硫酸镁联合拉贝洛尔对重度子痫前期患者血压、肾功能及胎盘相关血清指标的影响

Effect of magnesium sulfate combined with labetalol on blood pressure,renal function and placenta-related serum markers in patients with severe preeclampsia

目的分析重度子痫前期患者接受硫酸镁联合拉贝洛尔治疗后血压、肾功能及胎盘相关血清指标的变化情况。方法选取104例重度子痫前期患者作为研究对象,根据随机数字表法均分为对照组和研究组。对照组患者给予硫酸镁治疗,研究组在对照组治疗的基础上加用拉贝洛尔治疗,治疗5 d后比较2组患者的血压和脐动脉血流,测定血清胱抑素C(CysC)、一氧化氮(NO)、可溶性血管内皮生长因子受体1(sVEGFR1)和胎盘生长因子(PIGF)水平;并于胎盘娩出30 min内取胎盘组织块测定生成素(survivin)、X连锁凋亡抑制蛋白(XIAP)、胱氨酸蛋白酶-3(caspase-3)和胱氨酸蛋白酶-7(caspase-7)水平。结果治疗后,2组患者的收缩压、舒张压和心率均显著低于治疗前,且研究组均显著低于对照组(P<0.05);研究组患者24 h尿蛋白及血清CysC和sVEGFR1水平均显著低于对照组,血清NO和PIGF水平均显著高于对照组(P<0.05);研究组患者胎盘组织survivin和XIAP水平均显著高于对照组,caspase-3和caspase-9水平均显著低于对照组(P<0.05);研究组患者搏动指数(PI)和阻力指数(RI)均显著低于对照组,舒张末期血流速度及收缩期最大血流速度均显著高于对照组(P<0.05)。结论硫酸镁联合拉贝洛尔可明显改善重度子痫前期患者肾功能,降低血压及血管阻力,并减轻胎盘缺氧造成的凋亡,值得临床重视。

Objective To analyze the blood pressure,renal function and placenta-related serum markers in patients with severe preeclampsia after treating by magnesium sulfate combined with labetalol.Methods 104 cases of severe preeclampsia treated were selected as the research subjects.According to the random number table method,all the patients were divided into control group and study group.The patients in the control group were treated with magnesium sulfate.On the basis of the control group,the study group was treated with labetalol.5 d after treatment,the blood pressure and umbilical artery blood flow were compared between the 2 groups.The serum levels of cystatin C(CysC),nitric oxide(NO),soluble vascular endothelial growth factor receptor 1(sVEGFR1)and placental growth factor(PIGF)were measured.The levels of survivin,X-linked inhibitor of apoptosis(XIAP),cystine protease-3(caspase-3)and cystine protease-7(caspase-7)were measured within 30 min after placenta delivery.Results After treatment,the systolic blood pressure,diastolic blood pressure and heart rate of the 2 groups were significantly lower than those before treatment,and the study group was significantly lower than the control group(P<0.05);the 24 h urine protein and serum CysC and sVEGFR1 water in the study group were significantly lower than those in the control group,the serum NO and PIGF levels were significantly higher than those of the control group(P<0.05);the levels of survivin and XIAP in the placenta tissue of the study group were significantly higher than those of the control group,the levels of caspase-3 and caspase-9 were significantly lower than those of the control group(P<0.05);the pulse index(PI)and resistance index(RI)levels in the study group were significantly lower than those in the control group,the end diastolic velocity and systolic blood flow velocity were significantly higher in the control group than in the control group(P<0.05).Conclusion Magnesium sulfate combined with labetalol can significantly improve renal function,reduce blood pressure and vascular resistance in patients with severe preeclampsia,and reduce the apoptosis caused by placental hypoxia,which is worthy of clinical attention.