早发型重度子痫前期患者血清SPA,SPD及Hcy表达及临床意义

Expression and Clinical Significance of Serum SPA,SPD and Hcy in Patients with Early-onset Severe Preeclampsia

目的探讨早发型重度子痫前期(early onset severe pre-eclampsia,EOSP)患者血清表面活性蛋白A(surfactant associated protein A,SPA)、表面活性蛋白D(surfactant associated protein D,SPD)及同型半胱氨酸(homocysteine,Hcy)表达及临床意义。方法选取2020年8月~2021年8月期间邯郸市中心医院诊治的124例EOSP患者为研究对象,以同期60例健康体检孕妇为对照组。酶联免疫吸附实验(ELISA)检测各组血清SPA,SPD及Hcy水平。比较两组一般资料及血清SPA,SPD及Hcy水平的差异。Pearson相关分析血清SPA,SPD及Hcy水平与临床参数的相关性。多因素Logistic回归分析影响EOSP发生的影响因素。受试者工作曲线(ROC)分析血清SPA,SPD及Hcy对EOSP的诊断价值。结果相比于对照组,EOSP组血清SPA(13.27±5.14ng/ml vs 22.14±6.04ng/ml),SPD(8.73±2.38ng/ml vs19.34±3.46ng/ml)水平明显降低,Hcy(15.27±3.13μmol/L vs 8.35±2.32μmol/L)水平明显升高,差异具有统计学意义(t=10.353,24.299,15.214,均P<0.05)。EOSP组患者血清SPA,SPD水平与新生儿出生体质量呈正相关(r=0.515,0.447,均P<0.05),与体质量指数、舒张压、收缩压和24h尿蛋白定量呈负相关(r=-0.604~-0.413,均P<0.05);血清Hcy水平与新生儿出生体质量呈负相关(r=-0.538,P<0.05),与体质量指数、舒张压、收缩压和24h尿蛋白定量呈正相关(r=0.420~0.610,均P<0.05)。24h尿蛋白定量[1.266(1.110~1.444)]、舒张压[1.270(1.071~1.506)]、SPA[0.865(0.778~0.962)],SPD[0.877(0.781~0.985)]及Hcy[1.347(1.084~1.675)]是影响EOSP发生的独立因素。血清SPA,SPD和Hcy联合检测对EOSP诊断的曲线下面积(95%CI)为0.909(0.877~0.945),显著高于SPA,SPD和Hcy各指标单独检测0.780(0.726~0.836),0.758(0.705~0.810),0.740(0.692~0.789),差异具有统计学意义(Z=4.370,5.567,7.702,均P<0.05)。结论子痫前期患者血清SPA和SPD降低,Hcy升高,三者共同参与EOSP疾病发生发展,是影响ES-PE发生的独立危险因素。

Objective To investigate the expression and clinical significance of serum surfactant protein A(SPA),surfactant protein D(SPD)and homocysteine(Hcy)in patients with early-onset severe preeclampsia(EOSP).Methods A total of 124patients with EOSP diagnosed and treated in Handan Central Hospital from August 2020 to August 2021 were selected as the research objects,and 60 healthy pregnant women during the same period were selected as the control group.The serum levels of SPA,SPD and Hcy in each group were detected by enzyme-linked immunosorbent assay(ELISA).Statistical analysis was performed to compare the general data and serum levels of SPA,SPD and Hcy between the two groups.The correlation between serum SPA,SPD and Hcy levels and clinical indictors were analyzed by Pearson correlation analysis.Factors for the occurrence of EOSP were analyzed by multivariate Logistic regression analysis.Serum SPA,SPD and Hcy in the diagnosis of EOSP were analyzed by receiver operating curve(ROC)analysis.Results Compared with the control group,SPA(13.27±5.14ng/ml vs 22.14±6.04ng/ml),and SPD(8.73±2.38ng/ml vs 19.34±3.46ng/ml)were significantly decreased,while Hcy(15.27±3.13μmol/vs 8.35±2.32μmol/L L)was significantly increased,the differences were statistically significant(t=10.353,24.299,15.214,all P<0.05).The serum SPA and SPD levels in the EOSP group were positively correlated with newborn birth weight(r=0.515,0.447,all P<0.05),and negatively correlated with body mass index,diastolic blood pressure,systolic blood pressure and 24-hour urine protein quantification(r=–0.604~–0.413,all P<0.05).Serum Hcy level was negatively correlated with newborn birth weight(r=–0.538,P<0.05),and was positively correlated with body mass index,diastolic blood pressure,systolic blood pressure,and 24h urinary protein quantification(r=0.420~0.610,all P<0.05).24h urine protein quantification[1.266(1.110~1.444)],diastolic blood pressure[1.270(1.071~1.506)],SPA[0.865(0.778~0.962)],SPD[0.877(0.781~0.985)]and Hcy[1.347(1.084~1.675)]would be independent factors affecting the occurrence of EOSP.The area under the curve(95%CI)of combined detection of serum SPA,SPD and Hcy for diagnosis of EOSP was 0.909(0.877~0.945),which was significantly higher than that of SPA,SPD and Hcy separately detected by 0.780(0.726~0.836),0.758(0.705~0.810)and 0.740(0.692~0.789)(Z=4.370,5.567,7.702,all P<0.05).Conclusion The serum levels of SPA,SPD were decreased,while Hcy increased in patients with preeclampsia increase.They were involved in the occurrence and development of EOSP,and are independent risk factors for the occurrence of EOSP.