叶酸、维生素D辅助治疗对妊娠期高血压患者血管内皮功能及Th1/Th2细胞因子表达的影响

The effects of folic acid and vitamin D adjuvant therapy on vascular endothelial function and expression of Th1/Th2 cytokines in patients with hypertensive disorder complicating pregnancy

为探讨叶酸、维生素D辅助治疗对妊娠期高血压患者血管内皮功能及Th1/Th2细胞因子表达的影响,收集2017年5月至2018年6月于西北妇女儿童医院产二科就诊的妊娠期高血压患者92例,按随机数字表法分为对照组(40例)与观察组(52例)。对照组采用维生素D治疗,观察组加用叶酸联合治疗。采用硝酸还原酶法检测血浆中一氧化氮(NO)水平;采用放射免疫法检测血浆中内皮素1(endothelin 1,ET-1)水平;采用ELISA法检测血浆中五聚素3 (pentraxin 3,PTX-3)、CRP、IL-4、IFN-γ、IL-2水平;比较两组患者的母婴结局。治疗后,两组患者血压显著低于治疗前(P<0.05),观察组患者血压显著低于对照组(P<0.05);两组患者血浆中ET-1水平显著降低(P<0.05),NO水平显著升高(P<0.05),观察组ET-1、NO水平变化程度显著大于对照组(P<0.05);观察组血浆PTX-3、CRP水平降低幅度显著大于对照组(P<0.05);观察组IL-4表达水平显著高于对照组(P<0.05),而IFN-γ、IL-2表达水平显著低于对照组(P<0.05);观察组母婴结局中胎心异常、新生儿窒息、剖宫产发生率均显著低于对照组(P<0.05)。由此,叶酸、维生素D辅助治疗妊娠期高血压疾病可有效控制血压及改善患者血管内皮功能,减轻患者病情,其作用机制可能是通过纠正Th1/Th2细胞因子比例失调而发挥作用。

To investigate the effects of adjuvant therapy of folic acid and vitamin D on vascular endothelial function and Th1/Th2 cytokine expressions in patients with hypertensive disorder complicating pregnancy, a total of 92 patients with hypertension during pregnancy who attended the Department of Second Obstetrics in Northwest Women’s and Children’s Hospital from May 2017 to June 2018 were collected as the research group. The patients were randomly divided into the control group(40 cases) and the observation group(52 cases). The control group was treated with folic acid alone, and the observation group was treated with additional vitamin D. Nitrate reductase method was used to detect the level of nitric oxide(NO) in plasma. Radioimmunoassay was used to detect the level of endothelin 1(ET-1) in plasma. ELISA was used to detect the levels of pentraxin 3(PTX-3), CRP, IL-4, IFN-γ, IL-2 in plasma. The maternal and infant outcomes of the two groups were compared. After the treatment, the blood pressure of the two groups was significantly lower than that before the treatment(P<0.05), with the observation group significantly lower than that of the control group(P<0.05). The plasma levels of ET-1 were significantly decreased and the levels of NO were significantly increased in the two groups(P<0.05). The changes of ET-1 and NO in the observation group were significantly greater than those in the control group(P<0.05). The changes of PTX-3 and CRP of the observation group were more significant than those in the control group(P<0.05). The expression level of IL-4 in the observation group was significantly higher than that in the control group(P<0.05), while the expression levels of IFN-γ and IL-2 were significantly lower than those in the control group(P<0.05). The incidences of fetal heart abnormalities, neonatal asphyxia, and cesarean section in the observation group were significantly lower than those in the control group(P<0.05). In conclusion, folic acid and vitamin D can effectively control blood pressure and improve the vascular endothelial function of patients with hypertensive disorder complicating pregnancy and the underlying mechanism may be related to the correction of imbalance of Th1/Th2 cytokines.