外周血LDH、24-hUPro水平和脐动脉血流相关参数检测与子痫前期及新生儿预后的关系

Relationship of peripheral blood LDH,24-hUPro levels,and umbilical artery blood flow parameters with preeclampsia and neonatal prognosis

目的:乳酸脱氢酶(lactate dehydrogenase,LDH)是生物体内重要的氧化还原酶,主要在糖酵解过程中将丙酮酸转化为乳酸的胞内酶,异常表达于缺氧和氧化应激环境;24 h尿蛋白(24-hour urinary protein,24-hUPro)水平检测可以反映子痫前期进展过程中肾损伤、肾微血管细胞损伤情况,以及肾小球滤过能力;全身小动脉痉挛是子痫前期特征性的临床表现,发生后会导致子宫螺旋小动脉重铸不足,进而影响局部灌注不足,而呈现脐动脉血流相关参数变化,是孕晚期产检评估胎儿在母体内发育的重要手段。子痫前期作为产妇最严重的并发症之一,严重威胁产妇安全和新生儿预后。本研究旨在分析外周血LDH、24-hUPro水平和脐动脉血流相关参数检测与子痫前期及新生儿预后的关系。方法:选取2019年1月至2023年1月在黄山市人民医院建卡并于孕晚期诊断为子痫前期的72例产妇为研究对象,另纳入同期正常建卡的72例健康产妇为对照。收集入组对象一般资料,比较子痫前期组与健康组外周血LDH、24-hUPro水平、脐动脉血流相关参数[收缩期峰值血流速度/舒张末期血流速度(systolic blood flow velocity/enddiastolic blood flow velocity,S/D)、阻力指数(resistance index,RI)、搏动指数(pulsatility index,PI)]和母婴结局,绘制受试者操作特征(receiver operator characteristic,ROC)曲线,分析上述指标检测对子痫前期的预测效能,相关性分析子痫前期组外周血LDH、24-hUPro水平和脐动脉血流相关参数(S/D、RI和PI)与终止妊娠时间、新生儿体重和Apgar评分的关系。结果:子痫前期组与健康组产妇年龄、孕前BMI、初产妇情况、流产史和血红蛋白比较,差异均无统计学意义(均P>0.05)。子痫前期组收缩压、舒张压、外周血LDH、24-hUPro水平和脐动脉血流相关参数(S/D、RI和PI)均高于健康组(均P<0.05)。外周血LDH、24-hUPro水平和脐动脉血流相关参数(S/D、RI和PI)及联合检测预测子痫前期的曲线下面积(area under the curve,AUC)均>0.70,预测效能较好,且以联合最佳。根据ROC曲线获得外周血LDH,24-hUPro水平和脐动脉血流相关参数(S/D、RI和PI)的截断值分别为239.16 U/L、0.26 g、2.04、0.49和0.67。子痫前期组不良母婴结局发生率高于健康组(P<0.05)。子痫前期组终止妊娠时间早于健康组,新生儿体重、Apgar评分低于健康组(均P<0.05)。子痫前期组外周血LDH、24-hUPro水平和脐动脉血流相关参数与新生儿体重和Apgar评分均呈负相关关系(均P<0.05),与终止妊娠时间均无明显相关性(均P>0.05)。结论:子痫前期产妇外周血LDH、尿蛋白水平和脐动脉血流相关参数均有异常升高,临床可通过对其联合检测预测子痫前期的发生风险,且与母婴结局具有一定的相关性。此外,扩大样本量、延长观察时间继续观察新生儿后生长发育情况,进一步验证上述指标对新生儿远期生长发育的影响将会成为下一步的研究重点和方向。

Objective:Lactate dehydrogenase(LDH)is an important oxidoreductase in the body,primarily involved in the glycolytic process,converting pyruvate to lactate,and is abnormally expressed under hypoxic and oxidative stress environments.The level of 24-hour urinary protein(24-hUPro)reflects renal injury,microvascular injury,and glomerular filtration capacity during the progression of preeclampsia.Systemic arteriolar spasms,a characteristic clinical manifestation of preeclampsia,lead to insufficient remodeling of the uterine spiral arteries and reduced local perfusion,which is reflected in changes in umbilical artery blood flow parameters.These parameters are important to evaluate fetal development during the third trimester of pregnancy.As one of the most severe complications,preeclampsia poses significant risks to maternal safety and neonatal prognosis.This study aims to analyze the relationship between peripheral LDH,24-hUPro,umbilical artery blood flow parameters,and their association with preeclampsia and neonatal prognosis.Methods:A total of 72 pregnant women diagnosed with preeclampsia in the third trimester of pregnancy from January 2019 to January 2023 at Huangshan People’s Hospital were selected as the study group,with 72 healthy pregnant women as controls.General information was collected,and comparisons were made between the preeclampsia and healthy groups regarding peripheral blood LDH,24-hUPro levels,and umbilical artery blood flow parameters[systolic blood flow velocity/end-diastolic blood flow velocity(S/D),resistance index(RI),pulsatility index(PI)],along with maternal and neonatal outcomes.Receiver operator characteristic(ROC)curves were used to analyze the predictive efficacy of these indicators for preeclampsia.Correlation analysis was conducted between LDH,24-hUPro levels,umbilical artery blood flow parameters(S/D,RI,PI),termination of pregnancy time,neonatal weight,and Apgar scores in the preeclampsia group.Results:There were no significant differences between the preeclampsia and healthy groups in terms of maternal age,pre-pregnancy BMI,primiparae status,abortion history,and hemoglobin levels(all P>0.05).The preeclampsia group had higher systolic and diastolic blood pressure,peripheral blood LDH,24-hUPro levels,and umbilical artery blood flow parameters(S/D,RI,PI)than the healthy group(all P<0.05).The area under the curve(AUC)for predicting preeclampsia using peripheral blood LDH,24-hUPro,and umbilical artery blood flow parameters(S/D,RI,PI),both individually and combined,was>0.70,with the combined detection showing the best predictive performance.The ROC curve-derived cut-off values for peripheral blood LDH,24-hUPro,and umbilical artery blood flow parameters(S/D,RI,PI)were 239.16 U/L,0.26 g,2.04,0.49 and 0.67,respectively.The incidence of adverse maternal and neonatal outcomes was higher in the preeclampsia group(P<0.05).The preeclampsia group had earlier pregnancy termination time,lower neonatal weight,and lower Apgar scores compared to the healthy group(all P<0.05).Peripheral blood LDH,24-hUPro levels,and umbilical artery blood flow parameters in the preeclampsia group negatively correlated with neonatal weight and Apgar scores in the(all P<0.05),but not with pregnancy termination time(all P>0.05).Conclusion:Peripheral blood LDH,24-hUPro levels,and umbilical artery blood flow parameters are all abnormally elevated in pregnant women with preeclampsia.Clinically,combined detection of these indicators can predict the risk of preeclampsia and correlate with maternal and neonatal outcomes.In addition,expanding the sample size and extending the observation period to continue monitoring the growth and development of neonates will be the focus and direction of future research to further validate the impact of these indicators on the long-term growth and development of neonates.