子痫前期患者血清瘦素、sFlt-1/PLGF、C-反应蛋白及IP-10关系的研究

Relation of serum leptin level to circulating CRP,IP-10 and sFlt-1/PlGF ratio in normal pregnancy and preeclampsia

目的探讨子痫前期患者血清瘦素、C-反应蛋白(C-reactive protein,CRP)、干扰素诱导蛋白10(inducible protein10,IP-10)、特异性受体可溶性络氨酸激酶受体1(soluble fms-like tyrosine kinase-1,sFlt-1)/血清胎盘生长因子(placental growth factor,PLGF)的关系。方法用ELISA检测3组血清中leptin水平法测定66例子痫前期孕妇、60例正常孕妇、58例健康非孕妇空腹血清瘦素水平及IP-10浓度,用酶联免疫吸附实验双抗体夹心法,分别检测血清PLGF、sFlt-1水平;血清CRP浓度的测定采用TBA-40FR型全自动生化分析仪免疫比浊法进行测定。结果子痫前期患者血清瘦素浓度显著高于健康孕妇;健康孕妇血清中瘦素水平与血清CRP浓度、血清IP-10浓度有正相关关系(相关系数r1、r2分别为0.34、0.40),在子痫前期患者,血清瘦素水平和IP-10呈正相关关系(r=0.64);瘦素水平升高及sFlt-1/PlGF比值升高与病情严重程度呈正相关关系(r=0.70、0.72)。结论子痫前期血清瘦素水平高于正常孕妇,无论正常孕妇还是子痫前期孕妇其血清瘦素浓度升高与IP-10密切相关,提示:血清瘦素升高通过IP-10的抗血管生成作用导致了血管内皮功能障碍,而且,瘦素浓度升高及sFlt-1/PlGF比值升高增加了子痫前期发生的危险,与病情严重程度呈正相关,有可能成为监测子痫前期病情变化及预后的指标。

Objective To investigate the relationship of leptin level to CRP,IP - 10 and sFlt - 1/P1GF ratio in preeclamptic patients. Methods Sixty - six preeclamptic patients,60 healthy pregnant women and 58 healthy non - pregnant women were involved in this case - control study. Levels of leptin and IP - 10 in maternal sera were assessed by ELISA. Serum C -reactive protein （CRP） concentrations were measured by an autoanalyzer. Serum total soluble fms- like tyrosine kinase - 1 （sFh - 1 ） and biologically active placental growth factor （P1GF） levels were determined by electrochemiluminescence immunoassay. Results Serum leptin levels were significantly higher in preeclamptic patients than that in healthy pregnant women. Additionally, preeclamptic patients had significantly higher leptin levels as compared to healthy pregnant women. In healthy pregnant women, both IP - 10 and serum CRP concentrations showed significant positive linear association with the leptin levels （ rI = 0. 34, r2 = 0. 40 ）. In preeclamptic patients, a significant positive correlation was observed between serum concentrations of leptin and IP - 10（r =0. 64）. Furthermore,elevated serum leptin level and sFh - 1/P1GF ratio had an additive （joint） effect in the risk of preeclampsia（r = 0. 70,0.72） ,as shown by the substantially higher odds ratios of their combination than of either alone. Conclusion Increased serum levels of leptin were related to those of interferon - γ - inducible protein （IP） -10 both in normal pregnancy and preeclampsia, suggesting that circulating leptin might contribute to the development of endothelial dysfunction through the anti- angiogenic effect of IP- 10. Moreover,the combination of elevated serum leptin level and sFlt - 1/P1GF ratio was found to be additive for the risk of preeclampsia and to be positively correlated to the severity of illness, and may become an index to test the prognosis of preeclampsia patient.