妊娠期高血压疾病患者视网膜中央动脉血流动力学超声评估及与病情的相关性研究

Ultrasonic evaluation of central retinal artery hemodynamics in patients with hypertensive disorder complicating pregnancy and the correlation with disease

目的:研究妊娠期高血压疾病患者视网膜中央动脉血流动力学特征与内皮损伤分子、滋养细胞凋亡分子的相关性。方法:选择2013年5月~2015年12月在我院产科分娩的45例健康孕妇、37例妊娠期高血压患者、24例子痫前期患者,分别纳入对照组、GH组、PE组,行视网膜中央动脉超声并测定收缩期峰值流速(PSV)、舒张末期流速(EDV)、阻力指数(RI),采集血清并测定白细胞介素-6(IL-6)、IL-17、IL-24、趋化因子配体10(CXCL10)、软骨糖蛋白40(YKL40)的含量,采集胎盘组织并测定Fas、Fas L、Bax、Caspase-3、Caspase-9、XIAP、Survivin、Livin的表达量。结果:GH组和PE组孕妇的视网膜中央动脉PSV、EDV以及胎盘中XIAP、Survivin、Livin表达量均显著低于对照组,视网膜中央动脉RI、血清中IL-6、IL-17、IL-24、CXCL10、YKL40含量以及胎盘中Fas、Fas L、Bax、Caspase-3、Caspase-9表达量显著高于对照组;PE组孕妇的视网膜中央动脉PSV、EDV以及胎盘中XIAP、Survivin、Livin表达量均显著低于GH组,视网膜中央动脉RI及血清中IL-6、IL-17、IL-24、CXCL10、YKL40含量以及胎盘中Fas、Fas L、Bax、Caspase-3、Caspase-9表达量显著高于GH组;血清中IL-6、IL-17、IL-24、CXCL10、YKL40含量以及胎盘中Fas、Fas L、Bax、Caspase-3、Caspase-9表达量与PSV、EDV呈负相关,与RI呈正相关;胎盘中XIAP、Survivin、Livin表达量与PSV、EDV呈正相关,与RI呈负相关。结论:妊娠期高血压疾病患者视网膜中央动脉的血流特征为血流阻力显著增加、血流量显著减少,以上血流特征与母体内皮损伤、滋养细胞凋亡有关。

Objective： To study the correlation between central retinal artery hemodynamic characteristics in patients with hypertensive disorder complicating pregnancy and endothelial injury molecules as well as trophoblast cell apoptosis molecules. Methods：A total of 45 healthy pregnant women,37 patients with gestational hypertension and 24 patients with preeclampsia who gave birth in Obstetrics Department of our hospital between May 2013 and December 2015 were selected and included in the control group,GH group and PE group respectively,central retinal artery ultrasonography was done to determine PSV,EDV and RI,serum was collected to determine IL-6,IL-17,IL-24,CXCL10 and YKL40 content,and placenta tissue was collected to determine Fas,FasL,Bax,Caspase-3,Caspase-9,XIAP,Survivin and Livin expression. Results： Central retinal artery PSV and EDV as well as XIAP,Survivin and Livin expression in placenta of GH group and PE group were significantly lower than those of control group while central retinal artery RI,serum IL-6,IL-17,IL-24,CXCL10 and YKL40 content as well as Fas,FasL,Bax,Caspase-3 and Caspase-9 expression in placenta were significantly higher than those of control group; central retinal artery PSV and EDV as well as XIAP,Survivin and Livin expression in placenta of PE group were significantly lower than those of GH group while central retinal artery RI,serum IL-6,IL-17,IL-24,CXCL10 and YKL40 content as well as Fas,FasL,Bax,Caspase-3 and Caspase-9 expression in placenta were significantly higher than those of GH group; serum IL-6,IL-17,IL-24,CXCL10 and YKL40 content as well as Fas,FasL,Bax,Caspase-3 and Caspase-9 expression in placenta were negatively correlated with PSV and EDV,and positively correlated with RI; XIAP,Survivin and Livin expression in placenta were positively correlated with PSV and EDV,and negatively correlated with RI. Conclusions： Central retinal artery blood flow characteristics in patients with hypertensive disorder complicating pregnancy are the significantly increased blood flow resistance and the significantly decreased blood flow volume,and the above blood flow characteristics are associated with maternal endothelial injury and trophoblast cell apoptosis.