血清sFlt-1和PlGF联合检测对妊娠期急性脂肪肝病情严重程度和疾病预后的评估价值

Clinical value of combined detection of serum sFlt-1 and PlGF levels on severity and prognosis of acute fatty liver disease in pregnancy

目的 探讨可溶性fms样酪氨酸激酶-1(sFlt-1)和胎盘生长因子(PlGF)水平联合检测对妊娠期急性脂肪肝(AFLP)病情程度和预后评估的价值。方法 选择2018年1月-2021年7月收治的AFLP患者35例列入观察组,根据凝血酶原活动度(PTA)水平分为轻型组和重型组,根据治愈时间分为易治愈组和难治愈组。选择同期健康孕产妇35例,列入对照组。比较观察组和对照组的血清sFlt-1、PlGF、PBG、Alb、TBil、PT和Cr水平;比较观察组中不同病情程度和不同治愈时间亚组的血清sFlt-1和PlGF水平;比较血清sFlt-1和PlGF水平与PBG、Alb、TBil、PT和Cr水平的相关性,回归分析单独检测和联合检测sFlt-1和PlGF水平的诊断效能。结果 观察组的血清sFlt-1水平为(3 829.57±506.41)pg/mL,高于对照组的(516.48±87.25)pg/mL,PlGF水平为(152.64±35.17)pg/mL,低于对照组的(375.62±74.38)pg/mL,差异有统计学意义(t=187.258,16.492,P<0.05)。观察组的TBil、Cr和PT水平显著高于对照组,PBG和Alb水平低于对照组(P<0.05)。观察组中,重症和难治愈亚组的血清sFlt-1水平[(5 024.86±638.57)pg/mL,4 659.27±471.83 pg/mL]分别高于轻症亚组[(2 908.59±304.80)pg/mL,(3 260.85±369.42)pg/mL],差异有统计学意义(t=25.385,19.473,P<0.05);PlGF水平[(98.38±27.35)pg/mL,(107.34±29.68)pg/mL]分别低于轻症和易治愈亚组[(187.45±48.61)pg/mL,(172.56±45.19)pg/mL],差异有统计学意义(t=19.276,14.725,P<0.05)。Pearson分析显示,AFLP患者的血清sFlt-1水平与PBG和Alb水平呈负相关,与TBil、Cr和PT水平呈正相关(P<0.05);血清PlGF水平与PBG和Alb水平呈正相关,与TBil、Cr和PT水平呈负相关(P<0.05)。ROC曲线显示,sFlt-1和PlGF水平单独和联合检测诊断AFLP的曲线下面积(AUC)分别为0.925、0.903和0.976,联合检测的效能显著高于任一单项检测(P<0.05)。结论血清sFlt-1和PlGF水平对AFLP患者病情严重程度和预后评估的临床价值较高,联合检测的效能更佳。

Objective To explore the value of combined detection of soluble FMS like tyrosine kinase-1(sFlt-1)and placental growth factor(PlGF)in evaluating the severity and prognosis of acute fatty liver during pregnancy(AFLP).Methods 35 AFLP patients admitted from January 2018 to July 2021 were included in the observation group.According to the level of prothrombin activity(PTA),they were divided into mild group and severe group,and were divided into easy to cure group and difficult to cure group according to the cure time.Thirty-five healthy pregnant women were included in the control group.The serum levels of sFlt-1,PlGF,postprandial blood glucose(PBG),albumin(Alb),total bilirubin(TBil),prothrombin time(PT)and creatinine(Cr)in the observation group and the control group were compared.The levels of serum sFlt-1 and PlGF in subgroups with different severity of disease and different cure time were compared.The correlation between serum sFlt-1 and PlGF levels and PBG,Alb,TBil,PT and Cr levels was compared,and the diagnostic efficacy of sFlt-1 and PlGF levels alone and combined detection was analyzed by regression analysis.Results The serum sFlt-1 level in the observation group(3829.57±506.41 pg/mL)was higher than that in the control group(516.48±87.25 pg/mL),and the serum PlGF level(152.64±35.17 pg/mL)was lower than that in the control group(375.62±74.38 pg/mL).The difference was statistically significant(t=187.258,16.492,P<0.05).The levels of TBil,Cr and PT in observation group were significantly higher than those in control group,while the levels of PBG and Alb were lower than those in control groups(P<0.05).In the observation group,the serum sFlt-1 levels of severe and difficult to cure groups(5024.86±638.57 pg/mL,4659.27±471.83 pg/mL)were higher than those of mild and easy to cure groups(2908.59±304.80 pg/mL,3260.85±369.42 pg/mL),respectively,and the difference was statistically significant(t=25.385,19.473,P<0.05).PlGF levels(98.38±27.35 pg/mL,107.34±29.68 pg/mL)were lower than those of mild and difficult to cure groups(187.45±48.61 pg/mL,172.56±45.19 pg/mL),and the difference was statistically significant(t=19.276,14.725,P<0.05).Pearson analysis showed that the serum sFlt-1 level of AFLP patients was negatively correlated with PBG and Alb levels,but positively correlated with TBil,Cr and PT levels(P<0.05).Serum PlGF levels were positively correlated with PBG and Alb levels,but negatively correlated with TBil,Cr and PT levels(P<0.05).Receiver operating characteristic(ROC)curve showed that the area under curve(AUC)of sFlt-1,PlGF and combined detection for AFLP diagnosis were 0.925,0.903 and 0.976,respectively,indicating that combined detection was significantly more efficient than any single detection(P<0.05).Conclusion Serum sFlt-1 and PlGF levels have higher clinical value in evaluating the severity and prognosis of AFLP patients,and the combined detection is more effective.