胎膜早破产妇产褥感染影响因素及胎盘胎膜TLR4的预测价值

Influencing factors for puerperal infection in patients with premature rupture of membranes and predictive value of TLR4

目的分析胎膜早破(PROM)产妇产褥感染影响因素及胎盘胎膜组织Toll样受体4(TLR4)的预测价值。方法选取2016年5月-2020年5月淄博市第一医院妇产科收治的88例PROM患者作为研究对象,根据是否发生产褥感染分为感染组和未感染组,对其产褥感染相关因素、胎盘和胎膜组织TLR4表达量进行观察和分析,并采用受试者工作特征曲线(ROC)对胎盘胎膜组织TLR4表达量诊断产褥感染的价值进行分析。结果有14例患者发生产褥感染,感染率为15.91%。感染组中孕程<37周、产前贫血、妊娠期糖尿病、生殖道感染史、破膜时间≥12 h、产后出血的患者比例均高于未感染组,差异均有统计学意义(P<0.05)。Logistic多元回归模型分析结果显示,PROM产褥感染的发生与孕程具有相关性,孕程<37周可增加患者的产褥感染风险(P<0.001)。感染组患者胎盘和胎膜TLR4表达水平均高于未感染组(P<0.05)。胎盘、胎膜TLR4表达水平预测PROM产褥感染的ROC曲线下面积(AUC)均有统计学意义(P<0.05),在Cutoff值下,其灵敏度和特异度分别为0.643、0.714和1.000、0.986。结论发生产褥感染的PROM产妇可出现胎盘及胎膜组织TLR4表达上调,这一指标可用于辅助产褥感染的风险预测和早期诊断。

OBJECTIVE To analyze the influencing factors for puerperal infection in patients with premature rupture of membranes(PROM) and observe the predictive value of Toll like receptor 4(TLR4) in placenta and fetal membrane tissues. METHODS A total of 88 patients with PROM who were treated in the obstetrics department of Zibo First Hospital from May 2016 to May 2020 were recruited as the study subjects and divided into the infection group and the no infection group according to the status of puerperal infection. The related factors for puerperal infection and expression levels of TLR4 in placenta and fetal membrane tissues were observed, and the value of placenta and fetal membrane tissues TLR4 expression level in diagnosis of puerperal infection was analyzed by using receiver operating characteristic(ROC) curve. RESULTS Totally 14 patients had puerperal infection, with the infection rate 15.91%. The proportions of the patients with gestational age less than 37 weeks, prenatal anemia, gestational diabetes mellitus, history of genital tract infection, time of rupture of membranes no less than 12 hours, and postpartum hemorrhage were significantly higher in the infection group than in the no infection group(P<0.05).The result of multivariate logistic regression analysis showed that the incidence of puerperal infection in the PROM patients was associated with the gestational age, the less than 37 weeks of gestational age could increase the risk of puerperal infection(P<0.001). The expression level of TLR4 in placenta and fetal membranes was significantly higher in the infection group than in the no infection group(P<0.05). There was significant difference in the area under curve(AUC) of ROC of the placenta and fetal membrane tissues TLR4 expression level in prediction of puerperal infection(P<0.05), under cutoff value, the sensitivity and specificity were respectively 0.643 and 0.714, 1.000 and 0.986. CONCLUSION The PROM patients with puerperal infection may have the up-regulation of TLR4 in placenta and fetal membranes tissues, and the index may facilitate the prediction of risk of puerperal infection and early diagnosis.