基质金属蛋白酶-1、环氧合酶-2联合超声对瘢痕子宫分娩结局的预测价值

Predictive value of matrix metalloproteinase-1 and cyclooxygenase-2 combined with ultrasound on delivery outcomes of scarred uterus

目的分析观察基质金属蛋白酶-1(MMP-1)、环氧合酶-2(COX-2)联合超声检测子宫下段厚度对瘢痕子宫分娩结局的预测价值。方法选择2018年11月—2021年6月本院收治的瘢痕子宫孕妇198例,其中有133例行阴道分娩,65例行剖宫产分娩,比较不同分娩方式产妇和围产儿结局以及不同分娩方式产妇MMP-1、COX-2和超声检测子宫下段厚度的差异,分析影响瘢痕子宫阴道分娩的相关因素以及MMP-1、COX-2和超声检测子宫下段厚度对阴道分娩的诊断效能。结果剖宫产分娩组产妇产褥期感染率高于阴道分娩组(P<0.05),初次母乳喂养时间和住院天数长于阴道分娩组(P<0.05),新生儿Apgar评分低于阴道分娩组(P<0.05),新生儿出生体质量大于阴道分娩组(P<0.05);剖宫产分娩组MMP-1、COX-2表达高于阴道分娩组(P<0.05),子宫下段厚度小于阴道分娩组(P<0.05);多因素logistic回归分析结果显示,MMP-1≤1.31、COX-2≤2.31为影响瘢痕子宫阴道分娩的保护因素,子宫下段厚度≤3.52 mm为影响瘢痕子宫产妇阴道分娩的危险因素;ROC曲线结果显示,联合检测的AUC为0.980,敏感度为97.00%,特异度为92.30%,高于单独检测的AUC、敏感度和特异度。结论MMP-1、COX-2和子宫下段厚度是影响瘢痕子宫阴道分娩的相关因素,MMP-1、COX-2联合超声检测子宫下段厚度对瘢痕子宫分娩结局具有一定的预测价值。

Objective This paper aims to analyze and observe the predictive value of matrix metalloproteinase-1(MMP-1)and cyclooxygenase-2(COX-2)combined with ultrasound detection of lower uterine segment thickness on delivery outcomes of scarred uterus.Methods A total of 198 pregnant women with scarred uterus admitted to our hospital were selected between November 2018 and June 2021.Among them,133 cases underwent vaginal delivery and 65 cases underwent cesarean section delivery.The maternal and perinatal outcomes of different delivery methods and the differences of MMP-1,COX-2 and ultrasound in detecting the thickness of lower uterine section were compared.The related factors affecting vaginal delivery of scarred uterus and diagnostic efficacy of MMP-1,COX-2 and ultrasound in detecting the thickness of lower uterine segment on vaginal delivery were analyzed.Results The puerperal infection rate in cesarean delivery group was higher than that in vaginal delivery group(P<0.05),and the first breastfeeding time and hospital stay were longer than those in vaginal delivery group(P<0.05).The neonatal Apgar score was lower than that in vaginal delivery group(P<0.05),and the neonatal birth weight score was greater than that in vaginal delivery group(P<0.05).The levels of MMP-1 and COX-2 in cesarean delivery group were higher than those in vaginal delivery group(P<0.05),and the thickness of lower uterine segment was smaller than that in vaginal delivery group(P<0.05).Multivariate logistic regression analysis showed that MMP-1≤1.31 and COX-2≤2.31 were protective factors for vaginal delivery of scarred uterus,and the thickness of lower uterine segment≤3.52 mm was a risk factor to vaginal delivery of scarred uterus.ROC curve results showed that the AUC,sensitivity and specificity of combined detection were 0.980,97.00%and 92.30%,which was higher than those of single detection.Conclusion MMP-1,COX-2 and the thickness of lower uterine segment are related factors that affect vaginal delivery of scarred uterus.MMP-1,COX-2 combined with ultrasound detection of the thickness of lower uterine segment has certain predictive value on delivery outcomes of scarred uterus.