妊娠高血压综合征患者血清高分子量脂联素水平对二次妊娠子痫发生的影响

Effect of Serum High Molecular Weight Adiponectin on the Occurrence of Secondary Pregnancy with Eclampsia in Patients with Pregnancy-induced Hypertension

目的探讨妊娠高血压综合征患者血清高分子量脂联素水平对妊娠高血压综合征患者二次妊娠子痫发生的影响及其机制。方法选择2015年1月至2017年12月130例首次诊断为妊娠高血压综合征的患者进行研究,二次妊娠的中位间隔时间为28.5个月。分别测定血清高分子量脂联素和瘦素水平,计算胰岛素抵抗指数,血清炎症指标包括白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平,氧化应激指标包括甲基二醛(MDA)和氧化型低密度脂蛋白(ox-LDL)水平。检测胎盘组织中脂联素受体2和环氧合酶-2(COX-2)的表达水平。结果二次妊娠共发生子痫20例(15.38%),其中轻度妊高征2例,中度妊高征8例,重度妊高征10例,与无子痫患者相比差异有统计学意义(P﹤O.OOl)。重度妊高征患者血清高分子量脂联素水平明显低于轻、中度妊高征患者,轻度妊高征患者血清高分子量脂联素水平最高。重度妊高征患者瘦素水平显著高于轻度和中度妊高征患者,而轻度妊高征患者瘦素水平最低(P﹤O.05)。二次妊娠子痫患者高分子量脂联素水平显著低于无子痫患者,子痫患者瘦素水平显著升高。结论血清高分子量脂联素水平与妊高征患者二次妊娠子痫的发生密切相关,可能与影响胰岛素抵抗、炎症反应和氧化应激反应,增强胎盘中脂联素受体2和C0X-2蛋白表达有关。

Objective To investigate effects of serum high molecular weight(HMW)adiponectin on the occurrence of secondary pregnancy with eclampsia in patients with pregnancy一induced hypertension and its mechanism.Methods 130 patients who were first diagnosed as pregnancy一induced hypertension from Jan.2015 to Dec.2017 were selected for this study.The median interval of two pregnancies was 28.5 months.Serum HMW adiponectin and leptin levels were measured,insulin resistance index was calculated.Serum inflammatory markers included interleukin-6(IL-6)and tumor necrosis factor alpha(TNF-alpha)levels,oxidative stress indicators included methyl aldehyde(MDA)and oxidized low density lipoprotein(ox-LDL)level.The expression of adiponectin receptor 2 and cyclooxygenase-2(COX-2)in placental tissue was detected.Results There were 20 cases(15.38%)secondary pregnancy with eclampsia,including mild pregnancy-induced hypertension(2 cases),moderate pregnancy-induced hypertension(8 cases),and severe pregnancy一induced hypertension(10 cases).There was significant difference between sec・ondary pregnancy with eclampsia and those without eclampsia(P<0.001).Serum HMW adiponectin level in patients with severe pregnancy-induced hypertension was significantly lower than those in mild or moderate pregnancy-induced hypertension.Leptin levels in severe pregnancy一induced hypertension patients were significantly higher than those of mild and moderate pregnancy-induced hypertension patients,while leptin levels in mild pregnancy-induced hypertension patients were the lowest(P<0.05).The levels of HMW adiponectin in secondary pregnancy with eclampsia patients were significantly lower than those without eclampsia,and leptin levels in eclampsia patients were significantly higher.Conclusion The level of serum HMW adiponectin is closely related to the occurrence of secondary pregnancy eclampsia in pregnant women with pregnancy-induced hypertension.It may be related to insulin resistance,inflammatory reaction and oxidative stress reaction,and enhance the expression of adiponectin receptor 2 and COX-2 protein in placenta.