血清脑啡肽酶、儿茶酚抑素、SHARP1与子痫前期孕妇心功能和妊娠结局的关系分析

Analysis of the relationship between serum nepriysin,cathatin,SHARP1,cardiac function and pregnancy outcome in pre-eclampsia pregnant women

目的 分析不同病情程度子痫前期(preeclampsia, PE)孕妇血清脑啡肽酶(neprilysin)、儿茶酚抑素(catestatin)、分化型胚胎软骨发育基因1(split and hairy related protein-1,SHARP1)水平的变化及与心功能和妊娠结局的关系。方法 选取2020年3月至2022年2月德州市妇女儿童医院收治的128例PE患者,分为轻度PE组(75例)与重度PE组(53例),另选取同期于本院产检的50例健康孕妇作为健康组。检测并比较3组血清脑啡肽酶、儿茶酚抑素、SHARP1水平,对轻、重度PE患者行超声心功能检查,比较两组左室射血分数(LVEF)、心脏指数(CI)、心输出量(CO)、舒张早期峰值速度(E)/舒张晚期峰值速度(A)参数,进行Pearson相关性分析及Logistic回归模型分析。结果 重度PE组血清脑啡肽酶水平高于健康组、轻度PE组,儿茶酚抑素、SHARP1水平低于健康组、轻度PE组(P<0.05)。轻度PE组血清脑啡肽酶水平高于健康组,儿茶酚抑素、SHARP1水平低于健康组(P<0.05)。重度PE组LVEF、CI、E/A低于轻度PE组,CO高于轻度PE组(P<0.05)。Pearson相关性分析结果显示,血清脑啡肽酶与LVEF、CI、E/A呈负相关,与CO呈正相关(P<0.05),儿茶酚抑素、SHARP1与LVEF、CI、E/A呈正相关,与CO呈负相关(P<0.05)。PE患者中良好妊娠结局102例,不良妊娠结局26例。良好妊娠结局和不良妊娠结局患者的血压、24 h尿蛋白、尿素氮(BUN)、血肌酐(Scr)、脑啡肽酶、儿茶酚抑素、SHARP1水平比较差异有统计学意义(P<0.05)。经Logistic回归分析显示,血压、24 h尿蛋白、BUN、Scr、脑啡肽酶、儿茶酚抑素、SHARP1水平为PE患者不良妊娠结局的影响因素(P<0.05)。结论 血清脑啡肽酶在PE患者中水平上升,儿茶酚抑素、SHARP1水平下降,与病情严重程度密切相关,是影响孕妇不良妊娠的危险因素,且与心功能受损有关。

Objective To analyze the changes of serum neprilysin,catestatin and split and hairy related protein-1(SHARP1)levels in pregnant women with different disease severity of preeclampsia(PE)and their relationship with cardiac function and pregnancy outcome.Methods 128 patients with PE who were admitted in Dezhou Women's and Children's Hospital from March 2020 to February 2022 were selected,and they were divided into mild PE group(75 cases)and severe PE group(53 cases).In addition,50 healthy pregnant women who underwent obstetric examination in the hospital during the same period were selected as the healthy group.The serum neprilysin,catestatin and SHARPI levels in the three groups were detected and compared.The patients with mild and severe PE underwent ultrasonic cardiac function examination.The parameters of left ventricular ejection fraction(LVEF),cardiac index(CI),cardiac output(CO),early diastolic peak velocity(E)/late diastolic peak velocity(A)were compared between the two groups,and conducted Pearson analysis and Logistic regression model analysis.Results The serum neprilysin levelin the severe PE group were higher than that in the healthy group and mild PE group,and the catestatin and SHARP1 levels were lower than those in the healthy group and mild PE group(P<0.05).The serum neprilysin levelin the mild PE group was higher than that in the healthy group,and the catestatin and SHARP1 levels were lower than those in the healthy group(P<0.05).LVEF,CI and E/A in the severe PE group were lower than those in the mild PE group,and CO was higher than that in the mild PE group(P<0.05).Pearson method showed that serum neprilysin was negatively correlated with LVEF,CI,E/A,and positively correlated with CO(P<0.05),while catestatin and SHARP1 were positively correlated with LVEF,CI,E/A,and negatively correlated with CO(P<0.05).Among patients with PE,102 had good pregnancy outcomes,and 26 had adverse pregnancy outcomes.There were significant differences in blood pressure,24 h urinary protein,urea nitrogen(BUN),blood creatinine(Scr),neprilysin,catestatin,SHARPI levels between patients with good pregnancy outcomes and bad pregnancy outcomes(P<0.05).Logistic regression analysis showed that blood pressure,24 h urinary protein,BUN,Scr,neprilysin,catestatin,SHARP1 levels were the influencing factors of adverse pregnancy outcomes in patients with PE(P<0.05).Conclusion The serum neprilysin level is increased in patients with PE,and the catestatin and SHARP1 levels are decreased,they are closely related to the disease severity.They are risk factors affecting the adverse pregnancy of pregnant women,and which are related to impaired cardiac function.