产褥期感染危险因素分析及TAC、IFN-γ及α1-AG预测价值

Risk factors of the puerperal infection and the predictive value of total antioxidant capacity,interferon gamma andα1 acidic glycoprotein

目的:分析产褥期感染危险因素并探讨总抗氧化能力(TAC)、干扰素γ(IFN-γ)及α1酸性糖蛋白(α1-AG)预测价值。方法:回顾性收集2020年6月-2023年1月本院接诊的250例产妇临床资料,根据产褥期感染发生情况分为感染组(n=31)和未感染组(n=219),收集临床资料,分析产褥期感染危险因素,检测血清TAC、IFN-γ、α1-AG水平并采用受试者工作特征曲线(ROC)分析其预测产褥期感染价值。结果:单因素分析,两组年龄、孕周、产次、内分泌疾病比较无差异(P>0.05);两组产程、妇科炎症、妊娠高血压疾病、妊娠期糖尿病、产后出血、居住地、分娩方式、胎膜早破、卧床时间比较有差异(P<0.05);感染组血清IFN-γ(150.05±36.25 pg/ml)、α1-AG(156.35±40.91 mg/dl)高于未感染组(134.71±30.56 pg/ml、116.25±38.36 mg/dl),TAC(8.20±1.50 kU/ml)低于未感染组(10.83±2.45 kU/ml)(均P<0.05);白细胞计数、C反应蛋白及降钙素原水平产前两组无差异(P>0.05),产后两组均升高且感染组高于未感染组(P<0.05)。多因素非条件logistic分析,产程长、妇科炎症、妊娠高血压疾病、妊娠期糖尿病、产后出血、居住地为乡村、分娩方式为剖宫产、胎膜早破、卧床时间≥3d、TAC降低、IFN-γ升高及α1-AG升高均是产褥期感染发生的独立危险因素(P<0.05);ROC结果显示,预测产褥期感染血清TAC的曲线下面积(AUC)为0.808,灵敏度76.3%,特异度79.5,截断值9.56 kU/ml;血清IFN-γ的AUC为0.651,灵敏度61.5%,特异度69.4%,截断值141.24 pg/ml;血清α1-AG的AUC为0.753,灵敏度73.4%,特异度70.8%,截断值130.35 mg/dl。结论:产程长、妇科炎症、妊娠高血压疾病、妊娠期糖尿病、产后出血、居住地为乡村、剖宫产、胎膜早破、卧床时间长均是产褥期感染的独立危险因素,血清TAC、IFN-γ、α1-AG在产褥期感染者血清中表达异常且可对产褥期感染的发生有一定预测价值。

Objective:To analyze the risk factors of the puerperal infection,and to study the predictive value of the levels of total antioxidant capacity(TAC),interferon gamma(IFN-γ)andα1 acidic glycoprotein(α1-AG)of puerperas for their puerperal infection.Methods:The clinical data of 250 puerperas from June 2020 to January 2023 were selected in this study retrospectively.According to the incidence of puerperal infection or not,these puerperas were divided into the study group(31 puerperas with puerperal infection)and control group(219 puerperas without puerperal infection).The clinical data of the puerperas in the two groups were collected,and the risk factors of the puerperal infection of the puerperas in the two groups were analyzed.The serum TAC,IFN-γ and α1-AG levels of the puerperas in the two groups were detected,and the predictive value of which of the puerperas for predicting their puerperal infection was analyzed by subject working characteristic curve.Results:Univariate analysis showed that there were no significant differences in the age,the gestational weeks,the parity and the endocrine diseases occurrence of the puerperas between the two groups(P>0.05).There were signifficnt differences in the labor duration,the incidences of gynecological inflammation,gestational hypertension disease,gestational diabetes mellitus,and postpartum hemorrhage,the residence,the delivery mode,the premature rupture of membranes,and the time of the resting in bed of the puerperas between the two groups(P<0.05).The levels of serum IFN-γ(150.05±36.25pg/ml)and α1-AG(156.35±40.91mg/dl)of the puerperas in the study group were significantly higher than those(134.71±30.56pg/ml and 116.25±38.36mg/dl)of the puerperas in the control group.The TAC level(8.20±1.50kU/ml)of the puerperas in the study group was significantly lower than that(10.83±2.45kU/ml)of the puerperas in the control group(all P<0.05).There were no significant differences in the white blood cell count and the C-reactive protein and procalcitonin levels of the puerperas between the two groups(P>0.05).The white blood cell count and the C-reactive protein and procalcitonin levels of the puerperas in the two group after delivery had increased significantly,and which of the puerperas in the study group were significantly higher than of the puerperas in the control group(P<0.05).Multivariate unconditional logistic analysis showed that the long time of labor,the gynecological inflammation,the hypertensive disorders of pregnancy,the gestational diabetes mellitus,the postpartum hemorrhage,the rural residence,the cesarean section,the premature rupture of membranes,the time of resting in bed≥3 days,the decreased TAC level and the increased IFN-γ and α1-AG levels of the puerperas were the independent risk factors for their puerperal infection(P<0.05).ROC results showed that the area under the curve(AUC),the sensitivity,the specificity and the cut-off value of the serum TAC level of the puerperas for predicting their puerperal infection were 0.808,76.3%,79.5and 9.56kU/ml,respectively.The AUC,the sensitivity,the specificity and the cut-off value of the serum IFN-γ level of the puerperas for predicting their puerperal infection were 0.651,61.5%,69.4% and 141.24pg/ml,respectively.The AUC,the sensitivity,the specificity and the cut-off value of the serum α1-AG level of the puerperas for predicting their puerperal infection were 0.753,73.4%,70.8% and 130.35mg/dl,respectively.Conclusion:The long time of labor,the gynecological inflammation,the hypertensive disorders of pregnancy,the gestational diabetes mellitus,the postpartum hemorrhage,the rural residence,the cesarean section,the premature rupture of membranes and the long time of resting in bed of the puerperas are all the independent risk factors for their puerperal infection.The expressions of the serum TAC,IFN-γandα1-AG of the puerperas with puerperal infection are abnormal,and which have certain predicting values for the puerperal infection of the puerperas.