妊娠早、中期血清sEng和ADMA对子痫前期胎盘血管分布及妊娠结局影响

Effect of levels of sEng and ADMA on placental vascular distribution and pregnancy outcomes of women with preeclampsia during the first or the second pregnant trimester

目的:探讨早、中孕期血清可溶性内皮因子(sEng)和非对称性二甲基精氨酸(ADMA)对子痫前期胎盘血管形成的作用机制。方法:选取符合条件的孕妇分别采集孕10~13周、20~24周静脉血清。孕期出现子痫前期症状进入病例组(36例),正常孕妇为对照组(50例),酶联免疫吸附法检测两组血清sEng、ADMA、一氧化氮(NO)水平,胎盘静脉、CT增强扫描胎盘标本,采用AW4.6图像后处理工作站重建胎盘血管数字三维图像。比较两组血清sEng、ADMA、NO水平及胎盘重量、胎盘血管灌注量、胎盘血管分支以及新生儿出生体重,采用Pearson直线相关对血清指标与胎盘重量及其血管各指标进行相关性分析。结果:病例组早、中孕期血清sEng中位数(13.895ng/ml、6.596ng/ml)高于对照组(4.906 ng/ml、5.441 ng/ml),ADMA中位数(2.189μmol/L、1.954μmol/L)高于对照组(0.275μmol/L、0.349μmol/L),NO中位数(80.629μmol/L、106.024μmol/L)低于对照组(225.571μmol/L、226.232μmol/L)(P均<0.001);胎盘重量(467.15.±46.99)g、胎盘动脉灌注量(19.63±3.45)ml、静脉灌注量(24.46±4.51)ml、胎盘血管分支级别(5.77±0.76)级、新生儿出生体重(2857.69±396.90)g均低于对照组(P<0.05)。中孕期血清sEng、早中孕期血清ADMA与胎盘重量及其血管各指标和新生儿出生体重呈负相关,与早、中孕期血清NO呈正相关。结论:子痫前期患者早中孕期血清sEng及ADMA增加,引起NO合成减少,导致胎盘血管形态变化,进而引发子痫前期的发生。

Objective:To explore the effect of levels of serum soluble endothelial factor(sEng)and asymmetric dimethylarginine(ADMA)on the development of placental blood vessels of women with preeclampsia during the first or the second pregnant trimester.Methods:The serum sample of pregnant women at 10-13 gestational weeks and 20-24 gestational weeks were collected,which included 36 women with preeclampsia and 50 normal pregnant women.The levels of serum sEng,ADMA,and Nitric Oxide(NO)were detected by enzyme-linked immunosorbent assay.All the pregnant women underwent uterine artery Doppler examination to measure the PI.Placentas of the pregnant women who delivered were given CT scan after placental veins and arterial perfusion.Then the AW4.6 image post-processing workstation was used to reconstruct the three-dimensional image of placental blood vessels.The levels of sEng and ADMA,and PI were compared between the two groups,and the placental weight,vascular perfusion,vascular branch and neonatal birth weight were also compared.The correlation between levels of serum sEng,ADMA,NO and the placental blood vessels were analyzed by Pearson linear correlation.Results:The median concentration of sEng of women with preeclampsia during 10-13 weeks and 20-24 weeks were 13.895 ng/ml and 6.596 ng/ml,and those of ADMA were 2.189μmol/L and 1.954μmol/L,which were all significant higher than those of women in the control group(P<0.001),while the levels of NO were 80.629μmol/L and 106.024μmol/L,which were significant lower than those of women in the control group(P<0.000).The placental weight,placental vein vascular perfusion,placental arterial vascular perfusion,placental vascular branch,and neonatal birth weight of women with preeclampsia were(467.15±46.99)g,(24.46±4.51)ml,(19.63±3.45)ml,(5.77±0.76),and(2857.69±396.90)g,respectively,which all were significant lower than those of women in the control group(P<0.05).The levels of sEng and ADMA of women during the first or the second pregnant trimester were negatively correlation to the placental weight,the indexes of the placental vessels,and the neonatal birth weight,while NO level was positively correlation to the placental weight,the indexes of the placental vessels,and the neonatal birth weight.Conclusion:The levels of serum sEng and ADMA of women with preeclampsia during the first or the second pregnant trimester increase,which lead to the level of NO decreases and may lead to the placenta vascular morphologic changes,then cause the occurrence of preeclampsia.