NO、NOS、BNP水平变化与剖宫产后出血的关系研究

Relationship between serum NO,NOS,BNP levels and postpartum hemorrhage after cesarean section

目的探讨血清一氧化氮(NO)、一氧化氮合酶(NOS)、脑钠肽(BNP)水平变化与剖宫产后出血的关系。方法选取2017年3月至2020年1月在上海市宝山区吴淞中心医院治疗的剖宫产后出血患者130例(产后出血组)。根据出血量多少,分为小出血量组(出血量500~1000 ml)100例,中出血量组(出血量>1000~1500 ml)21例,大出血量组(出血量>1500 ml)9例。同时选取女性健康志愿者153例作为对照组。采用硝酸还原酶法检测NO和NOS,ELISA法检测BNP。比较产后出血组和对照组治疗前、不同出血量组治疗前及产后出血组治疗前后血清NO、NOS、BNP水平变化。采用ROC曲线评估NO、NOS、BNP单独诊断及3项指标联合诊断剖宫产后出血的效能。结果治疗前产后出血组患者血清NO、NOS、BNP水平均明显高于对照组(均P<0.05);治疗前小出血量组患者血清NO、NOS、BNP水平均低于大出血量组患者与中出血量组患者(均P<0.05),中出血量组患者NOS水平低于大出血量组(P<0.05);产后出血组患者治疗后患者血清NO、NOS、BNP水平明显低于治疗前(均P<0.05)。NO+NOS+BNP联合诊断剖宫产后出血的特异度、灵敏度均高于单项指标检测(均P<0.05)。结论血清NO、NOS、BNP表达水平与剖宫产后出血的发生、发展密切相关,剖宫产时应密切关注患者血清NO、NOS、BNP表达情况,以便出血时及时止血。

Objective To investigate the relationship between the changes of serumnitric oxide(NO),nitric oxide synthase(NOS),brain natriuretic peptide(BNP)levels and the severity of postpartumhemorrhage after cesarean section.Methods A total of 130 patients with post-cesarean hemorrhage(postpartum hemorrhage group)who were treated in Wusong Central Hospital of Baoshan District from March 2017 to January 2020 were enrolled,including 100 cases of mild bleeding(500-1000 ml),21 cases of moderate bleeding group(>1000-1500 ml),and 9 cases of severe bleeding(>1500 ml).At the same time,153 healthy volunteers were selected as the control group.Nitrate reductase method was used to detect NO and NOS,and ELISA was used to detect BNP.The serum NO,NOS and BNP levels of control group and postpartum hemorrhage group before treatment were compared,and those indicators in postpartum hemorrhage group before and after treatment were also compared.The specificity and sensitivity of NO,NOS,BNP alone or combination for diagnosis of post-cesarean hemorrhage were analyzed.Results The levels of serum NO,NOS and BNP in the patients with pre-treatment and post-partum hemorrhage were significantly higher than those in the control group(all P<0.05).Before treatment,serum NO,NOS,and BNP levels in patients with mild bleeding were lower than those in the moderate or severe bleeding groups,and the levels of NOS in the moderate bleeding group were lower than those in the major bleeding group(all P<0.05).The serum levels of NO,NOS,and BNP in patients in the postpartum hemorrhage group were significantly lower than those before treatment(all P<0.05).The specificity and sensitivity of combined NO+NOS+BNP in the diagnosis of post-cesarean hemorrhage were higher than that of single index detection(all P<0.05).Conclusion Serum NO,NOS,BNP levels are closely related to the occurrence and development of post-cesarean section bleeding,suggests that these indicators may be used for evaluation of hemorrhage during cesarean section.