血浆胎盘异铁蛋白与妊娠高血压综合征和胎儿生长迟缓的关系

Relationship between Placental Isoferritin and Pre-eclampsia/Intrauterine Growth Retardation

目的 探讨血浆胎盘异铁蛋白 (PLF)在妊娠高血压综合征和胎儿生长迟缓发病机制中的作用及其早期预测价值。方法 采用前瞻性研究方法 ,在妊娠 2 4～ 34周对 12 0例最初正常的孕妇 ,分别用ELISA法和Griess法测定血浆PLF和NO代谢产物亚硝酸基 /硝酸基 (NO2 -/NO3 -)水平 ,观测孕妇孕期血压的变化并随访妊娠结局。结果① 12 0例正常孕妇妊娠结局随访结果 ,发生胎儿生长迟缓 15例 (IUGR组 )、妊娠高血压综合征 19例 (妊高征组 ) ,86例妊娠结局正常 (正常组 )。②IUGR组和妊高征组PLF水平明显低于正常组 (P <0 0 1) ;NO水平明显高于正常组 (P <0 0 1) ;IUGR组与妊高征组血浆PLF和NO水平差异均无显著性 (均为P >0 0 5 ) ;血浆PLF水平与NO水平呈负相关(r=- 0 32 9,P <0 0 1)。③PLF预测IUGR、妊高征 ,其ROC曲线下面积分别为 0 977、 0 90 5。以PLF等于 4 0 0 μg/ml预测妊高征、以PLF等于 390 μg/ml预测IUGR时的Kappa指数分别为 0 6 4 5和 0 6 6 3,预测值与实际情况有良好的一致性。结论 血浆胎盘异铁蛋白水平的降低与胎儿生长迟缓和妊高征的发生有密切关系 ,血管内皮细胞损伤可能是其作用机制之一。

Objective To investigate the effect of placental isoferritin (PLF) activation on pathogenesis of pre-eclampsia and intrauterine growth retardation and its earlier predictive value. Methods A prospective double-blinded study was performed. There were 120 initial normal pregnant women at earlier third trimester (from 24 to 34 weeks). Plasma PLF and NO metabolites (nitrite/nitrate, NO 2 -/NO 3 -) were examined by using ELISA and Griess assay respectively. The blood pressure and outcomes of pregnancies were followed up. Results In 120 initial normal pregnant women, 15 pregnant women were suffered from intrauterine growth retardation (IUGR group), 19 from pre-eclampsia (pre-eclampsia group), 86 subject to normal outcome (normal group) at follow up. Compared with normal group, the levels of plasma PLF were significantly decreased in IUGR group and pre-eclampsia group (P<0.01), and the levels of plasma NO were significantly increased (P<0.01). There were no significant difference in plasma PLF and NO levels between IUGR group and pre-eclampsic group (P>0.05). The negative correlation between plasma PLF and NO levels was observed(r=-0.329,P<0.01). The areas under ROC of PLF predicting IUGR and pre-eclampsia were 0.977 and 0.905 respectively. At the cut point of 400 μg/ml PLF level, Kappa index of PLF levels predicting the outcome of pregnancy with pre-eclampsia were 0.645. At the cut point of 390 μg/ml PLF level, Kappa index of PLF levels predicting the outcome of pregnancy with IUGR were 0.663, which indicated the predictive values were consisted with the real conditions. Conclusion The decrease of plasma PLF levels at earlier third trimester was associated with IUGR and pre-eclampsia, and the endothelial cell damage may be one of its mechanisms. The plasma PLF level can be used as an earlier predictor for screening of IUGR and pre-eclampsia.