血清Hcy水平最佳切点与早产危险因素关系及其Logistic回归分析
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摘要
目的探讨血清同型半胱氨酸(Hcy)最佳切点选择与孕妇早产的关系,分析Hcy水平对早产儿结局影响。方法选择114例早产孕妇,103例正常产检孕妇为正常对照组,检测其Hcy、D-二聚体及超敏C反应蛋白;运用SPSS 13.0软件分析其ROC曲线,对早产危险因素进行多因素logistic回归分析。结果(1)早产孕妇组Hcy、HS-CRP以及D-二聚体水平高于正常对照组,差异有统计学意义(P<0.05)。(2)Logistic回归分析得出Hcy水平相对危险系数(OR)为9.736,并获得早产概率回归方程。(3)应用ROC曲线评价Hcy在早产的危险因子中预测值0.931;当Hcy为13.8μmol/L时,其Youden指数为0.784。(4)早产孕妇Hcy水平升高会导致发生SGA可能性明显增加。结论在预测早产危险因素时,Hcy最佳预测切值是13.8μmol/L,是早产独立危险因素之一。
Objective ine(Hcy)and premature delivery in pregnant women,and to analyze the influence of Hcy levels on the outcome ofpreterm infants.Methods Totally 114 cases of pregnant women were chosen as observation group and 103 cases ofnormal as control group.Hcy,D-D and hypersensitive C reactive protein were detected;analysis of the ROC curvewas conducted by using the SPSS 13 software and the risk factors for preterm delivery were analyzed using logisticmultivariate regression analysis.Results(1)The levels of Hcy,HS-CRP and D-D in preterm pregnant womenwere higher than those in control group and the difference was statistically significant(P < 0.05).(2)Logisticregression analysis showed that the relative risk coefficient(OR)of Hcy was 9.736,and the regression equation ofpremature birth probability was obtained.(3)ROC curve to evaluate the predictive value of Hcy in risk factors ofpreterm birth was 0.931;when Hcy was 13.8 μmol/L,the Youden index was 0.784.(4)Elevated levels of Hcy inpreterm women led to a marked increase in the likelihood of SGA.Conclusion When predicting risk factors forpreterm birth,the best predictive cutoff value for Hcy is 13.8 μmol/L,which is one of the independent risk factorsfor preterm birth.
Objective ine(Hcy)and premature delivery in pregnant women,and to analyze the influence of Hcy levels on the outcome ofpreterm infants.Methods Totally 114 cases of pregnant women were chosen as observation group and 103 cases ofnormal as control group.Hcy,D-D and hypersensitive C reactive protein were detected;analysis of the ROC curvewas conducted by using the SPSS 13 software and the risk factors for preterm delivery were analyzed using logisticmultivariate regression analysis.Results(1)The levels of Hcy,HS-CRP and D-D in preterm pregnant womenwere higher than those in control group and the difference was statistically significant(P < 0.05).(2)Logisticregression analysis showed that the relative risk coefficient(OR)of Hcy was 9.736,and the regression equation ofpremature birth probability was obtained.(3)ROC curve to evaluate the predictive value of Hcy in risk factors ofpreterm birth was 0.931;when Hcy was 13.8 μmol/L,the Youden index was 0.784.(4)Elevated levels of Hcy inpreterm women led to a marked increase in the likelihood of SGA.Conclusion When predicting risk factors forpreterm birth,the best predictive cutoff value for Hcy is 13.8 μmol/L,which is one of the independent risk factorsfor preterm birth.
引文
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[16]雷克竞,唐国红,姚开虎.38例足月与早产新生儿败血症临床特点及病原学比较[J].实用医学杂志,2016,32(5):742-746.
[17]SEALY J S,SLAUGHTER A J,CALDWELL C,et al.Neighborhood disadvantage and preterm delivery in Urban African Americans:The moderating role of religious coping[J].SSMPopul Health,2016,2(12):656-661.
[2]JOSEPH K S,FAHEY J,SHANKARDASS K,et al.Effects of socioeconomic position and clinical risk factors on spontaneous and iatrogenic preterm birth[J].BMC Pregnancy Childbirth,2014,27(14):117-128.
[3]GUNKO V O,POGORELOVA T N,LINDE V A.Proteomic profiling of the blood serum for prediction of premature delivery[J].Bull Exp Biol Med,2016,161(6):829-832.
[4]GOUTAUDIER N,SEJOURNE N,BUI E,et al.Premature delivery:a traumatic birth Posttraumatic stress symptoms and associated features[J].Gynecol Obstet Fertil,2014,42(11):749-754.
[5]KIM M W,HONG S C,CHOI J S,et al.Homocysteine folate and pregnancy outcomes[J].J Obstet Gynaecol,2012,32(6):420-524.
[6]胡娅莉.早产临床诊断与治疗指南(2014)[J].中华妇产科杂志,2014,49(7):481-485.
[7]KESROUANI A,CHALHOUB E,RASSY E,et al.Prediction of preterm delivery by second trimester inflammatory biomarkers in the amniotic fluid[J].Cytokine,2016,85(9):67-70.
[8]MAAYAN M A,LUBETSKY A,KUINT J,et al.The impact of genetic and environmental factors on homocysteine levels in preterm neonates[J].Pediatr Blood Cancer,2013,60(4):659-662.
[9]SAYYAH M M,GHORBANIHAGHJO A,ALIZADEH M,et al.The effect of high dose folic acid through out pregnancy on homocysteine(Hcy)concentrationand pre-eclampsia:A randomized clinical trial[J].PLo S One,2016,11(5):1-11.
[10]MACIEJEWSKI T M,LCKA R,CHELCHOWSKA M.Serum nitric oxide metabolites as a predictive factor of premature delivery[J].Pol Merkur Lekarski,2015,39(229):14-17.
[11]王容,凡伟,刘振寰.早产与孕妇TORCH感染的相关性研究[J].实用医学杂志,2013,29(14):2413-2414.
[12]刘丽红,杨群芳,刘丽芬,等.妊娠早期血浆同型半胱氨酸水平与早产的关系研究[J].吉林医学,2016,37(12):2853-2855.
[13]WADHWANI N S,PISAL H R,MEHENDALE S S,et al.Aprospective study of maternal fatty acids,micronutrients and homocysteine and theirassociation with birth outcome[J].Matern Child Nutr,2015,11(4):559-573.
[14]KOREVAAR T I,SCHALEKAMP T S,RIJKE Y B,et al.Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery:the generation R study[J].J Clin Endocrinol Metab,2013,98(11):4382-4390.
[15]OTA H,HASEGAWA J,SEKIZAWA A.Effect of sleep disorders on threatened premature delivery[J].J Perinat Med,2017,45(1):57-61.
[16]雷克竞,唐国红,姚开虎.38例足月与早产新生儿败血症临床特点及病原学比较[J].实用医学杂志,2016,32(5):742-746.
[17]SEALY J S,SLAUGHTER A J,CALDWELL C,et al.Neighborhood disadvantage and preterm delivery in Urban African Americans:The moderating role of religious coping[J].SSMPopul Health,2016,2(12):656-661.