血清TIMP-1、TGF-β1水平对瘢痕子宫再次妊娠产后出血的预测价值

Predictive value of serum TIMP-1 and TGF-β1 levels on postpartum hemorrhage in re-pregnancy of scar uterus

目的探讨瘢痕子宫再次妊娠产妇血清基质金属蛋白酶组织抑制因子-1(TIMP-1)、转化生长因子-β1(TGF-β1)水平及其对产后出血的预测价值。方法选取2019年3月至2021年12月在本院分娩的瘢痕子宫再次妊娠产妇217例,根据是否并发产后出血分为观察组(137例,发生产后出血)和对照组(80例,未发生产后出血)。同时收集产妇分娩孕周、孕次、子宫瘢痕厚度等临床资料。采用酶联免疫吸附法测定瘢痕子宫再次妊娠产妇血清TIMP-1、TGF-β1水平;Pearson法分析血清TGF-β1和TIMP-1表达水平的相关性;采用Logistic多因素回归分析影响瘢痕子宫再次妊娠产妇发生产后出血的相关因素;采用受试者工作特征(ROC)曲线分析血清TGF-β1和TIMP-1表达水平对瘢痕子宫再次妊娠产妇发生产后出血的预测效能。结果观察组血清TIMP-1水平高于对照组(P<0.05),血清TGF-β1水平低于对照组(P<0.05);观察组患者血清TIMP-1与TGF-β1表达呈负相关(r=-0.935,P<0.05)。观察组分娩孕周<40周、子宫瘢痕厚度<4 mm、刮宫次数≥2次的患者比例均高于对照组(P<0.05)。分娩孕周<40周、子宫瘢痕厚度<4 mm、刮宫次数≥2次、TIMP-1均为瘢痕子宫再次妊娠产妇发生产后出血的危险因素(P<0.05),TGF-β1为保护因素(P<0.05)。血清TIMP-1、TGF-β1预测瘢痕子宫再次妊娠产妇发生产后出血的曲线下面积(AUC)分别为0.881、0.901,而二者联合预测的AUC为0.959,优于血清TIMP-1、TGF-β1单独预测(Z=2.139、2.227,P=0.036、0.024)。结论瘢痕子宫再次妊娠产妇血清TIMP-1、TGF-β1水平与产后出血的发生密切相关,二者联合检测对其产后出血具有较好的预测价值。

Objective To investigate the levels of serum tissue inhibitor of metalloproteinase-1(TIMP-1)and transforming growth factor-beta1(TGF-β1)in lying-in woman with re-pregnancy of scar uterus and their predictive value for postpartum hemorrhage.Methods A total of 217 lying-in women with re-pregnancy of scar uterus delivered in our hospital from March 2019 to December 2021 were selected and divided into the observation group(137 cases with postpartum hemorrhage)and the control group(80 cases without postpartum hemorrhage)according to whether they were complicated with postpartum hemorrhage.At the same time,the clinical data such as gestational weeks,pregnancy times and thickness of uterine scar were collected.The serum TIMP-1 and TGF-β1 levels of lying-in women with re-pregnancy of scar uterus were detected by enzyme-linked immunosorbent assay;Pearson method was used to analyze the correlation between serum TGF-β1 and TIMP-1 expression levels;Logistic multivariate regression analysis was used to analyze the related factors of postpartum hemorrhage of lying-in women with re-pregnancy of scar uterus.The predictive value of serum TGF-β1 and TIMP-1 expression levels on postpartum hemorrhage of lying-in women with re-pregnancy of scar uterus was analyzed by receiver operating characteristic(ROC)curve.Results The serum TIMP-1 level in the observation group was higher than that in the control group(P<0.05),while the serum TGF-β1 level was lower than that in the control group(P<0.05).The expression of serum TIMP-1 was negatively correlated with TGF-β1 of patients in the observation group(r=-0.935,P<0.05).The proportions of patients with gestational weeks<40 weeks,thickness of uterine scar<4 mm,and times of curettage≥2 times in the observation group were higher than those in the control group(P<0.05).The gestational weeks<40 weeks,thickness of uterine scar<4 mm,and times of curettage≥2 times and TIMP-1 were all the risk factors for postpartum hemorrhage of lying-in women with re-pregnancy of scar uterus(P<0.05),and TGF-β1 was the protective factor(P<0.05).The area under the curve(AUC)of serum TIMP-1 and TGF-β1 in predicting postpartum hemorrhage of lying-in women with re-pregnancy of scar uterus was 0.881 and 0.901,respectively,while the AUC predicted by the combination of the two methods was 0.959,which was higher than that predicted by serum TIMP-1 and TGF-β1 separately(Z=2.139,2.227,P=0.036,0.024).Conclusion The levels of serum TIMP-1 and TGF-β1 in lying-in women with re-pregnancy of scar uterus are closely related to the occurrence of postpartum hemorrhage,and the combined detection of TIMP-1 and TGF-β1 has good predictive value for postpartum hemorrhage.