超声联合血清TXNIP和Sirt1水平对妊娠期高血压孕妇胎儿宫内缺氧预测价值

Predictive value of ultrasonic combined with serum levels of TXNIP and Sirt1 for intrauterine hypoxia in fetuses of pregnant women with gestational hypertension

目的探讨超声联合血清硫氧还蛋白相互作用蛋白(TXNIP)和沉默信息调节因子1(Sirt1)表达水平对妊娠期高血压(HDP)孕妇胎儿发生宫内缺氧的预测价值。方法将2021年5月至2023年6月北京市平谷区医院就诊的169例HDP孕妇纳入研究,其中发生宫内缺氧34例患者为宫内缺氧组,其他125例患者为正常组。采用皮尔逊法分析评估血清TXNIP、Sirt1表达水平与阻力指数(RI),搏动指数(PI)以及收缩期峰值血液流速比舒张末期血液流速(S/D)的相关性,使用受试者工作特征(ROC)曲线分析超声联合血清TXNIP、Sirt1表达水平对HDP孕妇胎儿宫内缺氧预测价值。结果宫内缺氧组Apgar评分低于正常组(t=8.961,P<0.001),宫内缺氧组RI、PI及S/D值较于正常组明显升高(t=5.694,6.525和7.678,P<0.001),两组血清TXNIP和Sirt1表达水平存在显著性差异(t=6.061和8.161,P<0.001),血清TXNIP表达水平与RI、PI及S/D值呈显著正相关(r=0.553,0.671和0.609,P<0.001),血清Sirt1表达水平与RI、PI及S/D值呈负相关(r=-0.546,-0.591和-0.761,P<0.001);RI、PI、S/D及血清TXNIP、Sirt1独立预测HDP孕妇胎儿宫内缺氧的曲线下面积(AUC)分别为0.790、0.750、0.836、0.768、0.873,联合预测的AUC为0.964,超声联合血清TXNIP、Sirt1预测优于各自单独预测(Z_(联合-RI)=3.610、Z_(联合-PI)=3.434,Z_(联合-TXNIP)=4.608,P均<0.001;Z_(联合-S/D)=2.528,Z_(联合-Sirt1)=2.514,P=0.011和0.012)。结论超声联合血清TXNIP、Sirt1表达对HDP孕妇胎儿宫内缺氧具有良好的预测价值。

Objective To investigate the predictive value of ultrasound combined with serum thioredoxin-interacting protein(TXNIP)and silent information regulator 1(Sirt1)expression levels in fetuses of pregnant women with hypertensive disorders of pregnancy(HDP)for intrauterine hypoxia.Methods 169 pregnant women with HDP who received treatment in Pinggu District Hospital in Beijing from May 2021 to June 2023 were included in the study.Among them,34 patients with intrauterine hypoxia constituted the intrauterine hypoxia group and the other 125 patients constituted the normal group.The correlation between the expression levels of TXNIP and Sirt1 in serum and resistance index(RI),pulsatility index(PI)and the ratio of systolic peak velocity to end-diastolic velocity(S/D)was evaluated by Pearson correlation analysis.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of ultrasound combined with serum TXNIP and Sirt1 expression levels for intrauterine hypoxia in fetuses of pregnant women with HDP.Results The Apgar score in intrauterine hypoxia group was lower than that in normal group(t=8.961,P<0.001).The values of RI,PI and S/D in intrauterine hypoxia group were significantly higher than those in normal group(t=5.694,6.525 and 7.678,respectively,P<0.001).Significant differences were observed in the expression levels of TXNIP and Sirt1 in serum between the two groups(t=6.061 and 8.161,respectively,P<0.001).The serum TXNIP expression level was positively correlated with RI,PI and S/D values(r=0.553,0.671 and 0.609,respectively,P<0.001),while the serum Sirt1 expression level was negatively correlated with RI,PI and S/D values(r=-0.546,-0.591 and-0.761,respectively,P<0.001).The independent predictive values,as indicated by the area under the curve(AUC),for RI,PI,S/D,and serum TXNIP and Sirt1 in predicting intrauterine hypoxia in fetuses of pregnant women with HDP were 0.790,0.750,0.836,0.768 and 0.873,respectively,and the AUC of combined prediction was 0.964.The combined prediction of ultrasound with serum TXNIP and Sirt1 was better than their individual predictions(Z_(combination-RI)=3.610,Z_(combination-PI)=3.434,Z_(combination-TXNIP)=4.608,P<0.001;Z_(combination-S/D)=2.528,Z_(combination-Sirt1)=2.514,P=0.011 and 0.012,respectively).Conclusion Ultrasound combined with serum TXNIP and Sirt1 expression has good predictive value for intrauterine hypoxia in fetuses of pregnant women with HDP.