UPLC-MS/MS法检测血浆内源性大麻素在预测先兆流产孕妇妊娠结局中的应用

Application of UPLC-MS/MS method in detecting endogenous cannabinoids in plasma for predicting pregnancy outcomes in women with threatened miscarriage

目的:研究孕妇外周血内源性大麻素水平周期变化规律,并分析基于孕早期内源性大麻素水平预测先兆流产孕妇妊娠结局的临床应用价值。方法:选择2020年5月至2022年5月在山东第一医科大学第一附属医院产检的1080例孕妇,其中880例孕早期发生先兆流产孕妇和200例正常妊娠孕妇,超高效液相色谱串联质谱(UPLC-MS/MS)法检测血中内源性大麻素水平,通过logistic回归分析先兆流产发展为难免流产的风险因素,并用ROC曲线评估孕酮、β-人绒毛膜促性腺激素(β-HCG)、花生四烯酸乙醇胺(AEA)预测先兆流产孕妇妊娠结局的性能。结果:发生难免流产的孕妇外周血AEA平均水平为(3.96±2.04)nmol/L,显著高于持续妊娠孕妇[(2.16±2.00)nmol/L](P<0.001)。年龄、AEA、孕酮、β-HCG、胎龄及阴道流血量是先兆流产发展为难免流产的风险因素(P<0.05)。孕早期内源性大麻素AEA,当阈值为2.565nmol/L时,用于预测先兆流产孕妇妊娠结局的准确率为86.7%,具有最优预测性能。结论:孕妇外周血内源性大麻素AEA水平测定是预测先兆流产患者妊娠结局的有效工具。

Objective:To study the periodic variation of endogenous cannabinoids(ECs)in peripheral blood of pregnant women in China,and to analyze the clinical application value of predicting the pregnancy outcome of pregnant women with threatened abortion based on the level of endogenous cannabinoids in early pregnancy.Methods:A total of 1080 pregnant women who underwent prenatal examination in the First Affiliated Hospital of Shandong First Medical University from May 2020 to May 2022 were selected as the research objects,including 880 pregnant women with threatened abortion in early pregnancy and 200 normal pregnant women.The level of endogenous cannabinoids in blood was detected by ultra-high performance liquid chromatography tandem mass spectrometry(UPLC-MS/MS).Logistic regression was used to analyze the risk factors of threatened abortion developing into inevitable abortion,and ROC curve was used to evaluate the performance of progesterone,β-HCG and AEA in predicting the pregnancy outcome of pregnant women with threatened abortion.Results:The average level of AEA in peripheral blood of pregnant women with inevitable abortion was(3.96±2.04)nmol/L,which was significantly higher than that of pregnant women with continuous pregnancy[(2.16±2.00)nmol/L](P<0.001).Age,AEA,progesterone,β-HCG,gestational age and vaginal bleeding were risk factors for the development of threatened abortion into inevitable abortion(P<0.05).When the threshold was 2.565nmol/L,the accuracy of endogenous cannabinoid AEA in early pregnancy for predicting the pregnancy outcome of pregnant women with threatened abortion was 86.7%,which had the best prediction performance.Conclusion:The determination of endogenous cannabinoid AEA level in peripheral blood of pregnant women is an effective tool to predict the pregnancy outcome of patients with threatened abortion.