子痫前期患者的胎盘微血管密度、血清VEGF和D-二聚体水平及其在预测不良妊娠结局中的价值

Placental microvascular density,serum VEGF and D-dimer levels of patients with pre-eclampsia and their value in the prediction of adverse pregnancy outcomes

目的分析子痫前期患者的胎盘微血管密度(MVD)、血清血管内皮生长因子(VEGF)和D-二聚体水平,并探讨三者在预测患者不良妊娠结局中的价值。方法纳入98例子痫前期患者(子痫前期组)和100例正常孕妇(对照组),并根据妊娠结局将子痫前期组患者分为结局良好组40例和结局不良组58例。分娩前,采用ELISA检测所有孕妇血清VEGF、D-二聚体水平,并采用超声微血管成像技术检测胎盘MVD。采用受试者工作特征曲线分析胎盘MVD、血清VEGF和D-二聚体水平单独及联合预测子痫前期患者出现不良妊娠结局的效能。结果与对照组比较,子痫前期组患者的血清VEGF水平及胎盘MVD降低,血清D-二聚体水平升高(均P<0.05)。与结局良好组比较,结局不良组患者血清VEGF水平及胎盘MVD降低,血清D-二聚体水平升高(均P<0.05)。预测子痫前期患者不良妊娠结局时,胎盘MVD、血清VEGF水平、血清D-二聚体水平及三者联合的灵敏度分别为81.03%、84.84%、75.86%、94.55%,特异度分别为75.00%、75.00%、80.00%、85.00%,曲线下面积分别为0.853、0.834、0.873、0.939。结论子痫前期患者胎盘MVD及血清VEGF水平降低,而血清D-二聚体水平升高,且妊娠结局不良者上述情况更为明显。胎盘MVD、血清VEGF和D-二聚体水平对子痫前期患者的不良妊娠结局均具有较好的预测价值,三者联合应用可进一步提高预测效能。

Objective To analyze the placental microvascular density(MVD),and the levels of serum vascular endothelial growth factor(VEGF)and D-dimer in patients with pre-eclampsia,and to explore the value of the three as above in the prediction of adverse pregnancy outcomes of the patients.Methods A total of 98 patients with pre-eclampsia(the pre-eclampsia group),and 100 normal pregnant women(the control group)were enrolled,and patients in the pre-eclampsia group were assigned to the good outcome group(n=40)or the adverse outcome group(n=58)according to the pregnancy outcomes.Before delivery,the ELISA was employed to detect serum VEGF,D-dimer levels in all pregnant women,and the superb microvascular imaging technique was performed to detect placental MVD.The efficiency of placental MVD,serum VEGF and D-dimer levels alone and jointly for predicting the occurrence of adverse pregnancy outcomes in patients with pre-eclampsia was analyzed by the receiver operating characteristic curve.Results Compared with the control group,the pre-eclampsia group exhibited decreased serum VEGF level and placental MVD,and an elevation of serum D-dimer level(all P<0.05).The adverse outcome group yielded declines of serum VEGF level and placental MVD,and an elevation of serum D-dimer level as compared with the good outcome group(all P<0.05).When the adverse outcomes of patients with pre-eclampsia were predicted,the sensitivities of placental MVD,serum VEGF level,serum D-dimer level and the combination of the thee were 81.03%,84.84%,75.86%,and 94.55%,respectively;the specificities were 75.00%,75.00%,80.00%,and 85.00%,respectively;the areas under the curve were 0.853,0.834,0.873,and 0.939,respectively.Conclusion The placental MVD and serum VEGF level of patients with pre-eclampsia decline,whereas D-dimer level is elevated,and the conditions as above are more significant in patients with adverse pregnancy outcome.The placental MVD,serum VEGF and D-dimer levels exert a good predictive value on adverse pregnancy outcome in patients with pre-eclampsia,and the combined application of the three can further improve the predictive efficiency.