目的 探讨胎盘植入性疾病(PAS)患者血清胎盘生长因子(PLGF)、妊娠相关血浆蛋白A(PAPP-A)水平与植入深度及产后出血的关系。方法 选择2018-06至2023-06海军第971医院收治的228例PAS患者(PAS组),根据PAS严重程度分为黏连型组(77例)、植入型组(88例)、穿透型组(63例),另选择同期妇产科收治的217例正常分娩孕妇为对照组。检测血清PLGF、PAPP-A水平,统计PAS患者产后出血情况,分析PLGF、PAPP-A与PAS植入深度和产后出血的关系。结果 PAS组血清PLGF[(509.64±127.48 )pg/ml vs. (356.12±101.24 )pg/ml]、PAPP-A[(4216.32±623.19) mU/L vs. (3213.54±305.43) mU/L]水平高于对照组(P＜0.05),穿透型组血清PLGF、PAPP-A水平高于植入型组和黏连型组(P＜0.05)。logistic回归分析显示,高水平PLGF、PAPP-A是PAS产后出血的危险因素(P＜0.05)。PLGF、PAPP-A预测PAS产后出血的曲线下面积为0.863、0.980,均具有较高价值(P＜0.05)。结论 PAS孕妇血清PLGF、PAPP-A水平增高与胎盘植入深度增加和产后出血风险有关,检测血清PLGF、PAPP-A水平有助于预测PAS产后出血情况。
Abstract
Objective To investigate the relationship between the levels of serum placental growth factor (PLGF), pregnancy-related plasma protein A (PAPP-A), implantation depth and postpartum hemorrhage in patients with placental implantable disease (PAS). Methods A total of 228 PAS patients (PAS group) admitted to No. 971 Hospital of PLA Army from June 2018 to June 2023 were selected and divided into adhesion group (77 cases), implantation group (88 cases) and penetration group (63 cases) according to placental implantation depth, and 217 pregnant women with normal delivery during the same period were selected as control group. The levels of Serum PLGF and PAPP-A were detected, postpartum hemorrhage of PAS patients was analyzed, and the relationship between PLGF, PAPP-A, PAS implantation depth and postpartum hemorrhage was analyzed. Results The levels of serum PLGF[(509.64±127.48)pg/ml vs. (356.12±101.24)pg/ml] and PAPP-A [(4 216.32±623.19)mU/L vs. (3213.54±305.43 )mU/L]in PAS group were higher than those in control group (P<0.05), and the levels of serum PLGF and PAPP-A in penetration group were higher than those in implant group and adhesion group (P<0.05). High level of PLGF and high level of PAPP-A were risk factors for PAS postpartum hemorrhage (P<0.05). The areas under the curve of PLGF and PAPP-A in predicting postpartum hemorrhage of PAS were 0.863 and 0.980, both of which had high value (P<0.05). Conclusions The increase of serum PLGF and PAPP-A levels in PAS pregnant women is associated with the increase of placenta implantation depth and the risk of postpartum hemorrhage. The detection of serum PLGF and PAPP-A levels is helpful to predict the postpartum hemorrhage in PAS.
关键词
胎盘植入性疾病 /
胎盘植入 /
产后出血 /
胎盘生长因子 /
妊娠相关血浆蛋白A
Key words
pernicious placenta previa /
placenta accreta spectrum /
postpartum hemorrhage /
placental growth factor /
pregnancy-associated plasma protein-A
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