早发型和晚发型重度子痫前期的异常补体激活

Dysregulated complement activation in early-onset severe preeclampsia and late-onset severe preeclampsia

目的探讨早发型和晚发型重度子痫前期中的补体经典和旁路途径异常激活。方法选取2013年7月-2014年11月在北京大学第一医院妇产科住院分娩的早发型重度子痫前期（severe preeclampsia,sPE）患者30例（早发sPE组）和晚发型重度子痫前期患者30例（晚发sPE组）为研究组,孕周匹配的正常妊娠孕妇为早、晚发型重度子痫前期的对照组（各30例）。采用酶联免疫法（ELISA）检测孕妇血浆补体C1q、C4d、C3a、Bb及膜攻击复合物（MAC）水平。结果①晚发sPE组C1q、C4d、C3a和MAC水平分别为118.25μg/ml（84.78-161.00μg/ml）、10.77μg/ml（3.66-22.32μg/ml）、4 018.80μg/ml（948.98-10 406.13μg/ml）和293.94ng/ml（205.45-351.38ng/ml）;晚发对照组各补体水平分别为92.06μg/ml（78.33-107.73μg/ml）、5.12μg/ml（2.80-9.34μg/ml）、34.80μg/ml（26.41-53.02μg/ml）和119.59ng/ml（50.97-200.09ng/ml）。两组各指标比较,差异有统计学意义（P均〈0.05）。②早发sPE组Bb、C3a和MAC水平分别为0.70μg/ml（0.57-0.77μg/ml）、872.66μg/ml（223.83-8 837.00μg/ml）和325.56ng/ml（231.95-442.23ng/ml）;早发对照组各补体水平分别为0.41μg/ml（0.40-0.50μg/ml）、38.63μg/ml（28.98-48.85μg/ml）和101.75ng/ml（97.86-140.48ng/ml）。两组各指标比较,差异有统计学意义（P均〈0.05）。结论补体系统异常激活与重度子痫前期发病有关,其中补体经典途径可能更多参与晚发型重度子痫前期的发病,早发型重度子痫前期的发病可能与补体旁路途径的激活有关。

Objective To investigate the activation of complement system in early-onset severe preeclampsia（EOSPE）and late-onset severe preeclampsia（LOSPE）.Methods 30 EOSPE patients,30 LOSPE patients,30 EOSPE controls and 30 LOSPE controls were involved in this case-control study.Circulating levels of C1 q,C4d,Bb,C3 a,and MAC were determined with ELISA.Results ① The circulating levels of C1 q,C4d,C3 a,MAC in LOSPE plasma were 118.25μg/ml（84.78-161.00μg/ml）,10.77μg/ml（3.66-22.32μg/ml）,4 018.80μg/ml（948.98-10 406.13μg/ml）and 293.94ng/ml（205.45-351.38ng/ml）;which in LOSPE controls were 92.06μg/ml（78.33-107.73μg/ml）,5.12μg/ml（2.80-9.34μg/ml）,34.80μg/ml（26.41-53.02μg/ml）and 119.59ng/ml（50.97-200.09ng/ml）.The concentrations of C1 q,C4d,C3 a,MAC in LOSPE plasma were significantly higher than which in LOSPE controls（P〈0.05）.② The circulating levels of Bb,C3 a,MAC in EOSPE plasma were 0.70μg/ml（0.57-0.77μg/ml）,872.66μg/ml（223.83-8 837.00μg/ml）and 325.56ng/ml（231.95-442.23ng/ml）;which in EOSPE controls were 0.41μg/ml（0.40-0.50μg/ml）,38.63μg/ml（28.98-48.85μg/ml）,and 101.75ng/ml（97.86-140.48ng/ml）.The concentrations of Bb,C3 aand MAC were significantly increased for the LOSPE as compared with controls（P〈0.05）.Conclusions The increase of activation of the complement system is closely related to severe preeclampsia.The excessive activation of classic pathway may be an important role in LOSPE developed,while overactive alternative pathway is related to EOSPE.