摘要
目的 探究初产妇产后血清25羟基-维生素D[25-(OH)D]、骨桥蛋白(OPN)、转化生长因子-β1(TGF-β1)表达水平对初产妇产后盆底功能障碍(PFD)的预测价值。方法 选取2021年1月至2023年2月河北北方学院附属第一医院408例初产妇为研究对象,根据是否发生盆底肌功能障碍将初产妇分为PFD组(n=146)和非PFD组(n=262),比较两组一般资料,比较PFD组不同POP、SUI分度的血清25-(OH)D、OPN、TGF-β1水平,分析影响初产妇产后PFD发生的因素及血清25-(OH)D、OPN、TGF-β1水平对初产妇产后PFD的预测价值。结果 PFD组年龄、产前BMI、孕期体质量增加>15 kg、阴道分娩、新生儿体质量>3.5 kg、第二产程延长占比、血清OPN水平显著高于非PFD组,血清25-(OH)D、TGF-β1水平显著低于非PFD组,差异均有统计学意义(P<0.05)。PFD组不同POP分度25-(OH)D、TGF-β1表达水平:POPⅠ度>POPⅡ度>POPⅢ度,OPN表达水平:POPⅠ度<POPⅡ度<POPⅢ度;不同SUI分度25-(OH)D、TGF-β1表达水平:SUIⅠ度>SUIⅡ度>SUIⅢ度,OPN表达水平:SUIⅠ度<SUIⅡ度<SUIⅢ度,差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,年龄升高、产前BMI增加、新生儿体质量>3.5 kg、第二产程延长、产后血清OPN水平升高是影响初产妇产后PFD的危险因素(P<0.05),产后血清25-(OH)D、TGF-β1水平升高为保护因素(P<0.05);ROC曲线分析显示,产后血清25-(OH)D、OPN、TGF-β1水平单独及联合预测初产妇产后PFD的AUC为0.849、0.857、0.835、0.956。结论 产后血清25-(OH)D、OPN、TGF-β1水平随POP、SUI分级增加而变化,三指标对初产妇产后PFD具有一定的预测价值。
Objective To explore the predictive value of expression levels of postpartum serum 25 hydroxyvitamin D[25⁃(OH)D],osteopontin(OPN)and transforming growth faction⁃β1(TGF⁃β1)in primip⁃aras with postpartum pelvic floor dysfunction(PFD).Methods 408 primiparas at Hebei North University Af⁃filiated First Hospital from January 2021 to February 2023 were selected as research subjects.The primiparas were divided into two groups:the PFD group(n=146)and the non⁃PFD group(n=262)based on the presence of pelvic floor dysfunction.General data between the two groups and serum levels of 25⁃(OH)D,OPN and TGF⁃β1 among different POP grades of POP and SUI in the PDF group were compared.The factors influencing the occurrence of postpartum PFD in primiparas and the predictive value of serum 25⁃(OH)D,OPN and TGF⁃β1 levels on postpartum PFD in primiparas were analyzed.Results The age,prenatal BMI,proportions of increased body mass during pregnancy(>15 kg),vaginal delivery,neonatal body mass(>3.5kg)prolonged sec⁃ond stage of labor and serum OPN level in the PFD group were significantly longer or higher than those in the non⁃PFD group while the levels of serum 25⁃(OH)D and TGF⁃β1 were significantly lower than those in the non⁃PFD group(P<0.05).The expression levels of 25⁃(OH)D and TGF⁃β1 were manifested as POP gradeⅠ>POP gradeⅡ>POP gradeⅢ,and SUI gradeⅠ>SUI gradeⅡ>SUI gradeⅢ,while the OPN expression level was shown as POP gradeⅠ<POP gradeⅡ<POP gradeⅢ,and SUI gradeⅠ<SUI gradeⅡ<SUI gradeⅢ(P<0.05).Multivariate logistic regression analysis showed that increased age,increased prenatal BMI,neonatal body mass>3.5 kg,prolonged second stage of labor,and postpartum serum OPN level were risk factors for postpartum PFD in primiparas(P<0.05),and increased postpartum serum 25⁃(OH)D and TGF⁃β1 levels were the protective factors(P<0.05).ROC curve analysis revealed that the AUCs of postpartum serum 25⁃(OH)D,OPN and TGF⁃β1 and combined diagnosis in predicting postpartum PFD were 0.849,0.857,0.835 and 0.956,respectively,and the combination had a higher diagnostic value.Conclusion The levels of 25⁃(OH)D,OPN and TGF⁃β1 in postpartum serum changed with the increase of POP and SUI grades.These indicators had a cer⁃tain predictive value for postpartum PFD in primiparas.
作者
杨博
石克威
李亚楠
尚芯羽
YANG Bo;SHI Kewei;LI Yanan;SHANG Xinyu(Department of Obstetrics,the First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei,China,075000)
出处
《分子诊断与治疗杂志》
2024年第4期725-729,共5页
Journal of Molecular Diagnostics and Therapy
基金
2023年度河北省医学科学研究课题计划项目(20231409)。