孕中期检测血管紧张素转化酶对预测妊娠高血压综合征的意义

The Significance of Detecting ACE in Middle Trimester of Pregnancy to Predict PIH

目的研究妊娠妇女孕中期(孕16～20周)的血管紧张素转化酶(angiotensin converting enzyme,ACE)的水平检测对妊娠高血压综合征(简称妊高征)的临床意义。方法选取2016年于上海中医药大学附属第七人民医院定期产检的妊娠妇女158例,检测其孕中期(孕16～20周)血管紧张素转化酶、尿微量白蛋白、血脂、血糖、肾功能、血压、腹围等妊娠高血压综合征的相关因素的水平,并随访整个孕期以确定是否进展为妊高征。结果孕中期妊高征组的血清尿素氮(2.99±0.93mmol/L),视黄醇结合蛋白(retinol-binding protein, RBP;40. 02±11.37 mg/L),β_2微球蛋白(1. 22±0. 27mg/L),舒张压(72. 51±8.87mmHg)、血清ACE(42.64±16.01U/L)水平方面均显著高于对照组,P<0.05。logistic回归分析显示,孕中期收缩压、血清ACE水平及RBP水平均是妊高征的独立危险因素(P <0.05)。应用ROC曲线计算孕中期ACE对预测妊高症的切点为34.5U/L(灵敏度为71.11%,特异性为72.73%)。结论孕中期收缩压、血清ACE水平及RBP水平均是妊高征的独立危险因素(P <0. 05),检测孕中期血清ACE水平对妊高征的早期诊断及评价具有重要临床意义。

Objective To study the relationship between the changes of angiotensin converting enzyme （ACE） levels and the incidence of pregnancy-induced hypertension （PIH） in the second trimester （16-20 weeks） of pregnant women. Methods 158 second trimester pregnant （ 16-20 gestational weeks） women in 2016 from Seventh People＇ s Hospital of Shanghai University of Traditional Chinese Medicine who undertook regular antenatal examination were selected for the study. The vascular tension factors related to pregnancy-induced hypertension syndrome , including angiotensin converting enzyme, urinary albumin, blood lipids, blood glucose, and renal function were measured, and then follow-up of the pregnancy to determine whether there was a progress of hypertension in pregnancy. Results For the second trimester pregnancy-induced hypertension group, the serum urea nitrogen （2.99± 0.93 mmol/L）, retinol- binding protein （40.02 ± 11.37 mg/L）, β2-microglobulin（1.22 ±0.27mg/L）, Diastolic Blood pressure（72. 51 ± 8.87mmHg）, and serum ACE（42. 64 ± 16. 01U/L） levels were significantly higher than the control group, P 〈 0. 05. Logistic regression analysis showed that the serum ACE level, serum RBP level and Systolic blood pressureall were considered as independent risk factors of pregnancy-induced hypertension in the second trimester, P 〈 0.05. Using ROC curve to calculate the cut- off point of ACE in the second trimester of pregnancy, the predict PIH was 34.5U/L （sensitivity was 71.11%, specificity was 72.73 % ）. Conclusion The high serum ACE level in the second trimester of pregnancy is an important but independent risk factor for the development of PIH. Detecting the serum ACE levels in the second trimester of pregnancy has important clinical significance for the prevention, early diagnosis and evaluation of PIH.