血清TSP-2聯合PTX3水平對產后出血的預測價值

［摘 要］目的 探討血小板反應蛋白2（TSP-2）與正五聚蛋白3（PTX3）在孕婦產后出血（PPH）患者血清中的表達，以及對PPH的預測價值。方法 選取2018年9月至2022年9月于我院分娩且發生PPH的126例孕婦作為研究組，另外選取同期126例于我院分娩的正常孕婦為對照組。采用ELISA法檢測血清TSP-2、PTX3水平，采用ROC曲線分析TSP-2、PTX3對孕婦PPH的預測價值，采用多因素Logistic回歸分析探究孕婦PPH的影響因素。結果 研究組血清鈣水平（t=2.158）、不良孕產史（χ2=8.966）顯著高于對照組（均P＜0.05）；研究組TSP-2、PTX3、凝血酶原時間（PT）、凝血酶時間（TT）、APTT顯著高于對照組（t值介于2.339～8.414之間，P＜0.05），而纖維蛋白原（FIB）水平顯著低于對照組（t=2.413，P＜0.05）。TSP-2對孕婦PPH預測的AUC值為0.729（95%CI：0.666～0.793），PTX3預測的AUC值為0.732（95%CI：0.669～0.794），兩者聯合預測的AUC值為0.808（95%CI：0.754～0.863），優于兩者單獨預測（Z兩者聯合-TSP-2=1.858，P=0.032；Z兩者聯合-PTX3=1.787，P=0.037）。多因素Logistic回歸分析顯示，TSP-2、PTX3、TT、FIB、PT、APTT、不良孕產史是孕婦PPH發生的影響因素（OR值介于1.131～2.249之間，P＜0.05）。結論 TSP-2、PTX3在孕婦PPH患者血清中均呈高表達，兩者聯合對PPH的發生具有一定的預測價值，可成為輔助預測孕婦PPH的標志物。

［關鍵詞］孕婦；產后出血；血小板反應蛋白2；正五聚蛋白3

Doi：10.3969/j.issn.1673-5293.2024.07.015

［中圖分類號］R173［文獻標識碼］A

［文章編號］1673-5293（2024）07-0091-05

Predictive value of serum TSP-2 combined with PTX3 levels for postpartum hemorrhage

［Abstract］ Objective To investigate the expression of thrombospondin-2 （TSP-2） and pentraxin 3 （PTX3） in the serum of pregnant women with postpartum hemorrhage （PPH） and predictive value for PPH. Methods 126 pregnant women who delivered in our hospital from September 2018 to September 2022 and experienced PPH were selected as the study group.Additionally，another 126 normal pregnant women who delivered at our hospital were chosen as the control group.The levels of serum TSP-2 and PTX3 were detected by enzyme-linked immunosorbent assay （ELISA），the predictive value of TSP-2 and PTX3 for maternal PPH was analyzed using receiver operating characteristic （ROC） curves.Multivariate logistic regression analysis was applied to analyze the influencing factors of PPH in pregnant women. Results The serum calcium levels （t=2.158） and adverse obstetric history （χ2=8.966） in the study group were significantly higher than those in the control group （P＜0.05）;TSP-2，PTX3，prothrombin time （PT），thrombin time （TT） and activated partial thromboplastin time （APTT） in the study group were significantly higher than in the control group （t values ranging from 2.339 to 8.414，P＜0.05），while the level of fibrinogen （FIB） was significantly lower than in the control group （t=2.413，P＜0.05）.The area under curve （AUC） value for predicting maternal PPH was 0.729 （95%CI：0.666-0.793） for TSP-2，0.732 （95%CI：0.669-0.794） for PTX3，and 0.808 （95%CI：0.754-0.863） for their combined prediction，which was superior to individual predictions （Zcombination-TSP-2=1.858，P=0.032;Zcombination-PTX3=1.787，P=0.037）.Multivariate logistic regression analysis showed that TSP-2，PTX3，TT，FIB，PT，APTT and adverse obstetric history were the influencing factors for the occurrence of maternal PPH （OR values ranging from 1.131 to 2.249，P＜0.05）. Conclusion TSP-2 and PTX3 both exhibit high expression in the serum of pregnant women with PPH.Their combination has a certain predictive value for the occurrence of PPH and can be an auxiliary marker for predicting PPH in pregnant women.

［Key words］ pregnant women;postpartum hemorrhage;thrombospondin-2;pentraxin 3

產后出血（postpartum hemorrhage，PPH）是一種嚴重的產科急癥，近年來發病率逐年上升。出血量過多可能導致缺鐵性休克，嚴重危害孕產婦的生命安全［1］。因此，早期預測對PPH的預防具有重要意義。血小板反應蛋白2（thrombospondin-2，TSP-2）主要由巨噬細胞、神經元、單核細胞分泌形成，廣泛表達于腫瘤、血管、真皮等部位，具備胚胎發育、血小板聚集和激活、新血管形成等多種生物學功能［2］。有研究發現TSP-2可參與血管的調節過程，抑制腫瘤的生長和血管的形成［3］。……