MMA对重度子痫前期患者剖宫产术后母体应激反应程度及胎盘内质网应激、细胞凋亡的影响

Effect of MMA on maternal stress reaction as well as placental endoplasmic reticulum stress and cell apoptosis in patients with severe preeclampsia after cesarean section

目的:研究预防性多模式镇痛(MMA)对重度子痫前期患者剖宫产术后母体应激反应程度及胎盘内质网应激、细胞凋亡的影响。方法:回顾性分析2014年5月~2016年10月期间在石家庄市妇幼保健院产科进行剖宫产的78例重度子痫前期患者,根据剖宫产术后镇痛方案不同分为MMA组和对照组。剖宫产术前及术后第1天、第3天时,测定血清中疼痛介质及应激激素的含量;剖宫产术后,测定胎盘中内质网应激分子的表达量。结果:术后第1天、第3天时,两组受试者母体血液循环中β内啡肽(β-EP)、SP、前列腺素E2(PGE2)、促肾上腺皮质激素(ACTH)、皮质醇(COR)、胰岛素(INS)、C-肽(CP)的含量均显著高于剖宫产术前,且MMA组患者母体血液循环中β-EP、SP、PGE2、ACTH、COR、INS、C-P的显著低于对照组;分娩后,MMA组胎盘中GRP78、GRP94、ERdj1、IRE1α、CHOP、Caspase-3的蛋白表达量显著低于对照组,XIAP、Survivin的蛋白表达量显著高于对照组,差异均有统计学意义(P<0.05)。结论:MMA对重度子痫前期患者剖宫产术后母体应激反应程度及胎盘内质网应激、细胞凋亡均具有显著抑制作用。

Objective：To study the effect of preventive multimodal analgesia（MMA）on maternal stress reaction as well as placental endoplasmic reticulum stress and cell apoptosis in patients with severe preeclampsia after cesarean section.Methods：78patients with severe preeclampsia who accepted cesarean section in Obstetrics Department of Shijiazhuang Maternal and Child Health Care Hospital between May 2014 and October 2016 were retrospectively analyzed and divided into MMA group and control group according to the different analgesia solutions after cesarean section.Before cesarean section as well as 1day and 3days after operation,serum levels of pain mediators and stress hormones were determined;after cesarean section,endoplasmic reticulum stress molecule expression levels in the placenta were determined.Results：1day and 3days after operation,β-EP,SP,PGE2,ACTH,COR,INS and C-P levels in maternal blood circulation of both groups of subjects were significantly higher than those before cesarean section,andβ-EP,SP,PGE2,ACTH,COR,INS and C-P levels in maternal blood circulation of MMA group were significantly lower than those of control group;after childbirth,GRP78,GRP94,ERdj1,IRE1α,CHOP and Caspase-3protein expression in placenta of MMA group were significantly lower than those of control group while XIAP and Survivin protein expression were significantly higher than those of control group.Conclusion：MMA has significant inhibitory effect on the maternal stress reaction as well as placental endoplasmic reticulum stress and cell apoptosis in patients with severe preeclampsia after cesarean section.