高敏C反应蛋白对早发型重度子痫前期孕妇围生儿病死率的预测价值研究

Predictive value of high-sensitivity C-reactive protein to perineonate mortality in early onset severe pre-eclampsia pregnant women

目的 探讨高敏C反应蛋白（hs-CRP）对早发型重度子痫前期（EOSPE）孕妇围生儿病死率的预测价值.方法 选取EOSPE孕妇75例（EOSPE组）,妊娠期高血压孕妇75例（对照组）,分别检测血清肿瘤坏死因子（TNF）-α、白细胞介素（IL）-2和hs-CRP水平.记录EOSPE组围生儿死亡情况,按照围生儿情况分为死亡亚组和存活亚组.结果 EOSPE组hs-CRP、TNF-α和IL-2明显高于对照组[（7.2±2.1）mg/L比（2.5±1.0）mg/L、（28.9±5.3）ng/L比（12.4±3.5）ng/L和（134.3±34.6）ng/L比（104.2±28.5）ng/L],差异有统计学意义（P〈0.05）.EOSPE组有18例围生儿死亡（死亡亚组）,57例围生儿存活（存活亚组）,死亡亚组hs-CRP明显高于存活亚组[（8.9±1.3）mg/L比（7.1±1.2）mg/L],差异有统计学意义（P〈0.05）,而两亚组TNF-α、IL-2比较差异无统计学意义（P〉0.05）.受试者工作特征曲线分析结果显示,hs-CRP预测EOSPE所致围生儿死亡的最佳阈值为7.98 mg/L,曲线下面积为0.779,95％CI为0.637～0.922,敏感度为0.83,特异度为0.68.结论 炎性反应参与EOSPE的病理生理过程,hs-CRP为预测EOSPE孕妇发生围生儿死亡的良好指标.

Objective To study the predictive value of high-sensitivity C-reactive protein （hs-CRP） to perineonate mortality in early onset severe pre-eclampsia （EOSPE） pregnant women. Methods Seventy-five pregnant women with EOSPE （EOSPE group） and 75 pregnant women with gestational hypertension （control group） were selected. The serum tumor necrosis factor （TNF）-α, interleukin （IL）-2 and hs-CRP levels were detected. The data of perineonate death in EOSPE group were recorded, then the pregnant women were divided into death subgroup and survival subgroup. Results The hs-CRP, TNF-αand IL-2 levels in EOSPE group were significantly higher than those in control group：（7.2 ± 2.1） mg/L vs. （2.5 ± 1.0） mg/L, （28.9 ± 5.3） ng/L vs. （12.4 ± 3.5） ng/L and （134.3 ± 34.6） ng/L vs. （104.2 ± 28.5） ng/L, and there were statistical differences （P〈0.05）. In EOSPE group, 18 perineonates died （death subgroup）, and 57 perineonates were survival （survival subgroup）. The hs-CRP in death subgroup was significantly higher than that in survival subgroup： （8.9 ± 1.3） mg/L vs. （7.1 ± 1.2） mg/L, and there was statistical difference （P〈0.05）. But there were no statistical differences in TNF-αand IL-2 between death subgroup and survival subgroup （P〉0.05）. Receiver operating characteristic curve analysis result showed that the best threshold of hs-CRP for predicting the perineonate mortality caused by EOSPE was 7.98 mg/L, and the area under the curve was 0.779 （95％CI 0.637 to 0.922）, with a sensitivity of 0.83 and a specificity of 0.68. Conclusions Inflammatory reaction is involved in the pathophysiological process of EOSPE, and hs-CRP is a good index to predict perineonate death in EOSPE pregnant women.