未足月胎膜早破合并绒毛膜羊膜炎孕妇血清淀粉样蛋白A、血小板激活因子水平的表达及临床意义

目的:检测未足月胎膜早破合并绒毛膜羊膜炎(HCA)孕妇血清淀粉样蛋白A(SAA)、血小板激活因子(PAF)水平,并探讨其临床意义。方法:选择从2013年7月到2017年7月,在我院接受治疗的165例胎膜早破孕产妇作为研究对象。165例患者中,未足月胎膜早破者80例(未足月胎膜早破组),足月胎膜早破者85例(足月胎膜早破组),再根据是否合并HCA分为合并HCA胎膜早破组43例和未合并HCA胎膜早破组122例。另选取同期在我院体检的80例健康孕产妇志愿者作为正常组,对比各组血清SAA和PAF水平,分析合并与未合并HCA胎膜早破组的妊娠结局,利用受试者工作特征(ROC)曲线分析血清SAA和PAF对未足月胎膜早破是否合并HCA的诊断价值。结果:未足月胎膜早破组及足月胎膜早破组的血清SAA和PAF水平均明显高于正常组,且未足月胎膜早破组又高于足月胎膜早破组,差异有统计学意义(P0.05)。未足月胎膜早破组80例患者中HCA发生率为35.00%(28/80),明显高于足月胎膜早破组的17.65%(15/85),差异有统计学意义(P0.05)。合并HCA胎膜早破组的血清SAA和PAF水平均明显高于未合并HCA胎膜早破组,差异有统计学意义(P0.05)。合并HCA的未足月胎膜早破患者血清SAA和PAF水平高于未合并HCA的未足月胎膜早破患者(P0.05)。合并HCA的胎膜早破组的产后大出血、剖宫产以及新生儿肺炎的发生率均明显高于未合并HCA胎膜早破组,差异有统计学意义(P0.05)。根据ROC曲线分析可知,血清SAA和PAF对未足月胎膜早破是否合并HCA的诊断价值较高。结论:血清SAA、PAF水平在未足月胎膜早破合并HCA孕妇中明显升高,二者对此种合并症具有较高的诊断价值。临床诊疗过程中可将SAA及PAF纳入到指标监测体系中,从而为临床治疗提供指导。

Expression and Clinical Significance of Serum amyloid Protein A and Platelet Activating Factor in Pregnant Women with Preterm Premature Rupture of Fetal Membranes Complicated with Chorioamnionitis

ABSTRACT Objective: To detect the expression of serum amyloid protein A (SAA) and platelet activating factor (PAF) in pregnant women with premature rupture of fetal membranes complicated with chorioamnionitis (HCA), and to explore its clinical significance. Methods: 165 pregnant women with premature rupture of fetal membranes who were treated in our hospital from July 2013 to July 2017 were selected as research subjects. Among 165 patients, there were premature rupture of fetal membranes (premature rupture of fetal membranes group) with 80 case, and there were full-term premature rupture of fetal membranes(full-term premature rupture of fetal membranes group) with 85 cases. According to whether the combined HCA, the patients were divided into combined HCA premature rupture of fetal membranes group with 43 cases and uncombined HCA premature rupture of fetal membranes group with 122 cases. Another 80 healthy pregnant women volunteers who were received physical examination in our hospital during the same period were selected as the normal group. The serum levels of SAA and PAF were compared in each group, the pregnancy outcomes of the combined HCA and uncombined HCA premature rupture of fetal membranes group were analyzed. The diagnostic value of serum SAA and PAF in combined with HCA in patients with preterm premature rupture of fetal membranes were analyzed by receiver operating characteristic (ROC) curve. Results: The levels of serum SAA and PAF in premature rupture of fetal membranes group and full-term premature rupture of fetal membranes group were significantly higher than those in the normal group, and the premature rupture of fetal membranes group was higher than that in the full-term premature rupture of fetal membranes group, the differences are statistically significant(P<0.05). The incidence of HCA of 80 patients in premature rupture of fetal membranes group was 35.00%(28/80), which was significantly higher than 17.65%(15/85) in the full-term premature rupture of fetal membranes group, the differences are statistically significant (P<0.05). The levels of serum SAA and PAF in combined HCA premature rupture of fetal membranes group were significantly higher than those in uncombined HCA premature rupture of fetal membranes group, the differences are statistically significant(P<0.05). The serum levels of SAA and PAF in patients with premature rupture of membranes without HCA were higher than those in patients without HCA (P<0.05). The incidence of postpartum hemorrhage, cesarean section and neonatal pneumonia in combined HCA premature rupture group was significantly higher than that uncombined HCA premature rupture of fetal membranes group, the differences are statistically significant(P<0.05). According to the ROC curve analysis, the serum SAA and PAF had a higher diagnostic value of in the diagnosis of combined with HCA in patients with preterm premature rupture of fetal membranes. Conclusion: The levels of serum SAA and PAF are increased significantly in preterm premature rupture of fetal membranes complicated with HCA, and the two have high diagnostic value for this complication. In the process of clinical diagnosis and treatment, SAA and PAF can be included in the index monitoring system, so as to provide guidance for clinical treatment.