产后盆底功能障碍初产妇分娩后血清MMP-1、OPN、CTGF水平变化及其预测效能

Changes of serum MMP-1,OPN and CTGF in primiparas with postpartum pelvic floor dysfunction after delivery and their predictive efficacy

目的观察产后盆底功能障碍(PFD)初产妇分娩后血清基质金属蛋白酶-1(MMP-1)、骨桥蛋白(OPN)、结缔组织生长因子(CTGF)水平变化情况,并分析其对初产妇产后PFD的预测效能。方法初产妇产后发生PFD的患者71例,记为PFD组。其中子宫脱垂者31例、压力性尿失禁者40例,分别采用MRI分度标准对子宫脱垂、压力性尿失禁患者进行分度。另选择同期产后复查无PFD的初产妇105例为对照组。采用酶联免疫吸附试验检测两组患者血清MMP-1、OPN、CTGF水平。以单因素分析中差异有统计学意义的指标为自变量并赋值,采用Logistic逐步回归分析法分析初产妇产后发生PFD的影响因素。采用受试者工作特征曲线(ROC)分析血清MMP-1、OPN、CTGF水平对初产妇产后发生PFD的预测效能。结果PFD组患者血清MMP-1、OPN、CTGF水平均高于对照组(P均<0.05)。子宫脱垂和压力性尿失禁Ⅲ度患者血清MMP-1、OPN、CTGF水平均高于Ⅱ度和Ⅰ度患者(P均<0.05),子宫脱垂和压力性尿失禁Ⅱ度血清MMP-1、OPN、CTGF水平均高于Ⅰ度患者(P均<0.05)。Logistic回归分析结果显示,血清MMP-1水平(OR=1.956,95%CI:1.742~2.035)、血清OPN水平(OR=2.015,95%CI:1.806~2.291)、血清CTGF水平(OR=2.139,95%CI:1.929~2.390)是初产妇产后发生PFD的影响因素(P均<0.01)。血清MMP-1水平预测初产妇产后发生PFD的AUC为0.771,取截断值为7.15μg/L时,血清MMP-1水平预测初产妇产后发生PFD的灵敏度为73.24%、特异度为76.19%。血清OPN水平预测初产妇产后发生PFD的AUC为0.747,取截断值为5.33 mg/L时,血清OPN水平预测初产妇产后发生PFD的灵敏度为70.42%、特异度为79.05%。血清CTGF水平预测初产妇产后发生PFD的AUC为0.819,取截断值为52.09μg/L时,血清CTGF水平预测初产妇产后发生PFD的灵敏度为74.65%、特异度为84.76%。取血清MMP-1水平截断值为7.15μg/L、OPN水平截断值为5.33 mg/L、CTGF水平截断值为52.09μg/L时,血清MMP-1、OPN、CTGF联合预测初产妇产后发生PFD的灵敏度为91.55%、特异度为93.33%。结论初产妇产后PFD患者血清MMP-1、OPN、CTGF水平升高,与疾病严重程度有关;血清MMP-1、OPN、CTGF水平是初产妇产后发生PFD的影响因素;检测血清MMP-1、OPN、CTGF可用于初产妇产后PFD的预测。

Objective To observe the changes of serum levels of matrix metalloproteinase-1(MMP-1),osteopontin(OPN),and connective tissue growth factor(CTGF) in primiparas with postpartum pelvic floor dysfunction(PFD) after delivery,and to analyze the predictive efficacy of the serum levels of MMP-1,OPN and CTGF for postpartum PFD in primiparas.Methods Seventy-one cases of PFD primiparas were classified as the PFD group.Among them,31 cases of uterine prolapse and 40 cases of stress urinary incontinence were graded by MRI grading standard,respectively.Another105 primiparas without PFD during postpartum review were selected as the control group.Serum levels of MMP-1,OPN,and CTGF were detected by enzyme-linked immunosorbent assay(ELISA).The indexes with statistically significant differences in univariate analysis were taken as independent variables and assigned values,and the influencing factors for postpartum PFD in primiparas were analyzed by Logistic stepwise regression analysis.Receiver operating characteristic(ROC) curve was used to analyze the predictive efficacy of serum MMP-1,OPN and CTGF levels for postpartum PFD in primiparas.Results The levels of MMP-1,OPN and CTGF in the PFD group were higher than those in the control group(all P<0.05).The levels of MMP-1,OPN and CTGF in patients with uterine prolapse and stress urinary incontinence degree Ⅲ were higher than those in patients with degree Ⅱ and degree Ⅰ(all P<0.05),and the levels of MMP-1,OPN and CTGF in patients with uterine prolapse and stress urinary incontinence degree Ⅱ were higher than those in patients with degree Ⅰ(all P<0.05).Logistic regression analysis showed that serum MMP-1 level(OR=1.956,95%CI:1.742-2.035),serum OPN level(OR=2.015,95%CI:1.806-2.291),serum CTGF level(OR=2.139,95%CI:1.929-2.390) were the influencing factors for postpartum PFD in primipara(all P<0.01).The AUC of serum MMP-1 level in predicting PFD in primiparas was 0.771;when the cut-off value was 7.15 μg/L,the sensitivity and specificity of serum MMP-1 in predicting postpartum PFD were 73.24% and 76.19%,respectively.The AUC of serum OPN level in predicting PFD in primiparas was 0.747;when the cut-off value was 5.33 mg/L,the sensitivity and specificity of serum OPN in predicting postpartum PFD were 70.42% and 79.05%,respectively.The AUC of serum CTGF in predicting postpartum PFD of primiparas was0.819;when the cut-off value was 52.09 μg/L,the sensitivity and specificity of serum CTGF in predicting postpartum PFD were 74.65% and 84.76%,respectively.When the cut-off value of serum MMP-1 was 7.15 μg/L,cut-off value of OPN was 5.33 mg/L,and cut-off value of CTGF was 52.09 μg/L,the sensitivity and specificity of MMP-1,OPN and CTGF combined in predicting postpartum PFD of primiparas were 91.55% and 93.33%,respectively.Conclusions The elevated levels of MMP-1,OPN,and CTGF in PFD patients are related to the severity of the disease.The levels of serum MMP-1,OPN and CTGF are the influencing factors for postpartum PFD in primiparas.Detection of serum MMP-1,OPN and CTGF can be used to predict postpartum PFD of primiparas.