胎盘生长因子与晚发型子痫前期患者超声血流参数的关系及对妊娠结局的影响

Relationship between placental growth factor and ultrasonic blood flow parameters in patients with late-onset preeclampsia and its effect on pregnancy outcome

目的 探究血清胎盘生长因子(PLGF)水平与晚发型子痫前期(LOPE)患者超声血流参数及妊娠结局的关系。方法 选择152例LOPE患者作为研究对象,根据血清PLGF水平,按照四分位法将患者分为P1组(<12.00 ng/L)、P2组(12.00~56.73 ng/L)、P3组(>56.73~89.41 ng/L)和P4组(>89.41 ng/L),每组38例。比较4组患者的临床资料,子宫动脉搏动指数(PI)、阻力指数(RI)、收缩期峰值流速(S)/舒张末期流速(D),不良妊娠结局情况;线性回归分析PLGF水平与患者临床特征的关系;分层交互分析LOPE病情程度对PLGF与超声血流参数之间关系的影响;多因素广义线性混合效应模型分析PLGF水平与LOPE患者不良妊娠结局的关系。结果 舒张压、24 h尿蛋白、PI、RI、S/D随着PLGF水平升高均依次降低(P<0.05),P1组重度LOPE比例、收缩压明显高于其余组(P<0.05),上述指标均是PLGF水平的影响因素(P<0.05);分层交互检验分析结果显示,LOPE病情程度不会影响PLGF与超声血流参数间的关系;不同PLGF水平患者间HELLP综合征、胎儿生长受限、胎儿窘迫、早产、新生儿窒息发生率比较差异有统计学意义(P<0.05),P1组早产发生率均高于其余组,其余不良妊娠结局情况均高于P3组和P4组;校正混杂协变量前后,PLGF水平与不良妊娠结局均存在统计学关联(P<0.05)。结论 血清PLGF水平影响LOPE患者子宫动脉血流参数及不良妊娠结局。

Objective To explore the relationship between the serum level of placental growth factor(PLGF)and ultrasonic blood flow parameters and pregnancy outcome in patients with late-onset preeclampsia(LOPE).Methods A total of 152 patients with LOPE were selected and divided into the P1(<12.00 ng/L)group,the P2(12.00-56.73 ng/L)group,the P3(>56.73-89.41 ng/L)group and the P4(>89.41 ng/L)group according to serum level of PLGF.There were 38 cases in each group.The clinical data,uterine artery pulsatility index(PI),resistance index(RI),peak systolic velocity(S)/end-diastolic velocity(D)and adverse pregnancy outcome were compared between the four groups.The relationship between PLGF level and clinical characteristics was analyzed by linear regression analysis.The influence of LOPE severity on the relationship between PLGF and ultrasonic blood flow parameters was analyzed by stratified interactive analysis.Multivariate generalized linear mixed effect model was used to analyze the relationship between PLGF level and adverse pregnancy outcome in patients with LOPE.Results The diastolic blood pressure,24 h urinary protein,PI,RI and S/D decreased significantly with the increase of PLGF level(P<0.05).The proportion of severe LOPE and systolic blood pressure were significantly higher in the P1 group than those of the other groups(P<0.05),and the above indexes were influencing factors of the level of PLGF(P<0.05).The results of stratified interactive test showed that the LOPE severity did not affect the relationship between PLGF and ultrasonic blood flow parameters.There were significant differences in the incidence of HELLP syndrome,fetal growth restriction,fetal distress,premature delivery and neonatal asphyxia between patients with different PLGF levels(P<0.05).The incidence of preterm delivery was higher in the P1 group than that in the other groups,and the other adverse pregnancy outcomes were higher in the P3 group and P4 group.Conclusion Serum PLGF levels affect uterine artery blood flow parameters and adverse pregnancy outcome in patients with LOPE.