子痫前期孕妇血清Endocan水平升高与宫内生长受限、不良妊娠结局的关系

Relationship between elevated serum Endocan level and intrauterine growth restriction,adverse pregnancy outcomes in pregnant women with preeclampsia

目的探讨子痫前期(PE)孕妇血清内皮细胞特异性分子1(Endocan)水平升高与胎儿宫内生长受限(IUGR)、不良妊娠结局的关系。方法选取2020年5月至2022年8月该院产科收治的49例PE患者作为研究对象。根据有无胎儿IUGR,将49例PE患者分为PE伴IUGR组28例和单纯PE组21例。同期招募39例血压无异常且无任何并发症的健康孕妇作为正常妊娠组。根据妊娠结局,将49例PE患者分为良好妊娠结局组与不良妊娠结局组。采用酶联免疫吸附试验检测所有研究对象血清Endocan水平。比较各组孕妇临床资料、新生儿特征,以及Endocan水平。采用Spearman相关分析血清Endocan与其他指标的相关性。绘制受试者工作特征(ROC)曲线分析血清Endocan在IUGR诊断和不良妊娠结局预测中的价值。结果正常妊娠组、单纯PE组、PE伴IUGR组Endocan水平分别为560.00(423.00,748.00)、592.00(479.00,923.50)、1571.00(1044.50,2129.50)pg/mL。与正常妊娠组Endocan水平比较,单纯PE组和PE伴IUGR组血清Endocan水平明显升高,差异均有统计学意义(P<0.05),且PE伴IUGR组血清Endocan水平较单纯PE组进一步升高,差异有统计学意义(P<0.05)。PE患者血清Endocan水平与子宫动脉搏动指数(PI)呈正相关(r=0.408,P=0.004)。血清Endocan诊断PE中胎儿IUGR的曲线下面积(AUC)为0.834(95%CI:0.720~0.948),灵敏度和特异度分别为78.6%和81.0%,Cut-off值为943 pg/mL。与良好妊娠结局组比较,不良妊娠结局组血清Endocan水平明显升高,差异有统计学意义(P<0.05)。血清Endocan水平预测不良妊娠结局的AUC为0.816(95%CI:0.685~0.946),灵敏度和特异度分别为80.0%和82.8%,Cut-off值为1197 pg/mL。结论PE患者血清Endocan水平升高与IUGR有关,并且可以预测不良妊娠结局。

Objective To explore the correlations between serum endothelial cell specific molecular 1(Endocan)level in preeclampsia(PE)pregnant women and fetal intrauterine growth restriction(IUGR),adverse pregnancy outcomes.Methods A total of 49 PE patients admitted to Hospital Obstetrics in Hainan,Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine from May 2020 to August 2022 were selected as the research objects.According to the presence or absence of fetal IUGR,49 PE patients were divided into PE with IUGR group(28 cases)and simple PE group(21 cases).During the same period,39 healthy pregnant women without abnormal blood pressure and any complications were recruited as the normal pregnancy group.According to the pregnancy outcome,the patients were divided into good pregnancy outcome group and adverse pregnancy outcome group.Serum Endocan level of all subjects was detected by enzyme-linked immunosorbent assay.The clinical data and Endocan level of each group were compared.Spearman correlation analysis was used to analyze the correlation between serum Endocan and other indicators.Receiver operating characteristic(ROC)curve was drawn to analyze the value of serum Endocan in the diagnosis of fetal IUGR and the prediction of adverse pregnancy outcomes.Results The levels of Endocan were 560.00(423.00,748.00),592.00(479.00,923.50),1571.00(1044.50,2129.50)pg/mL in normal pregnancy group,simple PE group and PE with IUGR group respectively.Compared with the normal pregnancy group,the serum Endocan level in the simple PE group and the simple PE group increased significantly(P<0.05),and the serum Endocan levels in the PE with IUGR group increased further than that in the simple PE group(P<0.05).Serum Endocan level in PE patients correlated positively with uterine artery pulsatility index(PI)(r=0.408,P=0.004).The area under the curve(AUC)of serum Endocan in the differential diagnosis of IUGR in PE was 0.834(95%CI:0.720-0.948),the sensitivity and specificity were 78.6% and 81.0% respectively,and the Cut-off value was 943 pg/mL.Compared with the normal pregnancy outcome group,the level of serum Endocan in the adverse pregnancy outcome group increased significantly(P<0.05).The AUC of serum Endocan level in predicting adverse pregnancy outcomes was 0.816(95%CI:0.685-0.946),the sensitivity and specificity were 80.0% and 82.8% respectively,and the Cut-off value was 1197 pg/mL.Conclusion Increased serum Endocan level in PE patients associates with IUGR and may predict adverse pregnancy outcomes.