凶险性前置胎盘患者血浆hPLmRNA表达水平及其对并发产后大出血的预测价值-现代医学

凶险性前置胎盘患者血浆hPLmRNA表达水平及其对并发产后大出血的预测价值

作者：周露

单位：大连市妇女儿童医疗中心产科二病房, 辽宁大连 116037

分类号：R714.56

出版年·卷·期（页码）：2022·50·第三期（348-353）

摘要：

目的：检测凶险性前置胎盘(PPP)患者血浆人胎盘催乳素(hPL)信使核糖核酸(mRNA)表达水平，并分析其对并发产后大出血的预测价值。方法：选取我院2016年2月至2020年9月收治的225例PPP患者和203例健康孕妇，分别作为疾病组和对照组。采用Northern blot方法检测两组血浆hPL mRNA表达水平。比较两组血浆hPL mRNA表达水平和产后大出血发生率，Logistic回归分析探讨血浆hPL mRNA表达水平与疾病组并发产后大出血的关系，绘制受试者工作特征(ROC)曲线分析其对疾病组并发产后大出血的预测价值。结果：疾病组血浆hPL mRNA表达水平、产后大出血发生率均高于对照组(P<0.001)；年龄≥35岁、孕前体质指数(BMI)>25 kg·m^-2、多次人工流产，胎盘植入Ⅲ型、胎盘粘连、合并妊高症、巨大儿、产道伤、血浆hPL mRNA高表达水平均是疾病组并发产后大出血的危险因素(P<0.05)；校正年龄、孕前BMI、多次人工流产,胎盘植入Ⅲ型、胎盘粘连、合并妊高症、巨大儿、产道伤、血浆hPL mRNA高表达水平仍是疾病组并发产后大出血的独立危险因素(P<0.05)；血浆hPL mRNA表达水平预测疾病组并发产后大出血的灵敏度、特异度、曲线下面积分别为84.78%、81.82%、0.876。结论：PPP患者血浆hPL mRNA表达水平偏高，产后大出血发生率高，血浆hPL mRNA表达水平是患者并发产后大出血的影响因素，且对PPP并发产后大出血的预测效能高。

Objective: To detect the expression level of plasma human placental prolactin(hPL) messenger RNA(mRNA) in patients with pernicious placenta previa(PPP), and to analyze its predictive value for postpartum hemorrhage. Methods: From February 2016 to September 2020, 225 patients with PPP and 203 healthy pregnant women were selected as disease group and control group. The plasma level of hPL mRNA expression was detected by Northern blot. The levels of plasma hPL mRNA expression and the incidence of postpartum hemorrhage were compared between the two groups. Logistic regression analysis was used to explore the relationship between plasma level of hPL mRNA expression and postpartum hemorrhage in the disease group. Receiver operating characteristic(ROC) curve was drawn to analyze its predictive value for postpartum hemorrhage in the disease group. Results: The plasma level of hPL mRNA expression and the incidence of postpartum hemorrhage in the disease group were higher than those in the control group(P<0.001). Age≥35 years old, pre pregnancy body mass index(BMI)>25 kg·m^-2, multiple induced abortion, type Ⅲof placenta implantation, placental adhesion, pregnancy induced hypertension, macrosomia, birth canal injury, plasma level of hPL mRNA expression were risk factors of postpartum hemorrhage in disease group(P<0.05). After adjusting for age, pre pregnancy BMI and abortion history, type Ⅲof placenta implantation, placental adhesion, pregnancy induced hypertension, macrosomia, birth canal injury and plasma level of hPL mRNA expression were still independent risk factors for postpartum hemorrhage in the disease group(P<0.05). The sensitivity, specificity and area under the curve of plasma level of hPL mRNA expression in predicting postpartum hemorrhage in disease group were 84.78%, 81.82% and 0.876, respectively. Conclusion: PPP patients have high plasma level of hPL mRNA expression and high incidence of postpartum hemorrhage. Plasma level of hPL mRNA expression is the influencing factor of patients with postpartum hemorrhage, and it has high prediction efficiency for PPP complicated with postpartum hemorrhage.

参考文献：

[1] 朱成玲,王静.凶险性前置胎盘对妊娠结局的影响及术前管理对母儿预后的改善作用[J].现代医学,2020,48(10):1279-1283.
[2] 杨菲菲,孟海霞.不同类型凶险性前置胎盘的母婴结局分析[J].新疆医科大学学报,2020,43(1):84-87.
[3] WOMAN Trial Collaborators.Effect of early tranexamic acid administration on mortality,hysterectomy,and other morbidities in women with post-partum haemorrhage(WOMAN):an international,randomised,double-blind,placebo-controlled trial[J].Lancet,2017,9(84):2105-2116.
[4] WU L M,CHEN C M,HSU H T,et al.Tailored education enhances healthy behaviour self-efficacy in childhood cancer survivors:a randomised controlled study with a 4-month follow-up[J].Eur J Cancer Care(Engl),2019,28(4):63-65.
[5] 胡龙,刘影,李爽.凶险性前置胎盘伴胎盘植入的MRI诊断价值[J].放射学实践,2019,34(1):45-49.
[6] 中华医学会妇产科学分会产科学组.产后出血预防与处理指南(2014)[J].中华妇产科杂志,2014,49(9):641-646.
[7] 潘剑芳.凶险性前置胎盘合并产后出血的影响因素分析[J].中国妇幼保健,2020,35(10):48-50.
[8] KRESOJA K P,EBNER M,ROGGE N I J,et al.Prediction and prognostic importance of in-hospital major bleeding in a real-world cohort of patients with pulmonary embolism[J].Int J Cardiol,2019,29(8):144-149.
[9] HUANG H,ZHANG Y,CAO M,et al.Effects of fasting on the activities and mRNA expression levels of lipoprotein lipase(LPL),hormone-sensitive lipase(HSL) and fatty acid synthetase(FAS) in spotted seabass Lateolabrax maculatus[J].Fish Physiol Biochem,2018,44(1):387-400.
[10] STIMSON R H,ANDERSON A J,RAMAGE L E,et al.Acute physiological effects of glucocorticoids on fuel metabolism in humans are permissive but not direct[J].Diabetes Obes Metab,2017,19(6):883-891.
[11] SANGIOVANNI T P,KIEBZAK G M.Prospective randomized evaluation of intraoperative application of autologous platelet-Rich plasma on surgical site infection or delayed wound healing[J].Foot Ankle Int,2016,37(5):470-477.
[12] 李小庆,邓小凤.再次剖宫产产后出血的发生率及相关因素分析[J].重庆医学,2020,4(9):108-111.
[13] TITTL L,ENDIG S,MARTEN S,et al.Impact of BMI on clinical outcomes of NOAC therapy in daily care-results of the prospective dresden NOAC registry(NCT01588119)[J].Int J Cardiol,2018,26(5):85-91.
[14] TANIMURA K,MORIZANE M,DEGUCHI M,et al.A novel scoring system for predicting adherent placenta in women with placenta previa[J].Placenta,2018,64(2):27-33.
[15] 梁娅嫚,徐雅琴,于漫,等.罗哌卡因不同给药方式对妊高症产妇分娩镇痛的影响观察[J].药物流行病学杂志,2019,28(5):298-301.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录