妊高症孕妇产褥期感染病原菌和危险因素及胎盘组织PI3K、Akt表达

Pathogens,risk factors for puerperal infections and expressions of PI3K and Akt in placental tissues of pregnant women with pregnancy-induced hypertension

目的探究妊高症孕妇产褥期感染病原菌和危险因素及胎盘组织磷脂酰肌醇3激酶(PI3K)、蛋白激酶B(Akt)表达。方法回顾性分析浙江省丽水市中医院妇产科在2016年8月—2021年8月收治的76例妊高症产妇产褥期临床资料,依据其产褥期是否感染分为感染组26例和非感染组40例,比较两组患者临床资料,分析产褥期感染的危险因素以及与胎盘组织PI3K、Akt表达的关联。结果剖宫产、产后大出血、产程>8 h、胎膜早破、妊娠期糖尿病、产前贫血的妊高症产妇发生产褥期感染的概率更高(P<0.05);产后大出血、产程是产褥期感染的危险因素(P<0.05);感染组产妇PI3K、Akt、哺乳动物雷帕霉素靶蛋白(mTOR)表达均低于非感染组(P<0.05),且微管轻链Ⅰ蛋白3-Ⅱ(LC3-Ⅱ)、自噬相关蛋白7(Atg7)表达及白细胞介素(IL)-6、IL-8、C-反应蛋白(CRP)水平均高于非感染组(P<0.05);PI3K预测产后产褥期感染的敏感性88.46%,特异性85.00%;Akt预测产后产褥期感染的敏感性88.46%,特异性87.50%;mTOR预测产后产褥期感染的敏感性92.31%,特异性92.50%。结论产程、产后大出血是妊高症孕妇产褥期感染的危险因素,且产妇胎盘组织PI3K、Akt表达情况可预测其感染风险。

OBJECTIVE To explore the distribution of pathogens,risk factors for puerperal infections and expressions of phosphatidylinositol-3 kinase(PI3K)and protein kinase B(Akt)in placental tissues of the pregnant women with pregnancy-induced hypertension.METHODS A total of 76 pregnant women with pregnancy-induced hypertension who were treated in obstetrics and gynecology department of Lishui Hospital of TCM from Aug 2016 to Aug 2021 were enrolled in the study,the clinical data of the subjects were retrospectively analyzed.The subjects were divided into the infection group with 26 cases and the non-infection group with 40 cases according to the status of puerperal infection.The clinical data were compared between the two groups,the risk factors for the puerperal infections and their association with the expressions of placental tissue PI3K and Akt were observed.RESULTS The pregnant women with pregnancy-induced hypertension who had cesarean section,postpartum massive hemorrhage,labor stage more than 8 hours,premature rupture of membrane,gestational diabetes mellitus and antenatal anemia were more likely to have puerperal infections(P<0.05).The postpartum massive hemorrhage and labor stage were the risk factors for the puerperal infections(P<0.05).The expression levels of PI3K,Akt and mammalian target of rapamycin(mTOR)of the infection group were lower than those of the non-infection group(P<0.05);the levels of microtubule-associated protein 1 light chain 3-Ⅱ(LC3-Ⅱ),autophagy 7(Atg7),interleukin(IL)-6,IL-8 and C-reactive protein(CRP)of the infection group were significantly higher than those of the non-infection group(P<0.05).The sensitivity of the PI3K was 88.46%in prediction of the postpartum puerperal infections,with the specificity 85.00%;the sensitivity of the Akt was 88.46%in prediction of the postpartum puerperal infections,with the specificity 87.50%;the sensitivity of the mTOR was 92.31%in prediction of the postpartum puerperal infections,with the specificity 92.50%.CONCLUSION Labor process and postpartum massive hemorrhage are the risk factors for the puerperal infections in the pregnant women with pregnancy-induced hypertension.The placental tissue PI3K and Akt can predict the risk of the infections.