摘要
目的探究剖宫产后产褥感染血清抗凝血酶原Ⅲ(AT-Ⅲ)、总抗氧化能力(TAC)及降钙素原(PCT)水平变化及与预后的关系。方法选择本院224例剖宫产后产褥感染产妇(观察组)临床资料,并纳入32例同期剖宫产后未发生产褥感染产妇作为对照组。比较两组产后1、3 d血清AT-Ⅲ、TAC、PCT水平变化情况;根据观察组临床疗效分为治疗无效者(预后不良组)、治疗有效组(预后良好组),比较两组产后1 d血清AT-Ⅲ、TAC、PCT水平差异,使用受试者工作特征曲线(ROC曲线)评估产后1 d血清AT-Ⅲ、TAC、PCT及其联合检测对剖宫产后产褥感染不良预后的预测价值。结果产后3 d时,观察组血清AT-Ⅲ、TAC均较产后1 d降低,血清PCT则较产后1 d升高,差异有统计学意义(P<0.05);对照组血清AT-Ⅲ、TAC均较产后1 d升高,血清PCT较产后1 d降低,差异有统计学意义(P<0.05);且产后1、3 d时,观察组血清AT-Ⅲ、TAC均低于对照组,血清PCT则高于对照组,差异有统计学意义(P<0.05)。两组年龄、孕周、分娩史及感染部位比较,差异均无统计学意义(P>0.05);预后不良组产后1 d血清AT-Ⅲ、TAC均低于预后良好组,血清PCT则高于预后良好组,差异有统计学意义(P<0.05)。经ROC曲线分析,发现产后1 d血清AT-Ⅲ、TAC、PCT水平对剖宫产后产褥感染不良预后均具有较高预测价值(AUC=0.827、0.903、0.906,P<0.05),其cut-off值分别为70.545%、6.810 kU/L、2.055μg/mL,且3项联合检测预测价值最高(AUC=0.979,P<0.05)。结论剖宫产后产褥感染能引起机体炎症反应及凝血功能障碍增强,抗氧化能力降低,产后早期监测血清AT-Ⅲ、TAC、PCT水平对产褥感染预后状况预测有利。
Objective To explore the changes of serum antithrombinⅢ(AT⁃Ⅲ),total antioxi⁃dant capacity(TAC)and procalcitonin(PCT)levels in puerperal infection after cesarean section and their rela⁃tionship with prognosis.Methods The clinical data of 224 cases of puerperae with puerperal infection after ce⁃sarean section(observation group)in our hospital were retrospectively analyzed,and 32 cases of puerperae without puerperal infection after cesarean section at the same time period were included as the control group.The changes of serum AT⁃Ⅲ,TAC and PCT levels were compared between the two groups at 1d and 3d after delivery.According to the clinical efficacy in the observation group,they were divided into the ineffective treat⁃ment group(poor prognosis group)and the effective treatment group(good prognosis group).Differences in AT⁃Ⅲ,TAC and PCT levels were compared between the two groups at 1d after delivery.Receiver operating characteristic curve(ROC curve)was used to evaluate the predictive value of serum AT⁃Ⅲ,TAC and PCT at 1d after delivery and combination of the three on poor prognosis of puerperal infection after cesarean infection.Results At 3d after delivery,the serum AT⁃Ⅲand TAC in the observation group were decreased compared with those at 1d after delivery while the serum PCT was increased compared with that at 1d after delivery(P<0.05).The serum AT⁃Ⅲand TAC in the control group were increased compared with those at 1d after delivery while the serum PCT was decreased compared with that at 1d after delivery(P<0.05).And at 1d and 3d after de⁃livery,the serum AT⁃Ⅲand TAC in the observation group were lower than those in the control group while the serum PCT was higher than that in the control group(P<0.05).There were no statistically significant differences in the age,gestational week,delivery history and infection sites between the two groups(P>0.05).The serum AT⁃Ⅲand TAC in the poor prognosis group at 1d after delivery were lower than those in the good prognosis group while the serum PCT was higher than that in the good prognosis group(P<0.05).ROC curve analysis found that the levels of serum AT⁃Ⅲ,TAC and PCT at 1d after delivery had a high predictive value on the poor prognosis of puerperal infection after cesarean section(AUC=0.827,0.903,0.906,P<0.05),and the cut⁃off values were 70.545%,6.810 kU/L and 2.055μg/mL,and the combination of the three had the highest predictive value(AUC=0.979,P<0.05).Conclusion Puerperal infection after cesarean section can cause the bodys inflammatory re⁃sponse and blood coagulation dysfunction to increase,and the antioxidant capacity is reduced.Early postpartum monitoring of serum AT⁃Ⅲ,TAC,PCT levels is beneficial to predict the prognosis of puerperal infection.
作者
李小芝
唐连敏
付翠芳
薛云
姚莉芸
LI Xiaozhi;TANG lianmin;FU Cuifang;XUE Yun;YAO Liyun(Department of Obstetrics,Xingtai Third Hospital,Xingtai,Hebei,China,054000;Department of Labo-ratory Medicine,Xingtai Third Hospital,Xingtai,Hebei,China,054000)
出处
《分子诊断与治疗杂志》
2020年第12期1691-1694,1699,共5页
Journal of Molecular Diagnostics and Therapy
基金
邢台市科技支撑计划项目(2018ZC115)。
作者简介
通信作者:李小芝,E⁃mail:zangzhuyu3284095@163.com。
