早发型重度子痫前期患者血清...PD及Hcy表达及临床意义_杨超.pdf

186现代检验医学杂志第 38 卷第 1 期2023 年 1 月J Mod Lab Med,Vol.38,No.1,Jan.2023早发型重度子痫前期患者血清 SPA,SPD 及 Hcy 表达及临床意义杨超，苗丽，马建彩，郑路路，李瑞雪，杨丽萍（邯郸市中心医院妇产科,河北邯郸 056000）摘要：目的探讨早发型重度子痫前期（early onset severe pre-eclampsia，EOSP）患者血清表面活性蛋白 A（surfactant associated protein A，SPA）、表面活性蛋白 D（surfactant associated protein D，SPD）及同型半胱氨酸（homocysteine，Hcy）表达及临床意义。方法选取 2020 年 8 月 2021 年 8 月期间邯郸市中心医院诊治的 124 例 EOSP 患者为研究对象，以同期 60 例健康体检孕妇为对照组。酶联免疫吸附实验（ELISA）检测各组血清 SPA,SPD 及 Hcy 水平。比较两组一般资料及血清 SPA,SPD 及 Hcy 水平的差异。Pearson 相关分析血清 SPA,SPD 及 Hcy 水平与临床参数的相关性。多因素 Logistic 回归分析影响 EOSP 发生的影响因素。受试者工作曲线（ROC）分析血清 SPA,SPD 及 Hcy 对 EOSP 的诊断价值。结果相比于对照组，EOSP 组血清 SPA(13.275.14ng/ml vs 22.146.04ng/ml)，SPD(8.732.38ng/ml vs 19.343.46ng/ml)水平明显降低，Hcy(15.273.13mol/L vs 8.352.32mol/L)水平明显升高，差异具有统计学意义（t=10.353，24.299,15.214，均P0.05）。EOSP组患者血清SPA,SPD水平与新生儿出生体质量呈正相关（r=0.515,0.447,均 P 0.05)，与体质量指数、舒张压、收缩压和 24h 尿蛋白定量呈负相关(r=-0.604 -0.413,均 P 0.05)；血清 Hcy水平与新生儿出生体质量呈负相关（r=-0.538,P 0.05)，与体质量指数、舒张压、收缩压和 24h 尿蛋白定量呈正相关(r=0.420 0.610,均 P 0.05)。24h 尿蛋白定量 1.266（1.1101.444）、舒张压 1.270（1.0711.506）、SPA0.865（0.7780.962），SPD0.877（0.7810.985）及 Hcy1.347（1.0841.675）是 影 响 EOSP 发 生 的 独 立 因 素。血 清SPA，SPD 和 Hcy 联合检测对 EOSP 诊断的曲线下面积（95%CI）为 0.909(0.8770.945)，显著高于 SPA，SPD 和 Hcy各指标单独检测 0.780(0.7260.836)，0.758(0.7050.810)，0.740(0.6920.789)，差异具有统计学意义(Z=4.370，5.567，7.702，均 P 0.05)。结论子痫前期患者血清 SPA 和 SPD 降低，Hcy 升高，三者共同参与 EOSP 疾病发生发展，是影响 ES-PE 发生的独立危险因素。关键词：早期重度子痫前期；表面活性蛋白 A；表面活性蛋白 D；同型半胱氨酸中图分类号：R714.245；R392.11文献标识码：A文章编号:1671-7414（2023）01-186-05doi:10.3969/j.issn.1671-7414.2023.01.035Expression and Clinical Significance of Serum SPA,SPD and Hcy in Patients with Early-onset Severe PreeclampsiaYANG Chao,MIAO Li,MA Jian-cai,ZHENG Lu-lu,LI Rui-xue,YANG Li-ping（Department of Obstetrics and Gynecology,Handan Central Hospital,Hebei Handan 056000,China）Abstract:ObjectiveTo investigate the expression and clinical significance of serum surfactant protein A(SPA),surfactant protein D(SPD)and homocysteine(Hcy)in patients with early-onset severe preeclampsia(EOSP).MethodsA total of 124 patients with EOSP diagnosed and treated in Handan Central Hospital from August 2020 to August 2021 were selected as the research objects,and 60 healthy pregnant women during the same period were selected as the control group.The serum levels of SPA,SPD and Hcy in each group were detected by enzyme-linked immunosorbent assay（ELISA）.Statistical analysis was performed to compare the general data and serum levels of SPA,SPD and Hcy between the two groups.The correlation between serum SPA,SPD and Hcy levels and clinical indictors were analyzed by Pearson correlation analysis.Factors for the occurrence of EOSP were analyzed by multivariate Logistic regression analysis.Serum SPA,SPD and Hcy in the diagnosis of EOSP were analyzed by receiver operating curve(ROC)analysis.ResultsCompared with the control group,SPA(13.27 5.14ng/ml vs 22.14 6.04ng/ml),and SPD(8.73 2.38ng/ml vs 19.34 3.46ng/ml)were significantly decreased,while Hcy(15.273.13 mol/vs 8.35 2.32 mol/L L)was significantly increased,the differences were statistically significant(t=10.353，基金项目：河北省医学科学研究课题计划（编号：20220553）。作者简介：杨超（1985-），女，硕士，主治医师，主要从事子痫前期工作，E-mail:。通讯作者：杨丽萍（1980-），女，硕士，主任医师，主要从事子痫前期工作，E-mail:。187现代检验医学杂志第 38 卷第 1 期2023 年 1 月J Mod Lab Med,Vol.38,No.1,Jan.202324.299，15.214，all P0.05).The serum SPA and SPD levels in the EOSP group were positively correlated with newborn birth weight(r=0.515,0.447,all P 0.05),and negatively correlated with body mass index,diastolic blood pressure,systolic blood pressure and 24-hour urine protein quantification(r=0.604 0.413,all P 0.05).Serum Hcy level was negatively correlated with newborn birth weight（r=0.538,P 0.05),and was positively correlated with body mass index,diastolic blood pressure,systolic blood pressure,and 24h urinary protein quantification(r=0.420 0.610,all P 0.05).24h urine protein quantification 1.266(1.1101.444),diastolic blood pressure 1.270(1.0711.506),SPA 0.865(0.7780.962),SPD 0.877(0.7810.985)and Hcy 1.347(1.0841.675)would be independent factors affecting the occurrence of EOSP.The area under the curve(95%CI)of combined detection of serum SPA,SPD and Hcy for diagnosis of EOSP was 0.909(0.8770.945),which was significantly higher than that of SPA,SPD and Hcy separately detected by 0.780(0.7260.836),0.758(0.7050.810)and 0.740(0.6920.789)(Z=4.370,5.567,7.702,all P0.05).ConclusionThe serum levels of SPA,SPD were decreased,while Hcy increased in patients with preeclampsia increase.They were involved in the occurrence and development of EOSP,and are independent risk factors for the occurrence of EOSP.Keywords:early severe preeclampsia；surfactant protein A；surfactant protein D；homocysteine；clinical significance子痫前期是妊娠期高血压疾病，全球范围内孕产妇子痫前期发病率达 4.6%1。早发型重度子痫前期(early onset severe pre-eclampsia,EOSP)是子痫前期中较严重的类型，可导致胎儿生长发育受限甚至死亡2。目前 EOSP 的临床治疗除终止妊娠外，无有效的治疗方案。EOSP 的发生与胎盘源性细胞因子分泌失常、免疫平衡失调等因素有关，但目前尚无有效早期诊断 EOSP 的血清标志物。深入研究EOSP 的疾病机制，寻找能够早期诊断 EOSP 的血清标志物，对于早期疾病预防和治疗意义重大。表面活性蛋白 A(surfactant protein A，SPA)和表面活性蛋白 D(surfactant protein D，SPD)是凝集素家族