脂联素与脐动脉超声血流指数预测重度子痫前期围产儿结局

Relationship between adiponectin combined with ultrasound blood flow index of the umbilical artery and ;perinatal outcome in women with severe preeclampsia

目的：探讨检测胎盘组织中脂联素的表达水平与观察脐动脉超声血流指数对重度子痫前期围产儿结局的预测作用。方法收集2014年2月至10月在郑州大学第三附属医院住院分娩的50例正常足月妊娠孕妇（对照组）和50例重度子痫前期患者（重度子痫前期组）的胎盘组织，采用实时荧光定量逆转录聚合酶链反应和免疫组织化学链霉菌抗生物素蛋白-过氧化物酶连结法检测2组胎盘组织中脂联素mRNA的相对表达量和蛋白定位、表达强度；同时应用彩色多普勒超声对2组孕妇进行胎儿脐血流动力学测定，并分析脂联素mRNA表达水平及脐动脉收缩期及舒张期血流比值（umbilical artery systolic/diastolic，UA-S/D）与围产儿结局的关系。采用两独立样本t检验、秩和检验或Spearman相关分析进行统计学处理。结果重度子痫前期组新生儿出生体重和胎盘重量低于对照组，身长短于对照组，UA-S/D、脐动脉搏动指数和脐动脉阻力指数均大于对照组（P值均＜0.05）。重度子痫前期组胎盘组织中脂联素蛋白的表达水平为（0.326±0.011），高于对照组的（0.116±0.011），差异有统计学意义（t=99.144，P=0.000）。重度子痫前期组胎盘组织中脂联素mRNA的表达水平为（4.18±1.80），高于对照组的（1.00±0.51），差异有统计学意义（t=11.985， P=0.000）。重度子痫前期组中UA-S/D与新生儿出生体重、发病孕周和分娩孕周均呈负相关（r值分别为－0.897、－0.469和－0.524，P值均＜0.01）；脂联素mRNA的相对表达量与新生儿出生体重、发病孕周和分娩孕周均呈负相关（r值分别为－0.580、－0.407和－0.449，P值均＜0.01），与孕妇体重指数和UA-S/D呈正相关（r值分别为0.261和0.788，P值均＜0.01）。结论重度子痫前期患者胎盘组织中脂联素mRNA表达水平和脐动脉血流指数均升高，并与围产儿不良结局有关。

Objective To investigate the relationship between adiponectin combined with the ultrasound blood flow index of the umbilical artery and perinatal outcome in women with severe preeclampsia. Methods Placental tissues were obtained from normal term pregnancies （control group, n=50） and severe preeclampsia patients （PE group, n=50） in Third Affiliated Hospital of Zhengzhou University from February 2014 to October 2014. The expression of adiponectin was examined using immunohistochemical methods and real-time polymerase chain reaction. The umbilical artery was measured by color Doppler, and the umbilical artery systolic/diastolic ratio （UA-S/D）, umbilical artery resistance index （UA-RI） and umbilical artery pulsatility index （UA-PI） were determined. The relationship between the expression of adiponectin in placental tissues, UA-S/D and perinatal outcome were analyzed. The data were analyzed using two dependent-sample t test, the log-rank test and Spearman correlation analysis. Results Compared with the control group, infants in the PE group had lower birth weight and placental weight, shorter height, and greater umbilical artery indices including UA-S/D, UA-RI and UA-PI （all P〈0.05）. The expression of adiponectin and its mRNA in placentae of the PE group was significantly higher than that of the control group （adiponectin： 0.326±0.011 vs. 0.116±0.011, t=99.144, P=0.000;mRNA：4.18±1.80 vs. 1.00±0.51, t=11.985, P=0.000）. UA-S/D had a negative correlation with birth weight, onset gestational age and gestational age at birth （r= - 0.897, - 0.469 and - 0.524, all P〈0.01）. The expression of adiponectin mRNA had a negative correlation with birth weight, onset gestational age, and gestational age at birth （r=-0.580,-0.407 and-0.449, all P〈0.01）. The expression level of adiponectin had positive correlations with body mass index of the mothers and the UA-S/D （r=0.261 and 0.788, both P〈0.01）. Conclusions The expression of adiponectin in placental tissues and blood flow index of the umbilical artery both increase in severe preeclampsia, and are associated with poor perinatal outcome.