妊娠期高血压疾病患者血浆蛋白Z检测的临床意义

Clinical Significance of Plasma Protein Z Detection in Patients with Hypertensive Disorder Complicating Pregnancy

目的探讨妊娠期高血压疾病患者血浆蛋白质Z(PZ)水平检测的临床意义。方法用ELISA法测定30例妊娠期高血压、33例子痫前期(19例轻度、14例重度)和60例正常妊娠妇女血浆PZ水平,以正常妊娠妇女血浆PZ水平的第5百分位数值作为PZ缺乏的标准(≤1.21mg/L),采用秩和检验和单因素方差分析比较PZ在各组之间中位数水平和缺乏率的差异。结果妊娠期高血压组和正常妊娠组之间血浆PZ的中位数水平差异无统计学意义(2.04mg/L vs 1.80mg/L,P>0.05),子痫前期组血浆PZ的中位数水平(1.57mg/L)显著低于妊娠期高血压组和正常妊娠组(P<0.001);正常妊娠组PZ水平的第5百分位数值为1.21mg/L;血浆PZ缺乏率妊娠期高血压组(23.3%)和子痫前期组(45.5%)显著高于正常妊娠组(3.3%)[让步比(OR)8.83,95%CI 1.71-45.7,P=0.006;OR24.2,95%CI 5.0-115.8,P=0.000],妊娠期高血压组和子痫前期组PZ缺乏率差异无统计学意义(OR2.7,95%CI 0.9-8.1,P=0.057)。结论子痫前期患者血浆PZ中位数水平明显减低,而且妊娠期高血压疾病患者血浆PZ缺乏率显著高于正常妊娠患者。提示PZ缺乏可能是妊娠期高血压疾病存在的一个危险因素。

Objective To study the clinical significance of plasma protein Z（PZ） in patients with hypertensive disorder complicating pregnancy.Methods This cross-sectional study included normal pregnant women（n=60）,patients with gestational hypertension（n=30） and patients with pre-eclampsia（PE,n=33,19 mild PE and 14 server PE）.The concentrations of maternal plasma PZ were measured by an ELISA method.PZ deficiency was defined as maternal plasma concentrations ≤5 th percentile of the normal pregnancy group（≤1.21 mg /L）.Non-parametric statistics and 1-way analysis of variance method（ANOVA） were used for analysis.Results Patients with PE had a lower median plasma concentration of PZ than normal pregnant women（PE：median 1.57 mg /L,range 0.41-3.01 mg /L vs normal pregnancy：median 2.04 mg /L,range 0.64-3.60 mg /L;P〈0.0001）;The median PZ concentrations in patients with gestational hypertension（median 1.80 mg /L,range 0.71-3.51 mg /L） was not significantly different from normal pregnant women（P〉0.05）;Two women with normal pregnancies had a low PZ level（3.3%）,compared with 7 patients with gestational hypertension（23.3%） and 15 patients with PE（45.5%）.Compared with normal pregnancy,the frequency of decreased PZ was significantly higher in patients with gestational hypertension and in PE（Odds ratio [OR]8.83,95% CI 1.71-45.7,P =0.006 and OR 24.2,95% CI 5.0-115.8,P =0.000,respectively）,but no significantly difference was found between patients with gestational hypertension and PE（OR 2.7,95%CI 0.9-8.1,P= 0.057）.Conclusion Patients with PE is associated with a significantly lower median level of plasma PZ than normal pregnancy,and a high rate of PZ deficiency is observed in patients with hypertensive disorder complicating pregnancy.It suggested that the decreased PZ may be a risk factor of hypertensive disorder complicating pregnancy.