妊娠期高血压疾病病人血CHE、GGT、LDH与病情程度的相关性研究

Study on the correlation between the levels of CHE,GGT and LDH,and severity of hypertensive disorder complicating pregnancy patients

目的:探讨妊娠期高血压疾病(HDCP)病人血清胆碱酯酶(CHE)、γ-谷氨酰转肽酶(GGT)、乳酸脱氢酶(LDH)表达变化及与病情程度的相关性。方法:选取80例HDCP病人,依据HDCP进展情况分为伴严重表现子痫前期组21例、不伴严重表现子痫前期组34例、单纯HDCP组25例,另选同期68名正常妊娠孕妇为对照组。比较4组血清CHE、GGT、LDH表达,分析HDCP病人血清各指标表达与血压指标[收缩压(SBP)、舒张压(DBP)]关系及与病人子痫前期发生的关联性,探讨血清各指标预测HDCP病人出现不良妊娠结局的价值。结果:SBP、DBP水平为伴严重表现子痫前期组>不伴严重表现子痫前期组>HDCP组>对照组(P<0.05~P<0.01);血清CHE为伴严重表现子痫前期组<不伴严重表现子痫前期组<HDCP组<对照组(P<0.01);血清GGT、LDH为伴严重表现子痫前期组>不伴严重表现子痫前期组>HDCP组>对照组(P<0.05~P<0.01);HDCP病人血清CHE表达与SBP、DBP水平均呈负相关关系(P<0.01),GGT、LDH表达与SBP、DBP水平均呈正相关关系(P<0.01)。在控制年龄、孕前体质量、孕周、产妇类型后,血清CHE水平与子痫前期发病呈负相关关系(P<0.01),GGT、LDH与子痫前期发病均呈正相关关系(P<0.01)。随访至分娩,出现不良妊娠结局HDCP病人血清CHE表达低于未出现不良妊娠结局HDCP病人(P<0.01),GGT、LDH表达高于未出现不良妊娠结局HDCP病人(P<0.01)。血清CHE、GGT、LDH预测HDCP病人出现不良妊娠结局的最佳截断值分别≤2.83 kU/L、>32.16 U/L、>256.06 IU/L,其曲线下面积均小于联合预测。结论:血清CHE、GGT、LDH异常表达是子痫前期发生的重要影响因素,并与HDCP病人病情程度存在一定相关性,三者联合预测HDCP病人出现不良妊娠结局效果更好。

Objective:To investigate the changes of serum levels of cholinesterase(CHE),γ-glutamyl transpeptidase(GGT)and lactate dehydrogenase(LDH)expression in patients with hypertensive disorder complicating pregnangcy(HDCP),and their correlation with the degree of disease.Methods:Eighty patients with HDCP were selected,and divided into the severe preeclampsia group(21 cases),non-severe preeclampsia group(34 cases)and simple HDCP group(25 cases)according to the progress of HDCP,and 68 normal pregnant women in the same period were selected as the control group.The serum levels of CHE,GGT and LDH in four groups were measured and compared.The relationship between the serum indicators,and levels of SBP and DBP,occurrence of preeclampsia in HDCP patients were analyzed,and the value of serum indexes in predicting adverse pregnancy outcome in HDCP patients was investigated.Results:The levels of SBP and DBP in the severe preeclampsia group,non-severe preeclampsia group,HDCP group and control group gradually decreased in turn(P<0.05 to P<0.01).The levels of CHE in the severe preeclampsia group,non-severe preeclampsia group,HDCP group and control group gradually increased in turn(P<0.05 to P<0.01).The levels of GGT and LDH in severe preeclampsia group,non-severe preeclampsia group,HDCP group and control group gradually decreased in turn(P<0.05 to P<0.01).The serum levels of CHE in HDCP patients was negatively correlated with the levels of SBP and DBP(P<0.01),and the serum levels of GGT and LDH were positively correlated with the levels of SBP and DBP(P<0.01).After controlling the age,prepregnancy body weight,gestational age and maternal type,the serum level of CHE was negatively correlated with the onset of preeclampsia(P<0.01),and the levels of GGT and LDH were positively correlated with the onset of preeclampsia(P<0.01).During follow-up to delivery,the expression of CHE in HDCP patients with adverse pregnancy outcome was lower than that in HDCP patients without adverse pregnancy outcome(P<0.01),while the expression of GGT and LDH in HDCP patients with adverse pregnancy outcome were higher than that in HDCP patients without adverse pregnancy outcome(P<0.01).The best cutoff values of CHE,GGT and LDH in predicting adverse pregnancy outcomes in HDCP patients were≤2.83 kU/L,>32.16 U/L and>256.06 IU/L,respectively,and the areas under the curve were smaller than that in combined prediction.Conclusions:The abnormal expression of serum CHE,GGT and LDH is an important influencing factor for the occurrence of preeclampsia,has a certain correlation with the degree of illness in HDCP patients,and the combination of the three is better in predicting adverse pregnancy outcomes in patients with HDCP.