期待治疗对早发型重度子痫前期合并胎儿生长受限患者血清可溶性Endoglin水平的影响

Impact of expectant treatment in patients with early onset severe preeclampsia and FGR on serum soluble endoglin level

目的探讨期待治疗对早发型重度子痫前期(EOSPE)合并胎儿生长受限(FGR)患者疗效和血清可溶性Endoglin(s Eng)水平的影响。方法选取2012年1月~2015年6月于解放军海军总医院行期待治疗的EOSPE合并FGR患者68例为研究组,另选取30例同期同孕周健康妊娠妇女为对照组。采用酶联免疫吸附法检测对照组入选时和研究组期待治疗前、治疗1 d和3 d的血清s Eng水平,统计研究组妊娠结局,比较不良妊娠结局孕产妇和良好妊娠结局孕产妇期待治疗期间的血清s Eng水平,并采用Spearman无条件相关分析法分析EOSPE合并FGR患者血清s Eng水平与其妊娠结局的关系,ROC曲线分析EOSPE合并FGR患者血清s Eng水平预测其妊娠结局的价值。结果研究组治疗前的血清s Eng水平为(5.88±0.59)ng/ml,高于对照组的(1.21±0.24)ng/ml及研究组治疗1 d和3 d的(3.96±0.39)ng/ml和(3.18±0.35)ng/ml(P<0.05)。研究组胎儿宫内窘迫、新生儿窒息、新生儿死亡、新生儿肺透明膜病、胎死宫内等不良妊娠结局总发生率为67.65%,且出现不良妊娠结局孕产妇期待治疗前后的血清s Eng水平均较良好妊娠结局孕产妇高(P<0.05)。Spearman无条件相关分析结果显示,EOSPE合并FGR患者血清s Eng水平与其不良妊娠结局发生率呈正相关(r=0.768,P<0.05)。结论 EOSPE合并FGR患者血清s Eng水平较高,期待治疗可降低其血清s Eng水平,而其血清s Eng水平与其妊娠结局密切相关且对妊娠结局的预测价值良好,s Eng可作为EOSPE合并FGR患者妊娠结局预测的参考指标。

Objective To explore the curative effect and impact of on serum soluble Endoglin level of expectant treatment in patients with early onset severe preeclampsia（EOSPE） and fetal growth restriction（FGR）. Methods 68 cases of EOSPE and FGR patients who had expectant treatment in our hospital from January 2012 to June 2015 were selected as the study group,and the other selected 30 healthy pregnant women in the same gestational weeks were selected as the control group. Enzyme-linked immunosorbent method was applied to detect the serum s Eng levels of control group when selected and the study group before treatment and at 1d and 3d after treatment. A pregnancy outcome of the study group was statistically calculated and the serum s Eng levels of the EOSPE and FGR women with adverse pregnancy outcome and normal pregnancy outcomes during treatment were compared. Spearman unconditionally correlation analysis was applied in analyzing the relationship between serum s Eng level of EOSPE and FGR patients with the pregnancy outcome,and ROC curve was applied in analyzing the value of serum s Eng levels predicting pregnancy outcome of patients with EOSPE and FGR. Results Serum s Eng levels of the study group before the treatment was（5.88 ± 0.59） ng/m L,which was higher than the（1.21 ± 0.24） ng/m L of control group and the（3.96 ± 0.39） ng/m L and（3.18 ± 0.35） ng/m L of the study group after treated with 1d and 3d（P〈0.05）. The incidence of adverse pregnancy outcomes, including fetal distress,neonatal asphyxia,neonatal death,neonatal pulmonary hyaline membrane disease and fetal intrauterine were 67.65%. And serum s Eng level of the patients with adverse pregnancy outcomes before and after treatment were relatively higher than that of the patients with normal pregnancy outcomes（P〈0.05）. Spearman unconditionally correlation analysis results showed that serum s Eng level of the patients with EOSPE and FGR was positively correlated with the adverse pregnancy outcomes incidence of（r = 0.768,P〈0.05）. Conclusion Serum s Eng level of patients with EOSPE and FGR is high and expectant treatment can reduce the serum s Eng level. The serum s Eng level is closely related to the pregnancy outcome and the value of serum s Eng level predicting the pregnancy outcome is fine. This can be related to s Eng as angiogenesis inhibiting factor can cause vascular disorders associated with endothelial dysfunction,therefore,it is possible that s Eng as reference index for the prediction of pregnancy outcome of patients with EOSPE merger FGR.