凝血指标与PDGF-BB、ET-1在不同严重程度子痫前期中的水平及对妊娠结局的预测价值

Levels of coagulation indexes,PDGF-BB and ET-1 in preeclampsia of different severity and predictive value of pregnancy outcome

目的 探讨凝血指标[部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(D-D)]与血小板衍生生长因子-BB(PDGF-BB)、内皮素-1(ET-1)在不同严重程度子痫前期(PE)孕妇中的水平及对妊娠结局的预测价值。方法 选取2021年1月至2023年3月该院收治的PE孕妇118例作为研究对象,根据病情严重程度分为PE组(71例)与重度PE组(47例);另选取同期在该院产检的健康孕妇59例作为对照组。对比3组APTT、PT、FIB、D-D、PDGF-BB、ET-1水平;分析APTT、PT、D-D、FIB、PDGF-BB、ET-1水平与PE严重程度的相关性。PE患者均随访至分娩,并根据妊娠结局将其分为妊娠结局良好组和妊娠结局不良组;采用受试者工作特征(ROC)曲线分析APTT、PT、D-D、FIB、PDGF-BB、ET-1对PE患者妊娠结局的预测效能;分析APTT、PT、D-D、FIB、PDGF-BB、ET-1对妊娠结局的影响。结果 重度PE组与PE组APTT、PT短于对照组,FIB、D-D、PDGF-BB、ET-1水平高于对照组,差异均有统计学意义(P<0.05);而重度PE组APTT、PT短于PE组,FIB、D-D、PDGF-BB、ET-1水平高于PE组,差异均有统计学意义(P<0.05)。Spearman相关分析结果显示,APTT、PT与PE严重程度呈负相关(r=-0.505、-0.513,P<0.05),而FIB、D-D、PDGF-BB、ET-1水平与PE严重程度呈正相关(r=0.559、0.607、0.618、0.642,P<0.05)。118例PE患者均完成了随访,其中妊娠结局良好组92例,妊娠结局不良组26例。妊娠结局不良组APTT、PT短于妊娠结局良好组,FIB、D-D、PDGF-BB、ET-1水平高于妊娠结局良好组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,APTT、PT、FIB、D-D、PDGF-BB、ET-1预测PE患者妊娠结局不良的曲线下面积分别为0.849、0.767、0.828、0.768、0.743、0.763,最佳截断值分别为29.39 s、11.85 s、5.44 g/L、0.93 mg/L、116.29 ng/L、2.24 mg/L;以ROC曲线获取的最佳截断值为分界值分为低值与高值,其中APTT、PT低值PE患者妊娠结局不良的风险是高值患者的15.231、7.411倍;FIB、D-D、PDGF-BB、ET-1高值PE患者妊娠结局不良的风险是低值患者的7.398、4.861、4.565、6.300倍。结论 APTT、PT、FIB、D-D、PDGF-BB、ET-1与PE病情程度显著相关,可作为PE患者妊娠结局的独立预测因子。

Objective To investigate the levels of coagulation indexes[activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(FIB)and D-dimer(D-D)],platelet-derived growth factor BB(PDGF-BB)and endothelin-1(ET-1)in different severity of preeclampsia(PE)pregnant patients and their predictive value on pregnancy outcome.Methods A total of 118 PE pregnant patients from January 2021 to March 2023 were selected as study subjects,which were divided into PE group and severe PE group according to the severity of the disease,and 59 healthy pregnant women who underwent prenatal routine examination during the same period in the hospital were selected as the control group.The levels of APTT,PT,FIB,D-D,PDGF-BB and ET-1 were compared among the three groups.The correlation between APTT,PT,D-D,FIB,PDGF-BB,ET-1 and the severity of PE was analyzed.The PE patients were all followed up until delivery,and they were divided into good pregnancy outcome group and poor pregnancy outcome group according to the outcome of the pregnancy.The receiver operating characteristic(ROC)curve was plotted to analyze predictive efficacy of APTT,PT,D-D,FIB,PDGF-BB and ET-1 pregnancy outcome of PE patients,and the influences of APTT,PT,D-D,FIB,PDGF-BB,ET-1 on pregnancy outcome were analyzed.Results The APTT and PT in the PE group and the severe PE group were shorter than those in the control group,and the FIB,D-D,PDGF-BB and ET-1 levels were higher than those in the control group,with statistically significant differences(P<0.05).The APTT and PT in the severe PE group were shorter than those in the PE group,and the FIB,D-D,PDGF-BB and ET-1 levels were higher than those in the PE group,with statistically significant differences(P<0.05).Spearman correlation analysis showed that APTT and PT were negatively correlated with the severity of PE(r=-0.505,-0.513,P<0.05),while FIB,D-D,PDGF-BB and ET-1 levels were positively correlated with the severity of PE(r=0.559,0.607,0.618,0.642,P<0.05).A total of 118 patients with PE completed follow-up,including 92 in the good pregnancy outcome group and 26 in the poor pregnancy outcome group.The APTT and PT in the poor pregnancy outcome group were shorter than those in the good pregnancy outcome group,and the FIB,D-D,PDGF-BB and ET-1 levels were higher than those in the good pregnancy outcome group,with statistically significant differences(P<0.05).The results of the ROC curves analysis showed that area under the curves of APTT,PT,FIB,D-D,PDGF-BB and ET-1 to predict the pregnancy outcome of PE patients were 0.849,0.767,0.828,0.768,0.743 and 0.763,respectively,with optimal cut-off values were 29.39 s,11.85 s,5.44 g/L,0.93 mg/L,116.29 ng/L,2.24 mg/L,respectively.The optimal cut-off values obtained by the ROC curves were categorized into low and high values.The risk of poor pregnancy outcome in PE patients with low values of APTT and PT was 15.231 and 7.411 times higher than that in patients with high values,and the risk of poor pregnancy outcome in PE patients with high values of FIB,D-D,PDGF-BB and ET-1 was 7.398,4.861,4.565 and 6.300 times higher than that in patients with low values.Conclusion A PTT,PT,FIB,D-D,PDGF-BB and ET-1 are significantly correlated with the severity of PE,and they can be used as independent predictors for pregnancy outcomes in PE patients.