早发型与晚发型重度子痫前期实验室检查结果及一般情况分析

Interpretation of laboratory test results in early and late onset severe preeclampsia

目的分析早发型与晚发型重度子痫前期（S－PE）实验室检查结果的差异，探讨其临床应用价值。方法收集山东大学附属省立医院2016年3至11月收治的S－PE患者108例，参照人民卫生出版社《妇产科学》（第7版）诊断标准，以妊娠34周为界分为早发型S－PE 64例（早发组）和晚发型S－PE 44例（晚发组）；选取正常妊娠妇女42名作为对照组，收集一般信息资料，并对Hb、PLT、纤维蛋白原（FIB）、D－二聚体、AST、ALT、尿素、肌酐、尿酸、CRP、尿蛋白等指标进行分组统计学分析，同时采用流式细胞术检测各组样本中辅助性T细胞1（Th1）、辅助性T细胞2（Th2）的比例并分析Th1 /Th2的比值，采用SPSS19.0统计软件对各指标进行F检验及统计学分析。结果早发组、晚发组和对照组之间孕前体重指数（29.55±4.49、30.66±5.13、26.62±3.17，F＝9.829，P〈0.05）、舒张压[（105.17±14.46）mmHg（1 mmHg＝0.133kPa）、（99.80±12.56）mmHg、（74.36±8.42）mmHg，F＝82.088，P〈0.05]、Hb[（123.22±14.38）g/L、（117.03±16.48）g/L、（112.62±11.24）g/L，F＝7.133，P〈0.05]、尿素[（6.56±2.36）mmol/L、（4.51±1.35）mmol/L、（3.04±0.87）mmol/L，F＝51.733，P〈0.05]、肌酐[（68.47±18.05）μmol/L、（61.37±14.37）μmol/L、（48.54±8.73）μmol/L，F＝23.737，P〈0.05] 、CRP[（7.68±8.76）mg/L、（5.88±6.03）mg/L、（3.56±2.41）mg/L，F＝4.735，P〈0.05]、尿蛋白[（3.66±0.76）g/L、（2.20±1.05）g/L、（0.19±0.40）g/L，F＝249.714，P〈0.05]差异有统计学意义。流式结果显示，早发组患者Th1比例（19.83±3.04）显著高于晚发组（14.49±2.79）和对照组（11.78±1.17），而Th2比例（1.02±0.12）明显低于晚发组（1.11±0.12）和对照组（1.56±0.11），差异有统计学意义（Th1：F＝135.110，P〈0.05；Th2：F＝293.687，P〈0.05）。结论实时监测S－PE患者肝肾功能、尤其是免疫功能等实验室检查指标，对评估早发型和晚发型S－PE病情及个性化治疗有指导意义，对保证母婴健康、改善母婴预后有很重要的临床价值。（中华检验医学杂志，2017, 40：180－185）

Objective To analyze the difference of laboratory test results between early-onset and late-onset severe preeelampsia and to investigate their clinical application values. Methods Totally 108 blood samples were collected from patients with severe preeclampsia who were diagnosed according to the Diagnostic Standard of Obstetrics and Gynecology（7th Edition） published by People＇s Medical Publishing House, in Shandong Provincial Hospital affiliated to Shandong University from March to November 2016, which consisted of 64 early-onset severe preeclampsia before 34 weeks gestation（ early onset group） and 44 late-onset severe preeclampsia after 34 weeks gestation （ late onset group ）. In addition, 42 women with normal pregnancies as the control group were selected. General clinical data were collected, and the blood sample was analyzed through detecting Hb, PLT, fibrinogen （ FIB）, D-dimer, AST, ALT, urea, creatinine （Cr）, uric acid, CRP, urine protein. The tested results were analyzed and compared. Flow cytometry was used to analyze the proportion of T helper 1 cells（ Thl ） and T helper 2 cells （Th2）, and the ratio of Thl/ Th2 was also calculated. All data and F test were performed by use of statistical software SPSS19. 0. Results The pre-pregnancy body mass index（29. 55 ± 4. 49, 30. 66 ± 5. 13, 26. 62 ±3. 17, F = 9. 829, P 〈 0. 05）, diastolic blood pressure [ （ 105.17 ±14. 46 ） mmHg （ 1 mmHg = 0. 133 kPa）, （ 99. 80 ± 12. 56 ） mmHg, （ 74. 36 ±8. 42 ） mmHg , F=82.088, P〈0.05], Hb[（123.22±14.38）g/L, （117.03 ±16.48）g/L, （112.62±11.24）g/L, F=7.133, P〈0.05], urea[（6.56±2.36）mmol/L, （4.51 ±1.35）mmol/L, （3.04 ± 0. 87 ）mmol,/L, F = 51. 733, P 〈 0. 05 ], Cr[ （68.47± 18.05 ） μmol/L, （61.37 ± 14. 37 ） μmol/ L, （48.54 ± 8.73 ） μmol/L, F = 23. 737, P 〈 0. 05 ], CRP [ （ 7.68±8.76 ） mg/L, （ 5.88 ± 6. 03 ） mg/L, （3.56±2.41）rag/L, F=4.735, P〈0.05], urine protein [ （ 3. 66 ± 0. 76 ） g/L , （2.20±1.05）g/L, （ 0. 19 ± 0.40 ） g/L, F = 249. 714, P 〈 0. 05 ] had a statistically significant difference among the early-onset, late-onset and control groups. The flow cytometry results demonstrated that the proportion of Thl in earlyonset group （ 19. 83 ± 3.04 ） was higher than that in both late-onset （ 14. 49 ± 2. 79 ） and control groups （ 11.78 ± 1.17 ）, on the contrary, the result of Th2 was much lower （ early-onset ： 1.02 ± 0. 12, late-onset ： 1.11 ± 0. 12, control： 1.56 ± 0. 11 ）, there was statistical significance among these three groups （Thl： F= 135.110,P 〈 0. 05 ;Th2 ： F = 293. 687, P 〈 0. 05 ）. Conclusions It＇ s necessary to real-time monitor the laboratory indicators, such as liver and kidney function, especially the immunologic function indicators for evaluating the disease of early-onset and late-onset severe preeelampsia and personal treatment, and for ensuring the health of mother and fetus and improving the prognostic of mother and fetus. （ Chin J Lab Med, 2017, 40： 180-185）