摘要
目的 分析激素六项变化瘢痕子宫产妇对再妊娠发生羊水过少的预测价值.方法 回顾性分析2021年5月至2023年3月宿州市第一人民医院收治的54例瘢痕子宫再妊娠发生羊水过少产妇临床资料,将其纳入羊水过少组,另选取同期54例瘢痕子宫再妊娠羊水正常产妇临床资料,将其纳入羊水正常组.两组产妇均接受激素六项[卵泡刺激素(follicle-stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradial,E2)、孕酮(progesterone,P)、睾酮(testosterone,T)、催乳素(prolactin,PRL)]检测.统计两组基线资料,采用二元Logistic分析激素六项与瘢痕子宫产妇再妊娠发生羊水过少的关系;采用接受者操作特征曲线(receiver operating characteristic curve,ROC)评估激素六项预测瘢痕子宫产妇再妊娠发生羊水过少的价值;采用样条函数与Logistic回归相结合的限制性立方样条法分析激素六项与瘢痕妊娠产妇再妊娠发生羊水过少的剂量反应关系.结果 羊水过少组多胎产妇占比为20.37％(11/54),高于羊水正常组的5.56％(3/54)(P＜0.05);羊水过少组 FSH、雌二醇、孕酮、PRL 分别为(8.11±1.83)IU/L、(125.61±61.43)pg/L、(16.33±3.15)mmol/L、(315.15±87.63)mIU/L,低于羊水正常组的(9.87±2.05)IU/L、(148.52±50.57)pg/L、(20.14±4.07)mmol/L、(366.18±99.36)mIU/L(P＜0.05);羊水过少组 LH、睾酮分别为(18.65±7.16)IU/L、(1.75± 0.19)mmol/L,与羊水正常组的(20.67±8.53)IU/L、(1.73±0.11)mmol/L比较,差异无统计学意义(P＞0.05).二元Logistic回归分析结果显示,多胎(OR=11.507,95％CI:2.174～60.902,P=0.004)是瘢痕子宫产妇再妊娠发生羊水过少的危险因素;FSH(OR=0.620,95％CI:0.224～0.845,P=0.001)、雌二醇(OR=0.988,95％CI:0.978～0.998,P=0.021)、孕酮(OR=0.750,95％CI:0.645～0.873,P＜0.001)高表达是瘢痕子宫产妇再妊娠发生羊水过少的保护因素.绘制ROC曲线,结果显示,FSH、孕酮及联合检测预测瘢痕子宫产妇再妊娠发生羊水过少的曲线下面积(area under the curve,AUC)分别为0.754、0.768、0.870;血清FSH、雌二醇、孕酮水平与瘢痕子宫产妇再妊娠发生羊水过少的关联强度呈线性剂量反应关系(P＜0.05);血清FSH、雌二醇、孕酮水平与瘢痕子宫产妇再妊娠发生羊水过少呈负相关,特别当FSH＜9.255 IU/L、雌二醇＜158.465 pg/L、孕酮＜19.000 mmol/L时,瘢痕妊娠产妇再妊娠发生羊水过少随FSH、雌二醇、孕酮水平降低而升高.结论 瘢痕子宫产妇激素六项中FSH、雌二醇、孕酮水平变化与其再妊娠羊水过少的发生关系密切,同时能有效预测再妊娠羊水过少风险.
Abstract
Objective To analyze the predictive value of six hormonal changes in pregnant women with scarred uterus for the occurrence of oligohydramnios in their second pregnancy.Methods A retrospective study was conducted to select the clinical data of 54 pregnant women with hypohydramnios in scarred uterus who were ad-mitted to the First People's Hospital of Suzhou from May.2021 to Mar.2023.They were included in the oligohy-dramnios group,and another 54 patients with normal amniotic fluid in scar uterus re-pregnancy during the same pe-riod were selected and included in the normal amniotic fluid group.Both groups of postpartum women underwent six hormone tests,including follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),proges-terone(P),testosterone(T),and prolactin(PRL).Two sets of baseline data were collected and binary logistic analysis was used to investigate the relationship between six hormones and oligohydramnios in women with scarred uterus during re-pregnancy.Receiver operating characteristic curve(ROC)was adopted to evaluate the six hormon-al factors in predicting oligohydramnios in pregnant women with scar uterus during re pregnancy.The restricted cu-bic spline method combining spline function and logistic regression were used to analyze the dose-response relation-ship between six hormones and oligohydramnios in scar pregnant women during re-pregnancy.Results The pro-portion of multiple pregnant women in the oligoamnios group[20.37％(11/54)]was higher than that in the normal amniotic fluid group[5.56％(3/54)](P＜0.05).The levels of FSH,E2,P and PRL in oligohydramnios group were lower than those in normal amniotic fluid group[(8.11±1.83)IU/L,(125.61±61.43)p/L,(16.33±3.15)mmol/L,(315.15±87.63)mIU/L],[(9.87±2.05)IU/L,(148.52±50.57)pg/L,(20.14±4.07)mmol/L,(366.18±99.36)mIU/L](P＜0.05);The levels of LH and T in oligohydramnios group[(18.65±7.16)IU/L,(1.75±0.19)mmol/L]were compared with those in normal amniotic fluid group[(20.67±8.53)IU/L,(1.73±0.11)mmol/L]and there was no significant difference between the two groups(P＜0.05).The results of binary logistic regression analysis showed that multiple pregnancy(OR=11.507,95％CI:2.174-60.902,P=0.004)was a risk factor for recurrent oligohydram-nios in women with scarred uterus.The high expression of FSH(OR=0.620,95％CI:0.224-0.845,P=0.001),E2(OR=0.988,95％CI:0.978-0.998,P=0.021),and P(OR=0.750,95％CI:0.645-0.873,P＜0.001)was a protective factor for oligohydramnios in pregnant women with scar uterus during re-pregnancy.The ROC curve was plotted,and the results showed that AUC of FSH,P,and combined detection for predicting oligohydramnios in pregnant women with scarred uterus during re-pregnancy were 0.754,0.768,and 0.870,respectively.The correlation be-tween serum levels of FSH,E2,and P and the occurrence of oligohydramnios in pregnant women with scarred uterus during re-pregnancy showed a linear dose-response relationship(P＜0.05).The levels of serum FSH,E2,and P were negatively correlated with the occurrence of oligohydramnios in pregnant women with scar uterus.Especially when FSH＜9.255 IU/L,E2＜158.465 pg/L,P＜19.000 mmol/L,the occurrence of oligohydramnios in pregnant wom-en with scar uterus increased with the decrease of FSH,E2,and P levels.Conclusion The six hormonal changes in pregnant women with scar uterus are closely related to the occurrence of oligohydramnios during re-pregnancy,and can effectively predict the risk of oligohydramnios during re-pregnancy.
维普
万方数据