子痫前期与妊娠合并慢性肾脏病孕妇血清免疫球蛋白、2微球蛋白、转铁蛋白水平及sF1t-1/PLGF差异研究

Study on the differences of serum immunoglobulin,β2 microglobulin,transferrin and sF1t-1/PLGF levels between preeclampsia and pregnant women with chronic kidney disease

目的探讨合并慢性肾脏病孕妇和子痫前期孕妇的β2微球蛋白、血清免疫球蛋白,转铁蛋白和水平差异。方法选取120例2018年6月至2019年6月期间桂东人民医院接收的孕妇,根据孕妇情况分为三组,即子痫前期(PE组)(50例)、肾脏病组(38例)和对照组(32例),所有孕妇检测β2微球蛋白、血清免疫球蛋白(immunoglobulin,Ig)(IgM、IgA、IgG)、转铁蛋白以及和sFlt-1和PLGF水平,计算sFlt-1/PLGF比值。结果三组孕妇血清IgA水平无明显差异(P>0.05);PE组与肾脏病组IgG水平及IgM较对照组明显降低(P值均<0.05),其中肾脏病组较PE组明显降低(P<0.05);三组孕妇血清β2微球蛋白水平比较存在明显差异,其中肾脏组孕妇较PE组及对照组明显升高(P值均<0.05);三组孕妇血清转铁蛋白水平比较也存在明显差异,肾脏病组较PE组、对照组明显降低(P值均<0.05),而PE组与对照组相比无明显差异(P>0.05);三组血清sFlt-1、PLGF水平以及sFlt-1/PLGF比值存在明显差异(P<0.05),其中PE组血清sFlt-1与sFlt-1/PLGF比值较肾脏病组与对照组明显升高,而PLGF水平降低(P<0.05);各指标相关性分析显示,PE组孕妇血压与转铁蛋白、β2微球蛋白水平、血清IgG、IgM无相关性(r=0.125、0.052、0.125、0.221,P值均>0.05);其24 h尿蛋白定量与转铁蛋白水平呈负相关(r=-0.441,P<0.05),与β2微球蛋白水平呈正相关(r=0.556,P<0.05),与IgM、IgM呈负相关(r=-0.425、-0.418,P值均<0.05);其分娩孕周与转铁蛋白水平呈正相关(r=0.415,P<0.05),与β2微球蛋白呈负相关(r=-0.433,P<0.05),与IgG、IgM无相关性(r=0.165,0.152,P<0.05);与血清sFlt-1及sFlt-1/PLGF比值呈正相关(r=0.665、0.796,P值均<0.05);与PLGF水平呈负相关(r=0.452,P<0.05);肾脏病组:孕妇血压与血清β2微球蛋白呈相关(r舒张压=0.556,r收缩压=0.592,P值均<0.05),与转铁蛋白与IgM、IgG均无相关性(r=0.127、0.114、0.121,P值均<0.05);24 h尿蛋白定量与IgM呈负相关(r=-0.524,P<0.05),与β2微球蛋白呈正相关(r=0.567,P<0.05);与转铁蛋白水平无相关性(r=0.254,P>0.05);分娩孕周与转铁蛋白呈正相关(r=0.417,P<0.05),与β2微球蛋白水平呈负相关(r=0.573,P<0.05),与IgG、IgM无相关性(r=0.246,0.235,P值均<0.05);与血清sFlt-1及sFlt-1/PLGF比值呈负相关(r=0.458、0.689,P值均<0.05);与PLGF水平呈正相关(r=0.431,P<0.05)。结论子痫前期孕妇与妊娠合并慢性肾脏孕妇的转铁蛋白、β2微球免疫蛋白及IgM、IgG、sFlt-1、PLGF水平均差异有统计学意义,特别是sFlt-1/PLGF比值可为二者的鉴别诊断提供依据。

Objective To investigate the difference of serum levels ofβ2 microglobulin,immunoglobulin,transferrin and sFlt-1/PLGF between pregnant women with chronic kidney disease and preeclampsia.Methods A total of 120 pregnant women received in Guidong People’s Hospital hospital from June 2018 to June 2019 were divided into three groups according to their pregnant conditions,PE group(50 cases),nephropathy group(38 cases)and control group(32 cases).The levels ofβ2-microglobulin,serum immunoglobulin(IgM,IgA,IgG),transferrin,soluble vascular endothelial growth factor receptor-1(sFlt-1)and placental growth factor(PLGF)were detected in all pregnant women,and the ratio of sFlt-1/PlGF was calculated.Results There was no significant difference in serum IgA level among the three groups(P>0.05);The levels of IgG and IgM in PE group and kidney disease group were significantly lower than those in control group(P<0.05),while those in renal disease group were significantly lower than those in PE group(P<0.05);There was significant difference in serumβ2-microglobulin levels among the three groups(P<0.05),and the level of serumβ2-microglobulin in renal group was significantly higher than that in PE group and control group(P<0.05);The level of serum transferrin in the three groups was also significantly different(P<0.05).The level of serum transferrin in renal disease group was significantly lower than that in PE group and control group(P<0.05),but there was no significant difference between PE group and control group(P>0.05);The levels of sFlt-1,PLGF and the ratio of sFlt-1/PlGF were significantly different among the three groups(P<0.05).The ratio of sFlt-1 and sFlt-1/PlGF in PE group was significantly higher than that in kidney disease group and control group,and PlGF level was decreased(P<0.05);In PE group,there was no correlation between blood pressure and transferrin,β2-microglobulin,serum IgG and IgM(r=0.125,0.052,0.125,0.221,all P values>0.05);The 24 h urinary protein was negatively correlated with transferrin(r=-0.441,P<0.05),positively correlated with microglobulin(r=0.556,P<0.05),and negatively correlated with IgM and IgM(r=-0.425,-0.418,all P values<0.05);The gestational weeks of delivery were positively correlated with transferrin(r=0.415,P<0.05),negatively correlated withβ2-microglobulin(r=-0.433,P<0.05),but not with IgG and IgM(r=0.165,0.152,all P values<0.05);Serum sFlt-1 and sFlt-1/PlGF ratio were positively correlated(r=0.665,0.796,both P values<0.05);In kidney disease group,blood pressure was correlated with serumβ2-microglobulin(rdiastolic blood pressure=0.556,rsystolic blood pressure=0.592,P<0.05),but not with transferrin,IgM and IgG(r=0.127,0.114,0.121,all P values<0.05);24 h urine protein was negatively correlated with IgM(r=-0.524,P<0.05),and positively correlated withβ2-microglobulin(r=0.567,P<0.05);There was no correlation with the level of post protein(r=0.254,P>0.05);The gestational weeks of delivery were positively correlated with transferrin(r=0.417,P<0.05),negatively correlated withβ2-microglobulin(r=0.573,P<0.05),but not with IgG and IgM(r=0.246,0.235,both P values<0.05).Serum sFlt-1 and sFlt-1/PlGF ratio were negatively correlated(r=0.458,0.689,both P values<0.05);There was a positive correlation between PlGF and PlGF(r=0.431,P<0.05).Conclusion The levels of transferrin,β2-microglobulin,IgM,IgG,sFlt-1 and PLGF are significantly different between PE and pregnant women with chronic kidney,especially the ratio of sFlt-1 to PLGF may provide a basis for their differential diagnosis of PE and chronic kidney.