摘要
目的 探究血管内皮生长因子(vascular endothelial growth factor,VEGF)、微血管密度(micro-vascular density,MVD)、辅助性T细胞17(T helper 17 cells,Th17)和调节性T细胞(regulatory T cells,Treg)与胎盘植入感染程度关系及预测预后价值。方法 选取我院收治的胎盘植入感染患者50例作为观察组,其中轻度20例,中度17例,重度13例,另选取同期未并发感染的胎盘植入患者50例作为对照组。根据妊娠结局将患者分为预后良好(n=29)与预后不良(n=21)。比较2组VEGF、MVD、Th17/Treg,分析VEGF、MVD、Th17/Treg与常规感染标志物[白细胞介素6(interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)]及胎盘植入感染程度关系,比较不同预后患者临床资料、VEGF、MVD、Th17/Treg,分析预后影响因素,评价VEGF、MVD、Th17/Treg对胎盘植入感染患者预后的预测价值。结果 观察组VEGF、MVD、Th17/Treg水平均高于对照组(P<0.05);胎盘植入感染患者VEGF、MVD、Th17/Treg均与胎盘植入感染程度呈正相关关系(P<0.05);预后不良患者VEGF、MVD、Th17/Treg水平均高于预后良好患者(P<0.05);Logistic回归方程,结果显示调整年龄、孕周等混杂因素后,VEGF、MVD、Th17/Treg仍为胎盘植入感染患者预后不良独立危险因素(P<0.05);绘制ROC曲线,结果显示VEGF、MVD、Th17/Treg预测胎盘植入感染患者预后的AUC分别为0.541(95%CI:0.388~0.689)、0.813(95%CI:0.671~0.913)、0.766(95%CI:0.618~0.878),应用Logistic二元回归拟合,构建各指标联合诊断的AUC,结果显示,各指标联合的AUC为0.890(95%CI:0.763~0.963),敏感度为90.48%,特异度为84.00%。胎盘植入感染患者常规感染标志物PCT(2.76±0.58)μg/L,CRP(48.23±15.84) mg/L,IL-6(124.38±29.26) ng/L,相关性分析可知,VEGF、MVD、Th17/Treg与PCT、CRP、IL-6水平呈正相关关系(P<0.05)。结论 胎盘植入感染患者VEGF、MVD、Th17/Treg明显升高,且与感染程度及预后密切相关,临床检测其水平,有助于该病病情评估及预后预测。
Objective To investigate the relationship between vascular endothelial growth factor(VEGF),micro-vascular density(MVD),helper T cells 17(Th17)/regulatory T cells(Treg)and the degree of placenta accreta complicated by infection and to predict the prognostic value.Methods In total,50 patients with placenta accreta complicated by infection admitted to our hospital were selected as the observation group,including 20 cases with mild,17 cases with moderate and 13 cases with severe disease,and another 50 patients with placenta accreta but without complicated infection during the same period were selected as the control group.The patients were divided into good prognosis(n=29)and poor prognosis(n=21)according to pregnancy outcome.VEGF,MVD,and Th17/Treg were compared between two groups,and VEGF,MVD,and Th17/Treg were analyzed in relation to conventional infection markers[interleukin-6(IL-6),C-reactive protein(CRP),procalcitonin(PCT)]and the severity of placenta accreta complicated by infection.The clinical data,VEGF,MVD,and Th17/Treg in patients with different prognoses were compared,to analyze the prognostic factors,and to evaluate the predictive value of VEGF,MVD,and Th17/Treg in the prognosis of patients with placenta accreta complicated by infection.Results The levels of VEGF,MVD and Th17/Treg in the observation group were higher than those in the control group(P<0.05);VEGF,MVD and Th17/Treg in patients with placenta accreta complicated by infection were positively correlated with the severity of placenta accreta complicated by infection(P<0.05).The levels of VEGF,MVD and Th17/Treg in patients with poor prognosis were higher than those in patients with good prognosis(P<0.05).Logistic regression equation showed that after adjusting for confounding factors such as age and gestational age,VEGF,MVD and Th17/Treg were still independent risk factors for the poor diagnosis of patients with placenta accreta complicated by infection(P<0.05).Receiver operating characteristic(ROC)curve was drawn,and the results showed that the area under the ROC curve(AUC)of VEGF,MVD and Th17/Treg for predicting the prognosis of patients with placenta accreta complicated by infection was 0.541(95%CI:0.388-0.689),0.813(95%CI:0.671-0.913),and 0.766(95%CI:0.618-0.878),respectively.Logistic binary regression fitting was applied to construct the AUC for the combined diagnosis of each index,and the results showed that the AUC for the combined index was 0.890(95%CI:0.763-0.963),with a sensitivity of 90.48%and a specificity of 84.00%.The correlation analysis of conventional infection markers PCT(2.76±0.58)μg/L,CRP(48.23±15.84)mg/L and IL-6(124.38±29.26)ng/L in patients with placenta accreta complicated by infection showed that VEGF,MVD and Th17/Treg were positively correlated with PCT,CRP and IL-6 levels(P<0.05).Conclusion VEGF,MVD,Th17/Treg are significantly increased in patients with placenta accreta complicated by infection,and are closely related to the severity of infection and prognosis.Clinical detection of their levels is helpful for disease assessment and prognosis prediction.
作者
苏瑞芬
解为全
吴小莉
SU Rui-fen;XIE Wei-quan;WU Xiao-li(Department of Gynaecology and Obsterics,Central Hospital of Enshi Tujia and Miao Autonomous Prefecture,Hubei Province,Enshi 445000,China)
出处
《河北医科大学学报》
CAS
2023年第4期439-443,477,共6页
Journal of Hebei Medical University
基金
恩施州科技计划拟立项项目(JCY202100001)。
关键词
侵入性胎盘
感染程度
预后
placenta accreta
severity of infection
prognosis
