妊高征孕妇高压氧治疗后血清sFlt-1、NEFA的表达及其临床意义

Expression and clinical significance of serum sFlt-1 and NEFA in hyperbaric oxygen therapy for pregnancy-induced hypertension

目的探讨妊高征孕妇高压氧治疗后血清可溶性fms样酪氨酸激酶1(sFlt-1)和非酯化脂肪酸(NEFA)的表达及其临床意义。方法回顾性分析2019年10月至2023年10月聊城市第二人民医院产一科收治的98例妊高征孕妇(研究组)的临床资料,并选取同期入院体检的98例正常孕妇作为对照组。研究组又根据孕妇妊娠情况分为良好妊娠组(n=78)和不良妊娠组(n=20)。研究组予以常规对症并联合高压氧治疗1个月。治疗前后取研究组孕妇血清样本,采用免疫荧光法检测血清sFlt-1水平,采用酶联免疫吸附法检测血清NEFA水平,并与对照组孕妇血清sFlt-1、NEFA水平作比较。记录2组孕妇分娩时新生儿早产、低体重儿、巨大儿、新生儿窒息等情况,并统计妊娠结局。比较良好妊娠组和不良妊娠组孕妇的一般资料,分析可能影响妊娠结局的相关指标。采用多因素Logistic回归分析影响妊高征孕妇高压氧治疗后妊娠结局的危险因素,绘制受试者工作特征(ROC)曲线评估血清sFlt-1、NEFA对不良妊娠的预测价值。结果治疗前研究组孕妇血清sFlt-1水平明显高于对照组,NEFA水平明显低于对照组(P<0.01)。研究组孕妇不良妊娠结局发生率(20.41%)明显高于对照组(2.04%),差异有统计学意义(χ^(2)=15.071,P<0.01)。良好妊娠组和不良妊娠组孕妇妊高征严重程度、收缩压比较差异有统计学意义(P<0.05或P<0.001)。治疗前不良妊娠组孕妇血清sFlt-1明显高于良好妊娠组,血清NEFA水平明显低于良好妊娠组(P<0.001)。与本组治疗前比较,2组孕妇治疗后血清sFlt-1明显降低、NEFA水平明显升高(P<0.01)。治疗后不良妊娠组血清sFlt-1水平高于良好妊娠组,血清NEFA水平低于良好妊娠组(P<0.05)。血清sFlt-1联合NEFA预测妊高征孕妇高压氧治疗后妊娠结局ROC曲线的曲线下面积为0.82,敏感度和特异度分别为83.49%、74.26%。结论妊高征孕妇高压氧治疗后血清sFlt-1、NEFA水平变化与妊娠结局密切相关,联合监测其水平变化对预测不良妊娠结局具有重要的临床指导意义。

Objective To investigate the expression and clinical significance of soluble fms-like tyrosine kinase-1(sFlt-1)and non-esterified fatty acids(NEFA)in serum in hyperbaric oxygen therapy for pregnancy-induced hypertension.Methods A retrospective analysis was conducted on the clinical data of 98 pregnant women with pregnancy-induced hypertension admitted to the Department of Obstetrics and Gynecology of the Second People’s Hospital of Liaocheng from October 2019 to October 2023(as research group),and another 98 normal pregnant women admitted for physical examination during the same period were selected as the control group.The research group was further divided into a good pregnancy group(n=78)and an adverse pregnancy group(n=20)based on the pregnancy status.The research group received routine symptomatic treatment combined with hyperbaric oxygen therapy for one month.Serum samples were taken from the patients in the research group before and after treatment.Serum sFlt-1 levels were detected using immunofluorescence method and serum NEFA levels were detected using enzyme-linked immunosorbent assay.They were compared with those in the control group.The pregnancy outcomes were recorded and compared,including premature birth,low body weight infants,macrosomia,and neonatal asphyxia.The general information of pregnant women in the good pregnancy group and the adverse pregnancy group was compared,and the relevant indicators that may affect pregnancy outcomes were analyzed.The multiple logistic regression analysis was used to identify risk factors affecting pregnancy outcomes in pregnant women with pregnancy-induced hypertension after hyperbaric oxygen therapy,and ROC curves were drawn to evaluate the predictive value of serum sFlt-1 and NEFA for adverse pregnancy outcomes.Results The serum sFlt-1 level of pregnant women in the research group was significantly higher than that in the control group,and the NEFA level was significantly lower than that in the control group(P<0.01).The incidence of adverse pregnancy outcomes in the research group(20.41%)was significantly higher than that in the control group(2.04%),and the difference was statistically significant(χ^(2)=15.071,P<0.01).There were statistically significant differences in the severity of pregnancy-induced hypertension and systolic blood pressure between the good pregnancy group and the adverse pregnancy group(P<0.05 or P<0.001).Before treatment,the serum sFlt-1 level in the adverse pregnancy group was significantly higher than that in the good pregnancy group,and the serum NEFA level was significantly lower than that in the good pregnancy group(P<0.001).The area under the curve for predicting pregnancy outcomes after hyperbaric oxygen therapy in pregnant women with pregnancy-induced hypertension using serum sFlt-1 combined with NEFA was 0.82,with sensitivity and specificity of 83.49%and 74.26%,respectively.Conclusion The level changes in serum sFlt-1 and NEFA levels in pregnant women with pregnancy-induced hypertension after hyperbaric oxygen therapy are closely related to pregnancy outcomes,therefore,jointly monitoring these levels is of important clinical guidance significance for predicting adverse pregnancy outcomes.