硫酸镁、低分子肝素钙联合钙通道阻滞药对子痫前期患者Flt-1、sEng值、细胞凋亡指标的影响

Effect of magnesium sulfate and low molecular weight heparin calcium combined with calcium channel blockers on Flt-1,sEng and apoptosis in patients with preeclampsia.

目的探讨硫酸镁、低分子肝素钙联合钙通道阻滞药对子痫前期患者血清血管内皮生长因子受体-1(Flt-1)、可溶性内皮因子(sEng)、细胞凋亡指标的影响。方法回顾性选取2018年2月至2021年2月遂宁市中心医院产科收治的300例子痫前期患者,根据孕妇入院后不同治疗方法分为观察组(n=150)和对照组(n=150),观察组给予硫酸镁+低分子肝素钙+钙通道阻滞药(硝苯地平)治疗,对照组患者仅给予硫酸镁治疗,两组均连续治疗5 d。比较两组患者治疗前后血清Flt-1与sEng水平、患者血压、细胞凋亡指标变化及母婴结局。结果治疗后,两组孕妇血清Flt-1、sEng水平均降低,且观察组血清Flt-1、sEng水平分别为(103.37±15.88)pg/mL、(16.34±4.25)ng/mL,显著低于对照组[(125.92±26.45)pg/mL、(23.56±7.78)ng/mL],差异均有统计学意义(P<0.05)。治疗后,两组孕妇血压指标均降低,且观察组收缩压、舒张压值分别为(122.75±10.84)、(82.29±5.35)mmHg,显著低于对照组[(138.58±13.65)、(90.76±7.38)mmHg],差异均有统计学意义(P<0.05)。治疗后,观察组孕妇促凋亡分子Fas、caspase-9水平分别为(3.48±1.31)ng/mg、(73.67±11.78)pg/mg,均低于对照组[(5.29±1.81)ng/mg、(91.56±15.42)pg/mg],观察组抗凋亡分子Bcl-2、Survivin水平分别为(63.63±14.48)、(52.85±13.46)ng/mg,均高于对照组[(45.29±15.67)、(37.37±15.54)ng/mg],差异均有统计学意义(P<0.05)。观察组孕妇不良妊娠结局总发生率为4.47%,明显低于对照组孕妇(14.47%),差异有统计学意义(P<0.05)。结论硫酸镁、低分子肝素钙联合钙通道阻滞药治疗子痫前期患者效果显著,能有效降低血压及血清Flt-1、sEng值,抑制细胞凋亡,改善母婴结局,安全性较高,是一种较理想的治疗方案。

Objective To investigate the effects of magnesium sulfate and low molecular weight heparin calcium combined with calcium channel blockers on serum vascular endothelial growth factor receptor-1(Flt-1),soluble endothelial factor(sEng)and apoptosis in patients with preeclampsia.Methods A total of 300 patients with preeclampsia admitted to the Department of Obstetrics and Gynecology in Suining Central Hospital from February 2018 to February 2021 were retrospectively selected and divided into observation group(n=150)and control group(n=150)according to different treatment methods after admission.The observation group was treated with magnesium sulfate+low molecular weight heparin calcium combined with calcium channel blockers(nifedipine),while the control group was treated with magnesium sulfate only.Both groups were treated for 5 consecutive days.The changes of serum Flt-1 and sEng levels,blood pressure before and after treatment apoptosis parameters and maternal and fetal outcomes were compared between the two groups.Results After treatment,serum Flt-1 and sEng levels in the two groups were decreased,and serum Flt-1 and sEng levels in the observation group were(103.37±15.88)pg/mL and(16.34±4.25)ng/mL,respectively,which were significantly lower than those in the control group[(125.92±26.45)pg/mL and(23.56±7.78)ng/mL],the differences were statistically significant(P<0.05).After treatment,blood pressure indicators in the two groups were decreased,and values of systolic blood pressure(SBP)and diastolic blood pressure(OBP)in the observation group were(122.75±10.84)and(82.29±5.35)mmHg,respectively,which were significantly lower than those of(138.58±13.65)and(90.76±7.38)mmHg in the control group,the differences were statistically significant(P<0.05).After treatment,the levels of pro-apoptotic molecules Fas and caspase-9 in the observation group were(3.48±1.31)ng/mg and(73.67±11.78)pg/mg,respectively,which were lower than those in the control group[(5.29±1.81)ng/mg and(91.56±15.42)pg/mg],the levels of anti-apoptotic molecules Bcl-2 and Survivin in the observation group were(63.63±14.48)and(52.85±13.46)ng/mg,respectively,which were higher than those in the control group[(45.29±15.67)and(37.37±15.54)ng/mg],the differences were statistically significant(P<0.05).The comparison of the incidence rate of adverse pregnancy outcomes between the two groups showed that the total incidence rate of 4.47%in the observation group was significantly lower than that in the control group(14.47%),the difference was statistically significant(P<0.05).Conclusion Magnesium sulfate and low molecular weight heparin calcium combined with calcium channel blockers is effective in the treatment of patients with preeclampsia.It can effectively reduce blood pressure and serum Flt-1,sEng,inhibit apoptosis,and improve maternal and fetal outcomes with high safety.It is an ideal treatment.