子痫前期孕妇血清胆碱酯酶、炎症因子的变化及意义

Changes and significance of serum cholinesterase and inflammatory cytokines in pregnant women with preeclampsia

目的探讨子痫前期与正常妊娠末期孕妇血清胆碱酯酶（CHE）、白细胞（WBC）、C-反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）的变化及临床意义。方法随机收集2012年6月~2014年6月住院孕妇共90例。其中30例正常妊娠妇女作为对照组,60例子痫前期患者作为子痫前期组（又分为轻度子痫前期组30例,重度子痫前期组30例）,再根据有无全身炎症反应综合征（SIRS）及肝功能损害分为有SIRS子痫前期组46例、无SIRS子痫前期组14例;有肝功能损害的子痫前期组15例和无肝功能损害的子痫前期组45例。记录第1天生命体征,同时检测血清CHE、血常规、CRP、TNF-α、肝肾功能和动脉血气。结果轻度子痫前期组、重度子痫前期组、子痫前期组SIRS发病率均高于对照组,差异有统计学意义（P〈0.05）,有SIRS子痫前期组较无SIRS子痫前期组孕妇WBC、CRP、TNF-α水平均升高,差异有统计学意义（P〈0.05）;轻度子痫前期组、重度子痫前期组、子痫前期组血清CHE水平低于正常对照组,差异有统计学意义（P〈0.05）;重度子痫前期组血清CHE水平低于轻度子痫前期组,差异有统计学意义（P〈0.05）;有SIRS子痫前期组较无SIRS子痫前期组孕妇血清CHE水平低,差异有统计学意义（P〈0.05）;有肝功能损害的子痫前期组较无肝功能损害的子痫前期组血清CHE水平低,差异有统计学意义（P〈0.05）。CHE与WBC呈负相关（r=-0.417,P〈0.05）,CHE与CRP呈负相关（r=-0.773,P〈0.05）,CHE与TNF-α呈负相关（r=-0.597,P〈0.05）。结论子痫前期孕妇血清CHE及炎症因子表达失衡可能与子痫前期的发病有关联,而且迷走神经活性下降与子痫病情相关。

Objective： To explore the changes and clinical significance of serum cholinesterase（ CHE）,white blood cell count（ WBC）,C- reactive protein（ CRP） and tumor necrosis factor- α（ TNF- α） levels in pregnant women with preeclampsia and normal late pregnant women. Methods： Ninety hospitalized pregnant women were randomly collected from June 2012 to June 2014,then they were divided into control group（ 30 normal pregnant women）,mild preeclampsia group（ 30 pregnant women）,and severe preeclampsia group（ 30 pregnant women）; the pregnant women with preeclampsia were divided into systemic inflammatory response syndrome（ SIRS） group（ 46 pregnant women） and non- SIRS group（ 14 pregnant women） according to combining with SIRS or not; the pregnant women with preeclampsia were divided into liver dysfunction group（ 15 pregnant women） and non- liver dysfunction group（ 45 pregnant women） according to combining with liver dysfunction or not. The vital signs were recorded on the first day,at the same time,serum CHE levels,routine blood test,CRP levels,TNF- α levels,liver and renal function,and arterial blood gas were detected in different groups. Results： The incidence rates of SIRS in mild preeclampsia group,severe preeclampsia group,and preeclampsia group were statistically significantly higher than those in control group（ P〈0. 05）,the levels of WBC,CRP,and TNF- α in SIRS group were statistically significantly higher than those in non-SIRS group（ P〈0. 05）; serum CHE levels in mild preeclampsia group,severe preeclampsia group,and preeclampsia group were statistically significantly lower than those in control group（ P〈0. 05）; serum CHE level in severe preeclampsia group was statistically significantly lower than that in mild preeclampsia group（ P〈0. 05）; serum CHE level in SIRS group was statistically significantly lower than that in non- SIRS group（ P〈0. 05）; serum CHE level in liver dysfunction group was statistically significantly lower than that in non- liver dysfunction group（ P〈0. 05）; serum CHE level was negatively correlated with WBC（ r =- 0. 417,P〈0. 05）,CRP（ r =- 0. 773,P〈0. 05）,and TNF- α（ r =- 0. 597,P〈0. 05） levels. Conclusion： Expression imbalance of serum CHE and inflammatory cytokines in pregnant women with preeclampsia may be correlated with onset of preeclampsia,the decrease of vagus nerve activity is associated with preeclampsia.