妊娠高血压综合征患者血浆粘附分子水平的变化

Changes of Plasma Cell Adhesion Molecules in Pregnancy-Induced Hypertension syndrome

目的探讨细胞粘附分子在妊娠高血压综合征(PIH)的免疫学病因中所发挥的作用。方法PIH组和对照组各30例,采用双抗体夹心酶联免疫吸附法检测血浆可溶性血管细胞粘附分子(VCAM)、细胞间粘附分子(ICAM)、E-选择素、P-选择素、L-选择素水平的变化,并探讨其与血尿酸、血肌酐水平、血小板计数之间的相关性。结果与对照组相比,中、重度PIH患者血浆可溶性VCAM-1、E-选择素、P-选择素水平均明显升高(P<0.05),轻度PIH组均未见显著差异(P>0.05);PIH组血浆可溶性ICAM-1水平无明显升高(P>0.05);中、重度PIH组血浆可溶性VCAM-1、P-选择素水平较轻度PIH明显升高(P<0.05),而ICAM-1、L-选择素、E-选择素水平未见组间差异。与对照组相比,重度PIH患者血尿酸、血肌酐水平均明显升高,血小板计数明显降低(均P<0.05),轻、中度PIH组无明显改变(P>0. 05);重度PIH患者血浆可溶性VCAM-1、E-选择素、P-选择素水平与血尿酸、血肌酐呈正相关,而P-选择素水平与血小板计数呈明显负相关。结论血浆可溶性VCAM-1、E-选择素、P-选择素水平变化可作为确定终止妊娠时机的参考指标;VCAM-1、P-选择素水平变化可作为中度PIH的检测指标;P-选择素、E-选择素水平变化可能具有较血尿酸、血肌酐更敏感的代表疾病严重程度倾向的作用。

Objective To investigate the relationship between plasma adhesion molecules level and the pre-cently unclear etiology of pregnancy induced hypertension(PIH). Methods PIH group and control group were consisted of 30 cases respectively, women with previous history of underlying hypertension, diabetes, chronic renal disease, platelet disorder, infection were excluded from the study. Enzyme-linked immunosorbent assay was used to determine plasma levels of soluable VCAM-1, ICAM-1, E-selectin, P-selectin and L-selectin, also the relationship with blood uric acid, creatinine and platelet. Results Compared with control group, the plasma concentration of VCAM-1, E-selectin and P-selectin in middle and severe PIH women were higher (All P < 0.05) , that in mild PIH women had no significantely change(P > 0.05); The ICAM-1 level of every PIH sub-groups had no great difference(P > 0.05); the plasma concentrations of VCAM-1, P-selectin in middle and severe PIH women were higher than that in mild PIH (P < 0.05). However the plasma concentration of ICAM-1, L-selectin and E - selectin had no great different change among three sub-group PIH patients (P > 0.05) . Compared with control, the uric acid and creatinine in blood of the severe patients increased highly, the platelet was lower; the correlation coefficients of VCAM-1, E-selectin, P-selectin and uric acid, creatinine in sever PIH were positive, that of P-selectin and platelet counts in sever PIH were negative. Conclusion The plasma changes of VCAM-1, E-selectin, P-selectin can be used to be a marker to terminate pregnancy; the plasma levels of VCAM-1, P-selectin can be used to diagnose the middle PIH. The plasma E-selectin and P-selectin are more sensitive to show the severity of PIH than the levels of uric acid and creatinine.