血清TIMP-1、VEGF水平对自然分娩初产妇产后压力性尿失禁严重程度的预测价值

Predictive Value of Serum TIMP-1 and VEGF Levels for the Severity of Postpartum Stress Urinary Incontinence in Primiparae Undergoing Natural Delivery

目的探讨自然分娩初产妇血清基质金属蛋白酶组织抑制因子-1(tissue inhibitor of metall oproteinase-1,TIMP-1)、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平对产后压力性尿失禁(post partum stress urinary incontinence,PSUI)严重程度的预测价值。方法选取2019年12月至2023年7月220例PSUI自然分娩初产妇为病例组,根据尿垫试验结果分为轻度组158例和中重度组62例。另纳入同期220例无PSUI的自然分娩初产妇作为对照组。采用ELISA法检测入组者血清TIMP-1、VEGF水平;采用Pearson法分析PSUI患者血清TIMP-1与VEGF的相关性;采用多因素Logistic回归分析PSUI患者疾病严重程度的影响因素;采用受试者工作特征曲线分析血清TIMP-1、VEGF对PSUI患者疾病严重程度的预测价值。结果病例组血清TIMP-1水平显著低于对照组,血清VEGF水平显著高于对照组(P<0.01)。中重度组血清TIMP-1水平显著低于轻度组,血清VEGF水平、年龄≥35岁比例、新生儿体质量显著高于轻度组(P<0.05,P<0.01)。PSUI患者血清TIMP-1与VEGF呈负相关(r=-0.671,P<0.05)。TIMP-1是PSUI患者疾病程度加重的保护因素(P<0.01),VEGF是PSUI患者疾病程度加重的危险因素(P<0.01)。TIMP-1、VEGF单独及联合预测PSUI患者疾病严重程度的曲线下面积(area under curve,AUC)分别为0.857、0.808、0.901,其中联合预测的AUC高于二者单独预测(P<0.01)。结论PSUI患者血清TIMP-1低表达,VEGF高表达,且TIMP-1、VEGF与病情程度密切相关,二者联合在预测PSUI患者疾病严重程度方面有较高的价值。

Objective To investigate the predictive value of serum tissue inhibitor of matrix metalloproteinase-1(TIMP-1)and vascular endothelial growth factor(VEGF)levels in postpartum stress urinary incontinence(PSUI)of primiparae undergoing natural delivery.Methods In total,220 primiparae with PSUI undergoing natural delivery from December 2019 to July 2023 were selected as the case group,and were divided into mild group(n=158)and moderate to severe group(n=62)ac-cording to the results of urine pad test.In addition,220 primiparae without PSUI undergoing natural delivery were included as control group.Serum TIMP-1 and VEGF levels were detected by ELISA.The correlation between serum TIMP-1 and VEGF in PSUI patients was analyzed by Pearson method.Multivariate Logistic regression was used to analyze the influencing factors of disease severity in PSUI patients.The predictive value of serum TIMP-1 and VEGF for disease severity in PSUI patients was analyzed by receiver operating characteristic(ROC)curve.Results The serum TIMP-1 level in the case group was significant-ly lower than that in the control group,while the serum VEGF level was significantly higher than that in the control group(P<0.01).Serum TIMP-1 level in moderate to severe group was significantly lower than that in mild group,while serum VEGF lev-el,proportion of patients aged≥35 years and newborn body weight were significantly higher than those in mild group(P<0.05,P<0.01).Serum TIMP-1 in PSUI patients was negatively correlated with VEGF(r=-0.671,P<0.05).TIMP-1 was a protec-tive factor for aggravation of disease severity in PSUI patients(P<0.01),and VEGF was a risk factor for aggravation of disease severity in PSUI patients(P<0.01).The area under the ROC curve(AUC)of TIMP-1 and VEGF alone and in combination for predicting the disease severity of PSUI patients was 0.857,0.808 and 0.901,respectively,and the AUC of combination of the two in the prediction was higher than that predicted by TIMP-1 and VEGF alone(P<0.01).Conclusion In PSUI patients,se-rum TIMP-1 expression is low,VEGF expression is high,and TIMP-1 and VEGF are closely related to the severity of the dis-ease.The combination of the two has high value in predicting the severity of the disease in PSUI patients.