妊娠高血压综合征患者病情严重程度与免疫、凝血功能的相关性分析

Analysis of the correlation between the severity of pregnancy-induced hypertension and immune and coagulation function

目的分析妊娠高血压综合征(PIH)病情严重程度与免疫、凝血功能的相关性。方法收集2013年6月—2018年6月湖北省妇幼保健院产科住院的PIH孕妇264例(PIH组)临床资料,根据其病情严重程度分为轻中度子痫前期(PE)亚组89例,重度PE亚组82例,子痫亚组93例;另选取同期40例正常晚期妊娠妇女为正常对照组。比较各组免疫功能指标(C3、C4、IgA、IgG、IgM)和凝血功能指标(Fib、PT、APTT)。结果与正常对照组比较,PIH组C3、C4、IgM、IgG、IgA、PT及APTT明显下降(t/P=4.542/<0.001、9.167/<0.001、5.352/<0.001、8.804/<0.001、2.490/0.013、14.831/<0.001、7.211/<0.001),而Fib含量则明显升高(t=13.199,P<0.001)。各亚组C3、C4、IgM、IgG、IgA的水平比较,子痫亚组<重度PE亚组<轻中度PE亚组(F/P=7.896/<0.001、6.643/<0.001、5.082/<0.023、8.090/<0.001、7.663/<0.001);Fib水平比较,轻中度PE亚组<重度PE亚组<子痫亚组(F/P=10.055/<0.001);PT、APTT水平比较,轻中度PE亚组>重度PE亚组>子痫亚组(F/P=11.324/<0.001、15.654/<0.001)。经Pearson线性相关分析,PIH患者病情严重程度与C3、IgG、IgM、APTT均存在一定的负相关关系(r/P=-0.338/<0.001、-0.435/<0.001、-0.298/<0.001、-0.387/<0.001),与Fib存在一定的正相关关系(r/P=0.498/<0.001),而与C4、IgA、PT并无显著相关性(P>0.05)。经多因素Logistic回归分析,IgG、Fib是影响PIH患者病情严重程度的危险因素(OR=1.377,P=0.022;OR=1.878,P=0.009)。结论免疫因子、凝血功能与PIH病情严重程度密切相关,及时检测PIH患者C3、C4、IgA、IgG、IgM和凝血功能,可及时发现并评估患者的病情。

Objective To analyze the correlation between the severity of pregnancy induced hyprtension( PIH) and immune and coagulation function. Methods The clinical data of 264 PIH pregnant women(PIH group) hospitalized in obstetrics Department of Hubei Maternal and Child Health Hospital from June 2013 to June 2018 were collected. According to the severity of the disease, they were divided into subgroup, mild to moderate preeclampsia(PE) subgroup, 89 severe PE subgroup and 93 eclampsia subgroup. Another 40 normal late pregnant women in the same period were selected as normal control group. The indexes of immune function(C3, C4, IgA, IgG, IgM) and coagulation function(Fib, PT, APTT) were compared among the groups. Results Compared with the normal control group, the C3, C4, IgM, IgG, IgA, PT and APTT in the PIH group were significantly decreased(t/P=4. 542/< 0. 001,t/P = 9. 167/< 0.001,t/P= 5. 352/<0.001,t/P=8.804/<0.001, t/P =2.490/0.013, t/P= 14.831/<0.001, t/P=7.211/<0. 001), and Fib content increased significantly(t= 13. 199,P < 0.001). Comparison of C3, C4, IgM, IgG, IgA levels, subeclampsia subgroup < severe PE subgroup < light to moderate PE subgroup( F/P = 7. 896/< 0. 001, F/P = 6. 643/< 0. 001, F/P = 5. 082/< 0. 023, F/P =8. 090/<0.001, F/P =7. 663/<0.001);Fib level comparison, mild to moderate PE subgroup < severe PE subgroup < eclampsia subgroup(F/P = 10.055/<0.001);PT, APTT levels were compared, mild to moderate PE subgroup > severe PE subgroup > eclampsia subgroup(F/P=11.324/<0. 001,F/P =15.654/<0.001). According to Pearson linear correlation analysis, there was a negative correlation between the severity of PIH and C3, IgG, IgM and APTT( r/P =-0. 338/<0.001<0.001, r/P=-0.435/<0.001, r/P =-0.298/<0.001, r/P =-0. 387/<0.001), there is a positive correlation with Fib(r/P=0.498/<0.001), but no significant correlation with C4, IgA, PT(P>0.05). After multivariate logistic regression analysis, IgG and Fib were the risk factors affecting the severity of PIH patients(OR = 1.377,P=0. 022;OR= 1.878,P =0. 009). Conclusion Immune factors and coagulation function are closely related to the severity of PIH. Timely detection of C3, C4, IgA, IgG, IgM and coagulation function in PIH patients can detect and evaluate the patient’s condition in time.