumin(GA),Alb and total cholesterol(TC)were detected among all puerperae in the morning before cesarean section.The occurrence of infection after cesarean section was counted,and the factors of general maternal data,surgical data and pregnancy-related complications that might affect postoperative infection were collected among all puerperae.Univariate analysis and multivariate logistic regression analysis were used to explore the risk factors affecting postoperative infection,and receiver operating characteristic(ROC)curve was plotted to explore the predictive value of serum indicators on postoperative infection.Results:The incidence rate of postoperative infection was 26.36%(29/110)among puerperae with GDM after cesarean section,including incision infection of 10.00%(11/110),urinary tract infection of 11.82%(13/110)and lung infection of 4.55%(5/110).There were statistically significant differences in the surgical incision length,intraoperative blood loss,presence or absence of prophylactic use of antibiotics,presence or absence of genital tract inflammation,amniotic fluid pollution and premature rupture of membranes and levels of serum FPG,HbA1c,GA and Alb between infection group and non-infection group of GDM puerperae after cesarean section(P<0.05).Multivariate logistic regression analysis showed that prophylactic use of antibiotics was a protective factor for infection after cesarean section in GDM puerperae(P<0.05),and the genital tract inflammation,amniotic fluid pollution,premature rupture of membranes,HbA1c>6.5%and Alb<40g/L were independent risk factors for postoperative infection(P<0.05).The areas under the ROC curves of serum HbA1c,Alb and the combination of the two in predicting infection after cesarean section in GDM puerperae were 0.733,0.700 and 0.797 respectively(P<0.05).Conclusion:There is a certain incidence rate of infection after cesarean section in GDM puerperae.Prophylactic use of antibiotics is the protective factor,and genital tract inflammation,amniotic fluid pollution,premature rupture of membranes and high serum HbA1c and low Alb levels are risk factors.The combined detection of serum HbA1c and Alb before surgery has a certain predictive value on postoperative infection.