摘要
目的分析子痫前期患者血清可溶性血管内皮生长因子受体-1(sFlt-1)水平及其与患者临床表现和预后的关系。方法选取2019年7月至2020年6月在杭州市妇产科医院行常规产前检查和分娩的子痫前期孕妇34例为子痫前期组,另择同期在本院行常规产前检查和分娩的无高血压、肾病、糖尿病等代谢性疾病的正常相近孕龄妇女28例为对照组。抽取对照组孕妇和子痫前期组孕妇首次诊断子痫前期时的静脉血5 ml检测血清sFlt-1水平。比较子痫前期组与对照组孕妇一般资料和实验室指标。根据子痫前期组孕妇的发病时间,分为早发型子痫前期组(<34周)与晚发型子痫前期组(≥34周),比较两组孕妇血清sFlt-1水平。根据患者有无重症表现,将子痫前期组分为重症组与非重症组,比较两组孕妇血清sFlt-1水平。以子痫前期组孕妇血清sFlt-1水平中位数为界,将子痫前期组分为高sFlt-1组与低sFlt-1组,比较两组孕妇一般资料和实验室指标;采用多因素logistic回归分析影响子痫前期孕妇血清sFlt-1水平的因素。结果(1)子痫前期组孕妇的尿酸、平均动脉压、血清sFlt-1水平、尿蛋白阳性率、并发症及胎儿宫内生长受限发生率均较对照组升高,而新生儿出生体重、分娩孕周及血清白蛋白水平均较对照组降低,差异均有统计学意义(均P<0.05)。(2)早发型子痫前期组孕妇的血清sFlt-1水平较晚发型子痫前期组升高[2463.45(1850.94,3647.55)pg/ml比1212.80(937.05,2031.22)pg/ml],差异有统计学意义(P<0.05)。(3)重症组孕妇的血清sFlt-1水平较非重症组升高[(3851.18±2235.17)pg/ml比(1987.07±1172.45)pg/ml],差异有统计学意义(P<0.05)。(4)高sFlt-1组孕妇的发病孕周、分娩孕周、血清白蛋白水平、PLT及Fib均较低sFlt-1组降低,而肌酐、尿酸、尿蛋白水平均较低sFlt-1组升高,差异均有统计学意义(均P<0.05)。(5)多因素分析显示,肌酐水平异常是子痫前期孕妇血清sFlt-1水平的独立影响因素(OR=1.178,95%CI:1.006~1.380,P<0.05)。结论子痫前期患者血清sFlt-1水平明显升高,且血清sFlt-1水平在早发型子痫前期和有并发症的重度患者中明显升高,尤其与肾脏功能损害指标相关。孕妇血清sFlt-1水平或可作为早发型子痫前期发病及病情进展的预测指标。
Objective To investigate serum levels of soluble FMS-like tyrosine kinase 1(sFlt 1)in patients with preeclampsia,and its clinical significance.Methods Thirty-four pregnant women with preeclampsia and 28 healthy pregnant women who attended antenatal care and delivered(control group)in Hangzhou Women's Hospital from July 2019 to June 2020 were enrolled in this study.The serum sFlt-1 levels were measured and compared between the two groups,and the correlation of the serum sFlt 1 level with the clinical indicators and prognosis were analyzed in patients with preeclampsia.According to the onset time of preeclampsia group,the pregnant women were divided into early-onset subgroup(<34 weeks)and late-onset subgroup(≥34 weeks).According to whether the patients had severe manifestations,the preeclampsia group was divided into severe subgroup and non-severe subgroup.According to the median serum sFlt-1 level of pregnant women in preeclampsia group,the preeclampsia group was divided into high sFlt-1 subgroup and low sFlt-1 subgroup.The general data and laboratory indicators of pregnant women in the subgroups were compared.Multivariate logistic regression analysis was used to analyze the influencing factors of serum sFlt-1 level in pregnant women with preeclampsia.Results Compared with the control group,the uric acid,mean arterial pressure,serum sFlt 1 level,urinary protein positive rate,incidence of complications and FGR in the preeclampsia group were significantly higher,while the neonatal birth weight,gestational age at delivery and serum albumin levels were significantly lower(all P<0.05).The level of serum sFlt 1 in the early-onset subgroup was significantly higher than this in the late-onset subgroup[2463.45(1850.94,3647.55)pg/ml vs.1212.80(937.05,2031.22)pg/ml,P<0.05].The level of serum sFlt-1 in the severe subgroup was significantly higher than this in the non-severe subgroup[(3851.18±2235.17)pg/ml vs.(1987.07±1172.45)pg/ml,P<0.05].The gestational age at onset,gestational age at delivery,serum albumin levels,PLT and Fib were significantly decreased in the high sFlt 1 subgroup compared with the low sFlt-1 subgroup,while the levels of creatinine,uric acid and urinary protein were significantly increased(all P<0.05).Multivariate logistic regression analysis showed that creatinine was an independent risk factor that influence the serum sFlt-1 in pregnant women with preeclampsia(OR=1.178,95%CI:1.006-1.380,P<0.05).Conclusion Compared with healthy pregnant women,serum sFlt 1 levels are higher in pregnant women with preeclampsia,among which serum sFlt 1 levels are higher in early-onset patients than in late-onset ones and higher in severe patients than in non-severe ones,and the serum sFlt-1 levels are correlated with indicators of renal function impairment.
作者
俞黎铭
文彩荷
罗腾飞
张敏
刘元伟
柴芸
YU Liming;WEN Caihe;LUO Tengfei;ZHANG Min;LIU Yuanwei;CHAI Yun(Department of Obstetrics,Hangzhou Women's Hospital,Hangzhou 310008,China)
出处
《浙江医学》
CAS
2022年第21期2260-2264,共5页
Zhejiang Medical Journal
基金
浙江省基础公益研究计划项目(LGF19H040007)。
