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可溶性fms样酪氨酸激酶1与胎盘生长因子比值与重度子痫前期孕产妇分娩后血压及降压药需求的相关性研究 被引量:3

Correlation of Antepartum sFlt-1/PLGF with Postpartum Blood Pressure Pattern and Antihypertensive Drugs Use in Severe Preeclampsia Pregnant Women
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摘要 背景胎盘分泌的可溶性fms样酪氨酸激酶1(sFlt-1)和胎盘生长因子(PLGF)等循环血管生成因子失衡可能导致内皮功能障碍,并可能在子痫前期(PE)的发生、发展中起关键作用。临床中观察到sFlt-1与PLGF比值(sFlt-1/PLGF)失衡的PE孕产妇临床症状及体征较重且可以作为重度子痫前期(sPE)的预测指标。研究证实sFlt-1能升高血压,而PLGF能降低血压。目的探讨sPE孕产妇分娩前sFlt-1/PLGF与分娩后0~3 d血压相关性,及其预测降压药需求的价值。方法选取2017年1月—2020年1月在六安市第二人民医院分娩的sPE孕产妇156例为sPE组,同时纳入正常分娩的健康孕产妇254例为对照组。根据年龄、妊娠前体质指数(BMI)、受教育程度、是否为初产妇、分娩前BMI进行倾向评分匹配,按照1∶1最近邻匹配法确定匹配关系,最终sPE组与对照组各纳入69例孕产妇。分娩前24~48 h测定sFlt-1、PLGF,计算sFlt-1/PLGF,分别在分娩后当天(T0)、分娩后1 d(T1)、分娩后2 d(T2)、分娩后3 d(T3)测量两组孕产妇血压。将降压药需求分为无、缓效降压药1~2次和缓效降压药≥3次或速效降压药≥1次。结果sPE组sFlt-1/PLGF高于对照组(P<0.05)。干预方法与时间在孕产妇分娩后最高SBP、DBP及分娩后最低SBP、DBP上存在交互作用(P<0.05),干预方法在孕产妇分娩后最高SBP、DBP及分娩后最低SBP、DBP上主效应显著(P<0.05),时间在孕产妇分娩后最高SBP、DBP及分娩后最低SBP、DBP上主效应显著(P<0.05);sPE组孕产妇T2及T3分娩后最低SBP高于T1,T3分娩后最低SBP高于T0(P<0.05);sPE组孕产妇T2及T3分娩后最低DBP高于T0及T1(P<0.05)。sPE孕产妇分娩前sFlt-1/PLGF与各时间点分娩后最高SBP、DBP呈正相关(P<0.05)。sPE孕产妇分娩前sFlt-1/PLGF与各时间点分娩后最低SBP、DBP呈正相关(P<0.05)。sPE组T0、T1、T2、T3缓效降压药≥3次或速效降压药≥1次所占比例分别为27.5%、33.3%、24.6%、21.7%。在T0、T1、T2、T3,全组中缓效降压药≥3次或速效降压药≥1次孕产妇的sFlt-1/PLGF分别高于对应时间点中无及缓效降压药1~2次孕产妇,缓效降压药1~2次孕产妇的sFlt-1/PLGF分别高于对应时间点中无孕产妇(P<0.05);在T0、T1、T2、T3,sPE组中缓效降压药≥3次或速效降压药≥1次孕产妇的sFlt-1/PLGF分别高于对应时间点中无及缓效降压药1~2次孕产妇,缓效降压药1~2次孕产妇的sFlt-1/PLGF分别高于对应时间点中无孕产妇(P<0.05)。在全组中,T0、T1、T2、T3 sFlt-1/PLGF预测缓效降压药≥3次或速效降压药≥1次的曲线下面积(AUC)分别为0.863、0.899、0.863、0.854,最佳截断值分别为90.23、93.65、81.39、70.85。在sPE组中,T0、T1、T2、T3 sFlt-1/PLGF预测缓效降压药≥3次或速效降压药≥1次的AUC分别为0.924、0.954、0.940、0.947,最佳截断值分别为254.44、265.84、242.51、237.93。结论sPE孕产妇分娩前sFlt-1/PLGF明显升高,且与分娩后血压呈正相关;分娩前sFlt-1/PLGF可预测sPE孕产妇分娩后降压药需求,并获得了其预测sPE孕产妇分娩后0~3 d降压药需求的最佳截断值,有助于sPE孕产妇分娩后血压的临床管理。 Background Imbalance of circulating angiogenic factors such as soluble fms-like tyrosine kinase 1(sFlt-1)and placental growth factor(PLGF)secreted by the placenta may lead to endothelial dysfunction and may play a key role in the occurrence and development of preeclampsia(PE).The imbalance of sFlt-1/PLGF has been clinically observed in pregnant women with severe symptoms and signs of PE,which may be used as a predictor for severe PE(sPE).New research confirms that sFlt-1 raises blood pressure while PLGF lowers it.Objective To explore the correlation between antepartum sFlt-1/PLGF and postpartum blood pressure(within three days after delivery)in sPE pregnant women,and its clinical value in predicting postpartum use of antihypertensive drugs.Methods Of the 156 sPE women and 254 normal women undergoing delivery in the Second People's Hospital of Liuan City from January 2017 to January 2020,69 sPE women(sPE group)and 69 normal women(control group)were enrolled finally at a ratio of 1∶1 with age,maternal BMI,education level,primiparas percentage,and maternal pre-delivery BMI matched using the K-NN algorithm.sFlt-1 and PLGF were measured at 24-48 hours before delivery,and sFlt-1/PLGF was calculated.Blood pressure was measured on the day of delivery(T0),1 day after delivery(T1),2 days after delivery(T2),and 3 days after delivery(T3),respectively.Postpartum use of antihypertensive drugs was classified into 3 categories:0,using extended-release antihypertensive drugs for 1 or 2 times,and using extended-release antihypertensive drugs at least 3 times or using immediate release antihypertensive drugs at least once.Results The sFlt-1/PLGF in the sPE group was higher than that in the control group(P<0.05).The prevalence of sPE and measurement time had an interaction on the highest and lowest postpartum SBP and DBP(P<0.05).The prevalence of sPE produced significant main effects on the highest and lowest postpartum SBP and DBP(P<0.05),and so did the measurement time(P<0.05).In the sPE group,the lowest postpartum SBP at T2 and T3 was higher than that at T1,and it at T3 was higher than at T0(P<0.05);the lowest postpartum DBP at T2 and T3 was higher than that at T0 and T1(P<0.05).The antepartum sFlt-1/PLGF was positively correlated with the highest postpartum SBP and DBP at each measurement time(P<0.05).And it was also positively correlated with the lowest postpartum SBP and DBP at each measurement time(P<0.05).The percentage of using extended-release antihypertensive drugs at least 3 times or using immediate release antihypertensive drugs at least once at T0,T1,T2 and T3 was 27.5%,33.3%,24.6%,and 21.7%,respectively.At T0,T1,T2 and T3,the sFlt-1/PLGF increased with the using frequency of extended-release or immediate release antihypertensive drugs in all participants,that is,it was lowest in those using no antihypertensive drugs,and became higher in those using extended-release antihypertensive drugs for 1-2 times,and even more higher in those using extended-release antihypertensive drugs for≥3 times or immediate release antihypertensive drugs≥1 time(P<0.05),as it did in the sPE group(P<0.05).For the prediction of using extendedrelease antihypertensive drugs at least 3 times or using immediate release antihypertensive drugs at least once at T0,T1,T2 and T3 in all the participants,the AUC of sFlt-1/PLGF was 0.863,0.899,0.863 and 0.854,respectively,when the optimal cutoff value was determined as 90.23,93.65,81.39,70.85,respectively.And for predicting that in the sPE group,the AUC of sFlt-1/PLGF was 0.924,0.954,0.940 and 0.947,respectively,when the optimal cutoff value was determined as 254.44,265.84,242.51,237.93,respectively.Conclusion Out study suggests that antepartum sFlt-1/PLGF was significantly increased in sPE pregnant women,and was positively correlated with postpartum blood pressure.Moreover,it may be used as a predictor of the postpartum use of antihypertensive drugs with the optimal cutoff value within three days after delivery were determined,which may help the clinical management of sPE pregnant women after delivery.
作者 郭丽 雷娟 李玲 GUO Li;LEI Juan;LI Ling(The Second People's Hospital of Liuan City,Liuan 237006,China)
出处 《实用心脑肺血管病杂志》 2020年第10期48-55,共8页 Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词 子痫 重度子痫前期 高血压 妊娠性 可溶性fms样酪氨酸激酶-1 胎盘生长因子 血压 降压药 Eclampsia Severe preeclampsia Hypertension,pregnancy Soluble fms-like tyrosine kinase-1 Placental growth factor Blood pressure Blood pressure medication
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