超声检测子宫下段瘢痕愈合情况及血清MMP-1、COX-2对二胎瘢痕子宫患者阴道分娩妊娠结局的预测价值

Ultrasound detection of lower uterine scar healing and predictive value of serum MMP⁃1 and COX⁃2 on pregnancy outcomes of vaginal delivery in second⁃child patients with scarred uterus

目的 探究超声检测子宫下段瘢痕愈合情况及血清基质金属蛋白酶-1(MMP-1)、环氧合酶-2(COX-2)对二胎瘢痕子宫患者阴道分娩妊娠结局的预测价值。方法 纳入2018年3月至2022年12月期间山西省儿童医院、山西省妇幼保健院产科210例计划进行阴道分娩的二胎瘢痕子宫产妇为研究对象,于孕晚期采用超声测量子宫下段厚度,评估瘢痕愈合情况,并采集产妇外周静脉血检测血清MMP-1、COX-2水平,统计妊娠结局,将患者分为结局良好组(n=158)和结局不良组(n=52),比较两组子宫瘢痕愈合情况超声检测结果及血清MMP-1、COX-2水平,采用Logistic回归分析二胎瘢痕子宫患者阴道分娩妊娠结局的影响因素,采用受试者工作特征(ROC)曲线评估血清MMP-1、COX-2水平单独及联合预测二胎瘢痕子宫患者阴道分娩妊娠结局的价值。结果 结局不良组子宫下段厚度小于结局良好组,瘢痕愈合分级低于结局良好组,血清MMP-1、COX-2水平高于结局良好组,差异均有统计学意义(P<0.05);Logistic多因素回归分析显示,MMP-1、COX-2、子宫下段厚度均为二胎瘢痕子宫患者阴道分娩不良妊娠结局的独立影响因素(P<0.05);ROC曲线显示,MMP-1、COX-2、子宫下段厚度联合预测不良妊娠结局的敏感度、特异度、曲线下面积分别为0.962、0.753、0.952。结论 二胎瘢痕子宫患者阴道分娩妊娠结局与子宫下段瘢痕愈合情况、血清MMP-1和COX-2水平密切相关,MMP-1、COX-2、子宫下段厚度联合检测对妊娠结局具有一定的预测价值。

Objective To explore the ultrasound detection of lower uterine scar healing and predictive value of levels of serum matrix metalloproteinase⁃1(MMP⁃1)and cyclooxygenase⁃2(COX⁃2).on pregnancy outcomes of vaginal delivery in second⁃child patients with scarred uterus.Methods 210 second child puerperae with scarred uterus who planned to undergo vaginal delivery in Department of Obstetrics of Shanxi Provincial Children's Hospital,Shanxi Provincial Maternal and Child Health Hospital from March 2018 to December 2022 were included as the study subjects.Ultrasound was used to measure the lower uterine segment thickness in the third trimester of pregnancy,and the scar healing was assessed and the peripheral venous blood of puerperae was collected to detect the levels of serum MMP⁃1 and COX⁃2,and the pregnancy outcomes were counted.The patients were divided into the good outcome group(n=158)and the poor outcome group(n=52),and the uterine scar healing,ultrasound detection results and serum MMP⁃1 and COX⁃2 levels were compared between both groups.The influencing factors of pregnancy outcomes of vaginal delivery in second⁃child patients with scarred uterus were analyzed by logistic regression analysis.The value of serum MMP⁃1 and COX⁃2 alone and in combination in predicting pregnancy outcomes in second⁃child patients with scarred uterus undergoing vaginal delivery was evaluated by the receiver operating characteristic(ROC)curve.Results The lower uterine segment thickness in the poor outcome group was thinner than that in the good outcome group,and the scar healing grading was lower than that in the good outcome group while the levels of serum MMP⁃1 and COX⁃2 were higher than those in the good outcome group,with statistically significant differences(P<0.05).Logistic multivariate regression analysis showed that MMP⁃1,COX⁃2 and lower uterine segment thickness were independent influencing factors of poor pregnancy outcomes of vaginal delivery in second⁃child patients with scarred uterus(P<0.05).The ROC curve revealed that the sensitivity,specificity and the area under the curve of the combination of MMP⁃1,COX⁃2 and lower uterine segment thickness in predicting poor pregnancy outcomes were 0.962,0.753 and 0.952 respectively.Conclusion The pregnancy outcomes of vaginal delivery are closely related to the healing of lower uterine scar and the levels of serum MMP⁃1 and COX⁃2 in second⁃child patients with scarred uterus,and the combined detection with MMP⁃1,COX⁃2 and lower uterine segment thickness has certain predictive value on pregnancy outcomes.