剖宫产产妇血清IGF-1及IGF-1R对盆腔器官脱垂及盆底肌力的预测价值研究-东南大学学报医学版

剖宫产产妇血清IGF-1及IGF-1R对盆腔器官脱垂及盆底肌力的预测价值研究

单位：濮阳市妇幼保健院孕产保健部产科病区, 河南濮阳 457000

关键词：胰岛素样生长因子-1 胰岛素样生长因子-1受体盆腔器官脱垂盆底肌力预测价值

分类号：R719.8

出版年·卷·期（页码）：2023·42·第四期（596-601）

摘要：

目的:探讨剖宫产产妇血清胰岛素样生长因子-1(IGF-1)及IGF-1受体(IGF-1R)表达,及其对盆腔器官脱垂(POP)及盆底肌力的预测价值。方法:选取2020年10月至2022年10月于本院进行产检并选择剖宫产的128例产妇为观察组,依据有无POP发生分为POP组(42例)和无POP(N-POP)组(86例);另选同期本院收治的128例患有乳腺增生、子宫肌瘤或卵巢囊肿等妇科疾病但盆底肌正常的妇女作为对照组。酶联免疫吸附法(ELISA)检测血清IGF-1、IGF-1R及IGF结合蛋白(IGFBP)-3水平;采用Pearson法分析血清中IGF-1、IGF-1R及IGFBP-3表达水平与盆底肌力指标的相关性;采用受试者工作特征(ROC)曲线评估血清中IGF-1、IGF-1R及IGFBP-3对POP的预测价值。结果:观察组IGF-1、IGF-1R水平显著低于对照组,IGFBP-3水平显著高于对照组(P<0.05);POP组IGF-1、IGF-1R水平显著低于N-POP组,IGFBP-3水平显著高于N-POP组(P<0.05);POP组盆底肌力、盆底Ⅰ类肌肌力、盆底Ⅱ类肌肌力及阴道动态压力显著低于对照组及N-POP组(P<0.05);IGF-1与盆底肌力、盆底Ⅰ类肌肌力、盆底Ⅱ类肌肌力及阴道动态压力均呈正相关(r值分别为0.369、0.325、0.436、0.510,均P<0.001);IGF-1R与盆底肌力、盆底Ⅰ类肌肌力、盆底Ⅱ类肌肌力及阴道动态压力均呈正相关(r值分别为0.336、0.318、0.442、0.476,均P<0.001);IGFBP-3与盆底肌力、盆底Ⅰ类肌肌力、盆底Ⅱ类肌肌力及阴道动态压力均呈负相关(r值分别为-0.348、-0.452、-0.391、-0.506,均P<0.001);Ⅱ度POP患者血清IGF-1、IGF-1R水平明显低于Ⅰ度患者,IGFBP-3水平明显高于Ⅰ度患者(P<0.05);ROC曲线显示,IGF-1对POP预测的AUC为0.855,IGF-1R对POP预测的AUC为0.842,IGFBP-3对POP预测的AUC为0.820,三者联合对POP预测的AUC为0.923,明显高于三者单独预测。结论:剖宫产后POP产妇IGF-1、IGF-1R低表达,IGFBP-3高表达,三者均与盆底肌力密切相关,且三者联合预测POP的价值较高。

Objective: To investigate the expression of serum insulin-like growth factor-1(IGF-1) and IGF-1R(IGF-1R) in parturients undergoing cesarean section, and their predictive value for pelvic organ prolapse(POP) and pelvic floor muscle strength. Methods: The observation group(128 cases) was selected from the parturients who were examined and delivered by cesarean section in our hospital from October 2020 to October 2022, who were grouped into POP group(42 cases) and N-POP group(86 cases) according to the occurrence of POP; another 128 women with gynaecological diseases such as breast hyperplasia, hysteromyoma or ovarian cyst but normal pelvic floor muscles admitted to our hospital in the same period were regarded as the control group; the levels of serum IGF-1, IGF-1R and IGFBP-3 were detected by ELISA; the correlation between the expression levels of IGF-1, IGF-1R and IGFBP-3 in serum and the indexes of pelvic floor muscle strength was analyzed by Pearson method; and the predictive value of IGF-1, IGF-1R and IGFBP-3 in serum for POP was evaluated by ROC curve. Results: The levels of IGF-1 and IGF-1R in the observation group were obviously lower than those in the control group, and the level of IGFBP-3 was obviously higher than that in the control group(P<0.05); the levels of IGF-1 and IGF-1R in POP group were obviously lower than those in N-POP group, and the level of IGFBP-3 was obviously higher than that in N-POP group(P<0.05); the pelvic floor muscle strength, pelvic floor class Ⅰ muscle strength, pelvic floor class Ⅱ muscle strength and vaginal dynamic pressure in POP group were obviously lower than those in the control group and the N-POP group(P<0.05); IGF-1 was positively correlated with pelvic floor muscle strength, pelvic floor class I muscle strength, pelvic floor class Ⅱ muscle strength and vaginal dynamic pressure(r=0.369, 0.325, 0.436, 0.510, all P<0.001); IGF-1R was positively correlated with pelvic floor muscle strength, pelvic floor class Ⅰ muscle strength, pelvic floor class Ⅱ muscle strength and vaginal dynamic pressure(r=0.336, 0.318, 0.442, 0.476, all P<0.001); IGFBP-3 was negatively correlated with pelvic floor muscle strength, pelvic floor class Ⅰ muscle strength, pelvic floor class Ⅱ muscle strength and vaginal dynamic pressure(r=-0.348, -0.452, -0.391, -0.506, all P<0.001); serum IGF-1 and IGF-1R levels in patients with grade Ⅱ POP were obviously lower than those in patients with grade Ⅰ POP, and IGFBP-3 level was obviously higher than that in patients with grade Ⅰ POP(P<0.05); the ROC curve showed that the AUC predicted by IGF-1 for POP was 0.855, the AUC predicted by IGF-1R for POP was 0.842, and the AUC predicted by IGFBP-3 for POP was 0.820, the AUC of POP predicted by the combination of the three was 0.923, which was obviously higher than that predicted by the three alone. Conclusion: The expression of IGF-1 and IGF-1R is low in POP puerpera after cesarean section, and the expression of IGFBP-3 is high, all of them are closely related to pelvic floor muscle strength, and the combined prediction for POP is of high value.

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