高龄产妇哺乳期血清血管紧张素Ⅱ水平与产后抑郁焦虑的相关性分析

A study on the relationship between the level of serum AngⅡ and postpartum depression and anxiety in the elderly parturients during lactation

目的 探讨高龄产妇哺乳期血清血管紧张素Ⅱ(AngⅡ)水平与产后抑郁焦虑的相关性。方法 选取2018年6月—2019年12月在宁波市精神病院就诊的孕产妇218例,以产后42 d内爱丁堡产后抑郁量表(EPDS)评分≥13分且年龄≥35岁为抑郁组(32例),同时筛选出与抑郁组年龄相匹配的30例产妇为非抑郁组。产妇产前24 h内和产后7 d分别抽取肘静脉血5 ml,采用酶联免疫吸附法(ELISA)检测雌二醇、孕酮及AngⅡ水平;利用Pearson法分析血清雌二醇、孕酮及AngⅡ水平与抑郁焦虑的相关性;利用受试者工作曲线(ROC)评价产妇血清激素和AngⅡ水平对产后抑郁焦虑的诊断价值。结果 抑郁组与非抑郁组产妇年龄、孕次、文化程度、经济收入、夫妻关系、分娩方式、喂养方式及婴儿性别差异无统计学意义(P>0.05);抑郁组产妇产后血清雌二醇、孕酮水平显著低于非抑郁组(P<0.05),AngⅡ水平显著高于非抑郁组(P<0.05);Pearson结果显示,抑郁组产妇产后7 d雌二醇、孕酮水平与EPDS评分均呈负相关(P<0.05),AngⅡ水平与EPDS评分呈正相关(P<0.05);ROC结果显示,产后7 d血清雌二醇、孕酮及AngⅡ水平诊断高龄产妇抑郁焦虑的曲线下面积(AUC)分别为0.755(95%CI:0.629~0.856,P=0.063)、0.878(95%CI:0.770~0.947,P=0.046)、0.882(95%CI:0.775~0.950,P=0.045),灵敏度分别为90.62%、81.25%、78.12%,特异度分别为56.67%、83.33%、93.33%,三者联合诊断的AUC为0.958(95%CI:0.904~0.969,P=0.016),灵敏度和特异度分别为87.50%、96.33%。结论 高龄产妇哺乳期血清AngⅡ水平升高与产后抑郁焦虑密切相关,对产后抑郁焦虑有一定的诊断价值。

Objective To explore the correlation between the level of serum AngⅡ and postpartum depression and anxiety in the elderly parturients.Methods 218 pregnant and lying in women were selected from June 2018 to December 2019 in our hospital.The parturients with Edinburgh Postpartum Depression Scale(EPDS) score ≥ 13 and the age ≥ 35 years old were selected as the depression group(32 cases),at the same time, 30 women matched with the age of depression group were selected as the non depression group.5 ml of elbow vein blood was taken from the parturients within 24 hours before delivery and 7 days after delivery, the levels of estradiol, progesterone and AngⅡ were detected by enzyme-linked immunosorbent assay(ELISA);Pearson’s method was used to analyze the correlation between the levels of serum estradiol, progesterone, AngⅡ and depression, anxiety;and ROC was used to evaluate the diagnostic value of serum hormone and AngⅡ levels in postpartum depression and anxiety.Results There was no significant difference in age, pregnancy times, education level, economic income, relationship between husband and wife, delivery mode, feeding mode, and gender of infants between depression group and non depression group(P>0.05);the levels of estradiol and progesterone in postpartum serum in depression group were significantly lower than those in non depression group(P<0.05),and the level of AngⅡ was significantly higher than that in non depression group(P<0.05);Pearson’s results showed that the postpartum 7 days levels of estradiol and progesterone were negatively correlated with the score of EPDS(P<0.05),and the level of AngⅡ was positively correlated with the score of EPDS(P<0.05);the results of ROC showed that the AUC of postpartum 7 days serum estradiol, progesterone and AngⅡ was 0.755(95% CI: 0.629-0.856,P=0.063),0.878(95% CI: 0.770-0.947,P=0.046),0.882(95% CI: 0.775-0.950,P=0.045), respectively, the sensitivity was 90.62%,81.25% and 78.12%, respectively, and the specificity was 56.67%,83.33%,93.33%,respectively, the AUC of the three combination was 0.958(95% CI: 0.904-0.969,P=0.016),and the sensitivity and specificity were 87.50% and 96.33%,respectively.Conclusion The increase of serum AngⅡ level in lactation period of the elderly parturient is closely related to postpartum depression and anxiety, which has certain diagnostic value for postpartum depression and anxiety.