妊娠期高血压疾病患者血清微小RNA-124-3p的表达及其临床意义研究

Study on the expression and clinical significance of serum miR-124-3p in patients with hypertensive disorder complicating pregnancy

目的探究微小RNA-124-3p(miR-124-3p)在妊娠期高血压疾病(HDCP)患者血清中的表达水平及其与妊娠结局的关系。方法选取2018年1月至2020年2月在邯郸市中心医院定期产检并分娩的80例HDCP患者作为患病组,按照病情程度将其分为妊娠期高血压组(n=39)、轻度子痫前期(PE)组(n=26)、重度PE组(n=15);按照是否发生不良妊娠结局将其分为不良妊娠组(n=31)和良好妊娠组(n=49)。另选取同期80例产检正常孕妇作为正常组。采用实时荧光定量聚合酶链反应(qRT-PCR)法测定血清miR-124-3p的表达水平;采用酶联免疫吸附试验(ELISA)测定血清胎盘生长因子(PLGF)的水平;比较正常组及不同病情严重程度HDCP患者的血清miR-124-3p、PLGF水平;采用Pearson检验分析HDCP患者血清miR-124-3p与PLGF表达水平的相关性;采用受试者工作特征(ROC)曲线评价血清miR-124-3p、PLGF对HDCP患者妊娠结局的预测价值。结果患病组血清miR-124-3p水平高于正常组,PLGF水平低于正常组(P<0.05);随HDCP病情加重,血清miR-124-3p水平升高,PLGF水平降低(P<0.05);HDCP患者血清miR-124-3p与PLGF的表达水平呈负相关(P<0.05)。患病组胎膜早破、胎儿窘迫、胎儿生长受限、早产、产后出血发生率高于正常组(P<0.05);不良妊娠组HDCP患者血清miR-124-3p水平高于良好妊娠组(P<0.05),PLGF水平低于良好妊娠组(P<0.05)。分别采用血清miR-124-3p、PLGF预测HDCP患者妊娠结局的曲线下面积(AUC)分别为0.844、0.849,截断值分别为1.86、38.78pg/mL,灵敏度均为87.1%,特异度分别为75.5%、73.5%,二者联合预测HDCP患者妊娠结局的AUC为0.942,其灵敏度、特异度分别为83.9%、89.8%。结论HDCP患者血清miR-124-3p表达水平升高,与PLGF水平呈负相关,且miR-124-3p、PLGF表达水平均与HDCP病情严重程度、妊娠结局相关,二者联合可提高对HDCP患者妊娠结局的预测效能,有利于临床判断HDCP患者的妊娠结局。

Objective To investigate the expression level of microRNA-124-3p(miR-124-3p)in serum of patients with hypertensive disorder complicating pregnancy(HDCP)and its relationship with pregnancy outcome.Methods A total of 80 HDCP patients who had undergone regular obstetrics checkups and gave birth in Handan Central Hospital from January 2018 to February 2020 were selected as the diseased group.They were divided into gestational hypertension group(n=39),mild preeclampsia(PE)group(n=26),severe PE group(n=15)according to the different severity of the illness,and divided into adverse pregnancy group(n=31)and good pregnancy group(n=49)according to whether an adverse pregnancy outcome has occurred.80 healthy pregnant women during the same period were selected as the normal group.The expression level of serum miR-124-3p was determined with real-time fluorescent quantitative polymerase chain reaction(qRT-PCR)method.The level of serum placental growth factor(PLGF)was measured with enzyme-linked immunosorbent assay(ELISA).Serum levels of miR-124-3p and PLGF were compared between normal subjects and patients with different HDCP severity.The correlation between serum miR-124-3p and PLGF expression in HDCP patients was analyzed with Pearson method.The predictive value of serum miR-124-3p and PLGF on the pregnancy outcome of HDCP patients was evaluated with receiver operating characteristic(ROC)curve.Results The serum miR-124-3p level of the diseased group was higher than that of the normal group,and the PLGF level was lower than that of the normal group(P<0.05).With the aggravation of HDCP,the serum miR-124-3p level increased,and the PLGF level decreased(P<0.05).The expression level of serum miR-124-3p in HDCP patients was negatively correlated with PLGF(P<0.05).The incidences of premature rupture of membranes,fetal distress,fetal growth restriction,premature delivery and postpartum hemorrhage in the diseased group were higher than those in the normal group(P<0.05).The serum miR-124-3p level of HDCP patients in the adverse pregnancy group was higher than that in the good pregnancy group,and the PLGF level was lower than that in the good pregnancy group(P<0.05).The area under the curve(AUC)of serum miR-124-3p and PLGF for predicting pregnancy outcome of HDCP patients was 0.844 and 0.849,respectively;the cut-off value was 1.86 and 38.78pg/mL,respectively;the sensitivity was both 87.1%,and the specificity was 75.5%and 73.5%,respectively.The AUC of the two combined prediction of pregnancy outcome in HDCP patients was 0.942,and its sensitivity and specificity were 83.9%and 89.8%,respectively.Conclusions The serum miR-124-3p expression level in HDCP patients is elevated,which is negatively correlated with PLGF,and the expression of miR-124-3p and PLGF are both related to the severity of HDCP and pregnancy outcome.The combination of the two can improve the predictive power of the pregnancy outcome of HDCP patients,which is conducive to clinical judgment of the pregnancy outcome of HDCP patients.