孕中期水通道蛋白1、白细胞介素37对高风险孕妇发生子痫前期的预测

Prediction of Preeclampsia in High-risk Pregnant Women by Aquaporin-1 and Interleukin-37 in the Second Trimester

目的探讨孕中期水通道蛋白1(AQP1)、白细胞介素37(IL-37)对高风险孕妇发生子痫前期的预测价值。方法选取2020年1月—2020年12月连云港市第一人民医院收治的70例孕早期预测有子痫前期的高风险孕中期孕妇作为研究对象,将其中22例发生子痫前期的孕妇分为子痫前期组,48例未发生子痫前期且血压维持正常的孕妇分为非子痫前期组,另选取同期在连云港市第一人民医院体检的30名健康非高风险孕妇作为对照组。对比三组孕妇孕中期AQP1、IL-37表达水平,应用受试者操作特征(ROC)曲线分析AQP1、IL-37对高风险孕妇发生子痫前期的预测价值。对所有产妇进行随访,记录70例有子痫前期高风险孕妇产后新生儿情况,将20例羊水污染程度为Ⅲ度、胎儿胎心率超过180次/min、新生儿Apgar评分<7分的产妇分为妊娠结局不良组,将其余的50例产妇分为妊娠结局良好组,对比两组产妇一般临床特征和孕中期相关临床指标,应用Logistic回归分析分析AQP1、IL-37对子痫前期不良妊娠结局的预测价值。结果三组孕妇孕中期AQP1、IL-37表达水平对比,子痫前期组明显高于非子痫前期组与对照组,差异有统计学意义(P<0.05);AQP1、IL-37两者联合对子痫前期的预测灵敏度和特异度明显高于AQP1、IL-37单一预测,差异有统计学意义(P<0.05),通过预测最高阈值和最低阈值计算出预测平均阈值,AQP1的预测阈值为14.58μg/L,IL-37为234.62 pg/mL;不良妊娠结局组与良好妊娠结局组孕妇年龄、身体质量指数、妊娠次数、产次、高血压家族史、妊娠前高血压史对比,差异无统计学意义(P>0.05),孕中期DBP、SBP、尿蛋白、AQP1、IL-37水平对比,差异有统计学意义(P<0.05);Logistic回归分析结果表明:尿蛋白、AQP1、IL-37是子痫前期高风险孕妇不良妊娠结局的独立影响因素(P<0.05)。结论孕中期AQP1、IL-37水平对高风险孕妇子痫前期具有重要预测价值,且其预测阀值分别为14.58μg/L、234.62 pg/mL,且两者联合的预测效能更高。同时,孕中期AQP1、IL-37也能够预测子痫前期高风险孕妇不良妊娠结局的发生,因此临床需要针对孕中期AQP1、IL-37水平升高的产妇进行相关干预,预防不良结局发生。

Objective To investigate the predictive value of aquaporin 1(AQP1)and interleukin 37(IL-37)in the second trimester of pregnancy on the occurrence of preeclampsia in high-risk pregnant women.Methods The 70 middle-pregnancy patients with high risk of predicting preeclampsia in early pregnancy admitted to Lianyungang First People's Hospital from January 2020 to December 2020 were selected as the study subjects.Among them,22 pregnant women with preeclampsia were divided into the pre eclampsia group.Among them,48 pregnant women without preeclampsia and with normal blood pressure were divided into the non preeclampsia group.In addition,30 healthy non high risk pregnant women who came to our hospital for physical examination at the same time were selected as the control group to compare the AQP1 The expression level of IL-37 and the predictive value of AQP1 and IL-37 on the occurrence of preeclampsia in high-risk pregnant women were analyzed by using the ROC curve.All parturients were followed up and recorded postpartum neonatal status in 70 pregnant women with high risk of preeclampsia.Twenty newborns with Apgar score less than 7,amnioticfluid pollution degree ofⅢ,and fetal heart rate of more than 180 beats/min were divided into the group with poor pregnancy outcome.The remaining 50 pregnant women were divided into the group with good pregnancy outcome.The general clinical characteristics of the two groups of parturients and the related clinical indicators in the second trimester of pregnancy were compared,and AQP1 The predictive value of IL-37 on adverse pregnancy outcome in preeclampsia.Results The expression levels of AQP1 and IL-37 in the third trimester of pregnancy were significantly different among the three groups.The expression levels of AQP1 and IL-37 in the pre-eclampsia group were significantly higher than those in the non-pre-eclampsia group and the control group(P<0.05);the predictive sensitivity and specificity of combination of AQP1 and IL-37 for preeclampsia were significantly higher than that of single prediction of AQP1 and IL-37,the predicted average threshold was calculated by predicting the highest and lowest thresholds,which were 14.58μg/L for AQP1 and 234.62 pg/mL for IL-37;there was no significant difference in the age,body mass index,pregnancy times,birth times,family history of hypertension and history of hypertension before pregnancy between the poor pregnancy outcome group and the good pregnancy outcome group(P>0.05),but there were significant difference in the levels of DBP,SBP,urinary protein,AQP1 and IL-37 in the second trimester of pregnancy(P<0.05);the results of logistic regression analysis showed that urinary protein,AQP1 and IL-37 were independent influencing factors of adverse pregnancy outcome in high-risk pregnant women with preeclampsia(P<0.05).Conclusion The levels of AQP1 and IL-37 in the second trimester of pregnancy have important predictive value for pre eclampsia in high-risk pregnant women,and their predictive threshold values are respectively 14.58μg/L,234.62 pg/mL,and the combination of the two has higher prediction efficiency.At the same time,AQP1 and IL-37 in the second trimester can also predict the occurrence of adverse pregnancy outcomes in high-risk pre eclampsia pregnant women.Therefore,clinical intervention should be carried out for pregnant women with elevated levels of AQP1 and IL-37 in the second trimester to prevent adverse pregnancy outcomes.