再生育子痫前期患者血清脂联素、肝细胞生长因子、胎盘生长 因子和杀伤细胞抑制性受体表达水平的变化

Changes in the expression levels of serum adiponectin,hepatocyte growth factor,placental growth factor and killer cell inhibitory receptor in patients with reproductive preeclampsia

目的观察再生育子痫前期患者血清脂联素、肝细胞生长因子(HGF)、胎盘生长因子(PLGF)和杀伤细胞抑制性受体(KIR)表达水平的变化。方法纳入2016年2月至2019年1月承德医学院附属医院妇产科就诊的单胎再生育孕妇,将子痫前期的单胎再生育孕妇106例纳入研究,列为子痫前期组。另纳入同时期就诊的妊娠期高血压(P IH)单胎再生育孕妇110例作为P IH组,健康再生育孕妇105名作为对照组。采用酶联免疫吸附试验法测定各组脂联素、HGF、PLGF和KIR的表达水平,采用免疫组化法检测各组胎盘组织中人白细胞抗原G(HLA-G)表达水平。根据实际情况将子痫前期组患者分为轻度子痫前期对照组、轻度子痫前期治疗组、重度子痫前期对照组和重度子痫前期治疗组,对照组进行常规治疗,治疗组在对照组基础上行早期干预,包括给予针对性药物、膳食、行为干预及预防并发症等措施。比较干预后对照组和治疗组患者上述指标的变化。结果相较于对照组,P IH组和子痫前期组脂联素[对照组:(14.23±3.19)比P IH组:(10.98±2.13)比轻度子痫前期组:(8.67±2.44)比重度子痫前期组:(6.72±1.96)mg/L,F=114.403]、PLGF[对照组:(402.51±77.94)比P IH组:(338.54±88.43)比轻度子痫前期组:(236.55±28.28)比重度子痫前期组:(114.09±23.93)ng/L,F=156.066]和HGF[对照组:(223.57±37.69)比P IH组:(180.15±33.47)比轻度子痫前期组:(164.73±25.67)比重度子痫前期组:(144.52±27.35)n g/L,F=14.058]水平降低,KIR[对照组:(7.25±2.89)比P IH组:(15.96±5.23)比轻度子痫前期组:(52.31±10.26)比重度子痫前期组:(104.33±17.52)ng/L,F=1576.399]水平升高;脂联素和PLGF水平随着病情加重而明显降低,KIR水平随着病情加重而明显升高(均P<0.01)。相较于对照组,P IH组和子痫前期组胎盘组织HLA-G相对表达强度和阳性表达率明显降低;其中随着病情加重,患者胎盘组织中HLA-G表达水平明显降低(均P<0.05)。干预后,轻度子痫前期对照组脂联素、PLGF水平明显上升,KIR水平下降(均P<0.05),轻度子痫前期治疗组上述各指标水平变化更为明显(P<0.05)。干预后,重度子痫前期对照组和重度子痫前期治疗组上述各指标较干预前有明显变化(均P<0.05),且重度子痫前期治疗组各指标变化更为明显(P<0.05)。结论再生育P IH及子痫前期患者血清脂联素、PLGF和HGF水平均明显下降,KIR水平明显升高,胎盘HLA-G相对表达强度降低,且均随病情的加重而明显变化。早期干预后,患者上述指标水平更趋于正常水平。

Objective To explore the changes of the expression levels of serum adiponectin, hepatocyte growth factor(HGF), placental growth factor(PLGF) and killer cell inhibitory receptors(KIR) in patients with reproductive preeclampsia(PE). Methods The patients who attended the Obstetrics and Gynecology Department of Affiliated Hospital of Chengde Medical College from February 2016 to January 2019 were enrolled, and 106 cases who met the criteria were included in the study and classified as the preeclampsia group. In addition, 110 cases of pregnant women with hypertension and 105 healthy pregnant women with reproductive births who were treated at the same time were included as pregnancy-induced hypertension(PIH) group and control group. The expression levels of adiponectin, HGF, PLGF and KIR were determined by enzyme-linked immunosorbent method, and the expression of human leucocyte antigen-G(HLA-G) in placental tissue was detected by immunohistochemistry. According to the actual situation, the patients in the preeclampsia group were divided into mild PE control group, mild PE treatment group, severe PE control group and severe PE treatment group. The control group received conventional treatment, and the treatment group received early intervention, including treatment, diet, behavior intervention and prevention of complications. The changes of the above indicators between the control group and the treatment group after intervention were compared. Results Compared with the healthy control group, the adiponectin[control:(14.23±3.19) vs PIH:(10.98±2.13) vs mild PE:(8.67±2.44) vs severe PE:(6.72±1.96)mg/L,F=114.403], PLGF[control:(402.51±77.94) vs PIH:(338.54±88.43) vs mild PE:(236.55±28.28) vs severe PE:(114.09±23.93)ng/L,F=156.066] and HGF[control:(223.57±37.69) vs PIH:(180.15±33.47) vs mild PE:(164.73±25.67) vs severe PE:(144.52±27.35)ng/L,F=14.058] levels of the PIH group and the preeclampsia group were significantly reduced, and the KIR level was significantly increased [control:(7.25±2.89) vs PIH:(15.96±5.23) vs mild PE:(52.31±10.26) vs severe PE:(104.33±17.52)ng/L,F=1 576.399](all P<0.05);The adiponectin and PLGF levels reduced and the level of KIR increased significantly with the aggravation of the disease(P<0.01). Compared with the healthy control group, the relative expression intensity and positive expression rate of HLA-G in the pregnancy-induced hypertension group and the preeclampsia group were significantly reduced(P<0.05);among them, as the disease worsened, the expression level of HLA-G in the placenta tissue of the patients was obvious decrease(P<0.05). After intervention, adiponectin and PLGF levels in mild PE control group were significantly increased(P<0.05), and KIR levels were significantly decreased(P<0.05). But the changes of above indexes in mild PE group were more obvious(P<0.05). After intervention, the above indexes in severe PE control group and severe PE treatment group were significantly changed compared with those before intervention(P<0.05), and the changes in severe PE treatment group were more obvious(P<0.05). Conclusions The serum levels of adiponectin, PLGF and HGF in reproductive hypertension and preeclampsia patients significantly decrease, the KIR level significantly increases, and the relative expression intensity of placental HLA-G decreases, and they all change significantly with the aggravation of the disease. After early intervention, the patient’s above-mentioned index levels tend to be more normal.