子痫前期患者血清ACA、D-二聚体、IP-10、PLGF水平变化及与妊娠结局的关系

Changes in serum ACA,D-dimer,IP-10 and PLGF levels and their relationship with pregnancy outcomes in patients with preeclampsia

目的研究子痫前期患者血清抗心磷脂抗体(ACA)、D-二聚体、趋化因子(IP-10)及胎盘生长因子(PIGF)水平变化及预测不良妊娠结局的价值。方法选取2020年2月至2021年6月张家口市第一医院收治的子痫前期患者62例,分为轻度组(30例)和重度组(32例)。另外选取同期于本院分娩的正常产妇58名作为对照组。检测各组血清抗心磷脂抗体-免疫球蛋白G(ACA-IgG)、抗心磷脂抗体-免疫球蛋白M(ACA-IgM)、D-二聚体、IP-10及PIGF水平。随访至妊娠结束,并比较三组妊娠结局。分析血清ACA-IgG、ACA-IgM、D-二聚体、IP-10、PLGF水平与妊娠结局的关系。通过受试者工作特征曲线(ROC)分析血清ACA-IgG、ACA-IgM、D-二聚体、IP-10、PLGF水平预测妊娠结局的效能。结果ACA-IgG、ACA-IgM、D-二聚体、IP-10组间比较:重度组>轻度组>对照组,差异有统计学意义(F=102.643、155.868、170.863、286.744,均P<0.05)。PLGF组间比较:重度组<轻度组<对照组,差异有统计学意义(F=59.953,P<0.05)。三组不良妊娠事件发生率:重度组>轻度组>对照组,差异具有统计学意义(χ^(2)=20.284,P<0.05)。不良妊娠结局患者血清ACA-IgG、ACA-IgM、D-二聚体、IP-10水平高于良好妊娠结局患者,PIGF低于良好妊娠结局患者(t=6.371、5.573、5.307、7.257、5.734,均P<0.05)。血清ACA-IgG、ACA-IgM、D-二聚体、IP-10水平与不良妊娠结局呈正相关,而PLGF水平与不良妊娠结局呈负相关(r=0.292、0.359、0.297、0.282、-0.318,均P<0.05)。ROC曲线分析结果显示,sFIt-1、PIGF预测子痫前期患者妊娠结局均具有较高的效能,其中PIGF效能最高,约登指数最高时对应临界值为72.04 pg/mL,曲线下面积为0.856,敏感度为87.20%、特异度为80.18%。结论子痫前期患者血清ACA、D-二聚体、IP-10异常增高,PLGF异常降低,且与不良妊娠结局密切相关。

Objective To study the variations in of serum levels of anticardiolipin antibody(ACA),D-dimer,interferon-inducible protein-10(IP-10)and placental growth factor(PIGF)as well as their predictive value for adverse pregnancy outcomes in patients with preeclampsia.Methods 62 patients with preeclampsia admitted to Zhangjiakou First Hospital from February 2020 to June 2021 were selected as the subjects.They were divided into two groups:mild(30 cases)and severe(32 cases).In addition,58 normal parturients who gave birth in the hospital during the same period were included as the control group.The serum levels of anticardiolipin antibody-immunoglobulin G(ACA-IgG),anticardiolipin antibody-immunoglobulin M(ACA-IgM),D-dimer,IP-10 and PIGF were measured in each group.Follow-up was conducted until the end of pregnancy,and the pregnancy outcomes were compared among the three groups.The relationship between serum levels of ACA-IgG,ACA-IgM,D-dimer,IP-10,PLGF,and pregnancy outcomes was analyzed.The efficiency of these serum levels in predicting pregnancy outcomes was analyzed using the receiver operating characteristic curve(ROC).Results The levels of serum ACA-IgG,ACA-IgM,D-dimer and IP-10 were found to be higher in the severe group compared to the mild group and the control group(F=102.643,155.868,170.863,286.744,P<0.05).Conversely,PLGF levels were lower in the severe group compared to the mild group and the control group(F=59.953,P<0.05).The total incidence rate of adverse pregnancy outcomes was higher in the severe group compared to the mild group and the control group(χ^(2)=20.284,P<0.05).Serum levels of ACA-IgG,ACA-IgM,D-dimer and IP-10 in patients with adverse pregnancy outcomes were higher than those in patients with good pregnancy outcomes,while PIGF level was lower than that in patients with good pregnancy outcomes(t=6.371,5.573,5.307,7.257,5.734,P<0.05).Serum levels of ACA-IgG,ACA-IgM,D-dimer and IP-10 were positively correlated with adverse pregnancy outcomes,and PLGF level was negatively correlated with adverse pregnancy outcomes(r=0.292,0.359,0.297,0.282,-0.318,P<0.05).The ROC curve analysis results showed that sFIt-1 and PIGF were effective in predicting pregnancy outcomes in patients with preeclampsia with PIGF being the most efficient.The corresponding cutoff value,area under the curve,sensitivity and specificity were 72.04 pg/mL,0.856,87.20%and 80.18%when the Yoden index was the highest.Conclusion Serum ACA,D-dimer and IP-10 levels are abnormally increased in patients with preeclampsia,while PLGF level is abnormally reduced.These indicators are closely associated with adverse pregnancy outcomes.