常熟地区妊娠中期产妇维生素A与维生素E水平现状及其对子痫前期的预测价值

Current status of vitamin A and vitamin E levels in second trimester pregnant women in Changshu area and their predictive value for preeclampsia

目的探究常熟地区妊娠中期产妇维生素A、维生素E水平现状及其对子痫前期的预测价值。方法选取南京中医药大学常熟附属医院妇产科2017年6月至2020年6月收治的1194例规律产检产妇作为研究对象。于孕中期(15~20周)抽取静脉血,分别采用高效液相色谱、液相串联质谱法检测产妇维生素A、维生素E水平。根据子痫前期发生情况,将产妇分为子痫前期组(病例组,n=71)和非子痫前期组(对照组,n=1123),根据子痫前期病情进一步将病例组分为子痫前期组(n=49)与重度子痫前期组(n=22)。比较两组外周血中维生素A、维生素E水平及母婴结局,并观察病例组子痫前期、重度子痫前期产妇外周血维生素A、维生素E水平与病情严重程度的相关性。结果1194例产妇中,共71例子痫前期产妇,发生率为5.95%。病例组外周血维生素A、维生素E均低于对照组(P<0.05)。重度子痫前期组外周血维生素A、维生素E均略低于子痫前期组,但差异均无统计学意义。病例组早产、低体质量出生儿、产后出血及剖宫产发生率均高于对照组(P<0.05)。ROC曲线分析结果显示,维生素A、维生素E预测子痫前期发生的曲线下面积分别为0.90、0.70,特异度分别为89.8%、63.7%,灵敏度分别为80.3%、44.0%。结论子痫前期产妇妊娠中期维生素A、维生素E水平降低,尤其是维生素A水平,能初步预测子痫前期发生,但孕中期外周血中维生素A、维生素E水平与病情严重程度的相关性尚不明确。

Objective To observe current status of vitamin A and vitamin E levels in second trimester pregnant women in Changshu area and their predictive value for preeclampsia.Methods 194 pregnant women with regular obstetrics who were admitted to the Department of Obstetrics and Gynecology of Changshu Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from June 2017 to June 2020 were selected as the research subjects.Venous blood was drawn in the second trimester(15-20 weeks),and the levels of vitamin A and vitamin E were detected by high performance liquid chromatography and liquid tandem mass spectrometry,respectively.According to the occurrence of preeclampsia,pregnant women were divided into preeclampsia group(case group,n=71)and non-preeclampsia group(control group,n=1123),according to the condition of preeclampsia,the cases were further divided into preeclampsia group(n=49)and severe preeclampsia group(n=22).The levels of vitamin A and vita-min E in peripheral blood and maternal and infant outcomes were compared between the two groups,and the correlation between the levels of vita-min A and vitamin E in peripheral blood of pregnant women with preeclampsia and severe preeclampsia and the severity of the disease in the case group was observed.Results Among the 1194 pregnant women,there were 71 pregnant women with preeclampsia,and the incidence rate was 5.95%.The peripheral blood levels of vitamin A and vitamin E in the case group were lower than those in the control group(P<0.05).The peripher-al blood vitamin A and vitamin E in the severe preeclampsia group were slightly lower than those in the preeclampsia group,but the difference was not statistically significant.The incidences of premature birth,low birth weight infants,postpartum hemorrhage and cesarean section in the case group were higher than those in the control group(P<0.05).The results of ROC curve analysis showed that the areas under the curve of vitamin A and vitamin E for predicting the occurrence of preeclampsia were 0.90 and 0.70,the specificity was 89.8%and 63.7%,and the sensitivity was 80.3%and 44.0%,respectively.Conclusion The decrease of vitamin A and vitamin E levels,especially the level of vitamin A,in the mid-pregnan-cy of pregnant women with preeclampsia can preliminarily predict the occurrence of preeclampsia,but the correlation between the levels of vitamin A and vitamin E in peripheral blood and the severity of the disease not clear.