产后出血危险因素分析及NO、PLT、25(OH)D的预测价值

Analysis of the risk factors of postpartum hemorrhage and the predictive values of the levels of nitric oxide,platelet count and 25 hydroxyvitamin D

目的:探讨产后出血的危险因素分析一氧化氮(NO)、血小板计数(PLT)及25羟维生素D(25(OH)D)预测产后出血价值。方法:回顾性收集2020年1月-2023年1月本院接诊的75例产妇临床资料,以产后出血发生情况分为出血组(n=30)和非出血照组(n=45),收集临床资料,分析产后出血危险因素,检测血清NO、PLT及25(OH)D水平并采用受试者工作特征(ROC)曲线分析预测产后出血价值。结果:两组体质指数、分娩孕周、妊娠期贫血发生情况无差异(P>0.05),两组年龄、流产次数、产次、分娩方式、胎儿体质量、妊娠并发症、胎盘粘连、前置胎盘比较有差异(P<0.05);出血组血清NO(104.66±13.45μmol/L)水平高于非出血组(74.29±9.14μmol/L),25(OH)D(11.40±2.61 ng/ml)、PLT(190.50±20.87)×10^(9)/L水平低于非出血组[14.30±3.35 ng/ml、(211.35±21.32)×10^(9)/L](均P<0.05);多因素非条件logistic分析,年龄≥35岁、流产≥2次、产≥2次、剖宫产、胎儿体质量≥4000g、妊娠并发症、胎盘粘连、前置胎盘,以及NO水平较低、PLT及25(OH)D水平较高均是产后出血独立危险因素(P<0.05);ROC分析,预测产后出血血清NO的曲线下面积(AUC)为0.961,灵敏度86.1%,特异度89.3%,截断值89.56μmol/L;血清PLT的AUC为0.824,灵敏度81.3%,特异度86.1%,截断值197.24×10^(9)/L;血清25(OH)D的AUC为0.740,灵敏度82.2%,特异度83.6%,截断值12.35 ng/ml。结论:产后出血患者血清NO、PLT及25(OH)D表达异常,是产后出血的独立危险因素且可预测产后出血发生。

Objective:To study the predictive values of the levels of nitric oxide(NO),platelet count(PLT)and 25 hydroxyvitamin D(25(OH)D).Methods:The clinical data of 75 pregnant women admitted to hospital from January 2020 to January 2023 were collected retrospectively.According to the postpartum hemorrhage occurred or not,these women were divided into group A(30 women with postpartum hemorrhage)and group B(45 women without postpartum hemorrhage).The clinical data of the women in the two groups were collected,and the risk factors of the postpartum hemorrhage of the women in the two were analyzed.The levels of serum NO,PLT and 25(OH)D of the women in the two groups were detected,and the predictive values of which for the postpartum hemorrhage of the women was analyzed by receiver operating characteristic(ROC)curve.Results:There were no significant differences in the body mass index,the gestational weeks at delivery,and the incidence of anemia during pregnancy of the women between the two groups(P>0.05).There were significant differences in the age,the abortion number,the parity,the delivery mode,the neonatal weight,the pregnancy complications rate,and the incidences of placental adhesion and placenta previa of the women between the two groups(P<0.05).The level of serum NO(104.66±13.45μmol/L)of the women in group A was significantly higher than that(74.29±9.14μmol/L)of the women in group B.The levels of 25(OH)D(11.40±2.61ng/ml)and PLT(190.50±20.87×10^(9)/L)of the women in group A were significantly lower than those(14.30±3.35ng/ml and 211.35±21.32×10^(9)/L)of the women in group B(all P<0.05).Multivariate unconditional logistic analysis showed that the age≥35years old,the abortion number≥2times,the parity≥2times,the cesarean section history,the fetal weight≥4000g,the pregnancy complications,the placental adhesion,the placenta previa,the low level of NO and the high levels of PLT and 25(OH)D of the women were the independent risk factors for their postpartum hemorrhage(P<0.05).ROC analysis showed that the area under the curve(AUC)of the serum NO level of the women for predicting their postpartum hemorrhage was 0.961,the sensitivity of which was86.1%,the specificity of which was 89.3%,and the cut-off value of which was 89.56μmol/L.The AUC of the serum PLT level of the women for predicting their postpartum hemorrhage was 0.824,the sensitivity of which was 81.3%,the specificity of which was 86.1%,and the cut-off value of which was 197.24×109/L.The AUC of the serum 25(OH)D level of the women for predicting their postpartum hemorrhage was 0.740,the sensitivity of which was82.2%,the specificity of which was 83.6%,and the cut-off value of which was 12.35ng/ml.Conclusion:The expressions of the serum NO,PLT and 25(OH)D of the women with postpartum hemorrhage are abnormal and are the independent risk factors for the postpartum hemorrhage of the women,and which can predict the occurrence of the postpartum hemorrhage of the women.