Analysis of factors related to postpartum depression in pregnancyinduced hypertension syndrome patients and construction and evaluation of nomograms

BACKGROUND It is positive to integrate and evaluate the risk factors for postpartum depression in patients with pregnancy-induced hypertension syndrome and to detect highrisk patients as early as possible,which has application value for the clinical development of personalized prevention programs and prognosis of patients.AIM To analyze factors related to postpartum depression in patients with pregnancyinduced hypertension and construct and evaluate a nomogram model.METHODS The clinical data of 276 patients with pregnancy-induced hypertension admitted to Huzhou Maternity and Child Health Care Hospital between January 2017 and April 2022 were retrospectively analyzed.We evaluated the depression incidence at 6 wk postpartum.The depression group included patients with postpartum depression,and the remainder were in the non-depression group.Multivariate logistic regression analysis and the LASSO regression model were applied to analyze the factors related to postpartum depression in patients with pregnancyinduced hypertension.After that,a risk prediction model nomogram was constructed and evaluated.RESULTS Multivariate logistic regression analysis showed that vitamin A deficiency(VAD)during pregnancy and puerperium,family history of hypertension,maternal intestinal flora imbalance,eicosapentaenoic acid(EPA),and docosahexaenoic acid(DHA)were independent risk factors for postpartum depression in patients with pregnancy-induced hypertension(P<0.05).We constructed the nomogram model based on these five risk factors.The area under the curve,specificity,and sensitivity of the model in predicting postpartum depression in patients with pregnancy-induced hypertension was 0.867(95%confidence interval:0.828–0.935),0.676,and 0.889,respectively.The average absolute error was 0.037(Hosmer-Lemeshow testχ2=10.739,P=0.217).CONCLUSION VAD during pregnancy and puerperium,family history of hypertension,maternal intestinal flora imbalance,EPA,and DHA affect postpartum depression in patients with pregnancy-induced hypertension.

Isolated proteinuria as an initial sign of severe preeclampsia

Two pregnant women who initially developed proteinuria alone followed by serious preeclampsia are presented to emphasize that there is no adequate technical term to express the period of proteinuria alone based on the current criteria of pregnancy-induced hypertension. Case 1 exhibited a urinary protein concentration of 46 mg/dL in the absence of hypertension, and abdominal pain due to placental abruption with hypertension at gestational week (GW) 29–3/7 and 29–4/7, respectively. Case 2 exhibited a urinary protein/creatinine ratio of 2.67, developed hypertension, required cesarean section, and developed posterior reversible encephalopathy syndrome at GW 28–1/7, 29–6/7, and 32–0/7, and on postpartum day 2, respectively. As women with proteinuria alone are not diagnosed as having preeclampsia and as a diagnosis of gestational proteinuria can be made only at 12 weeks postpartum, a prospective technical term applicable to the condition of proteinuria alone is needed to increase physicians’ attention to this condition.

低蛋白血症和蛋白尿对妊高征围产期结局的影响

目的探讨低蛋白血症、尿蛋白的丢失对妊娠高血压综合征(妊高征)患者围产期结局的影响。方法对妊高征患者110例和60例正常妊娠对照组的血清总蛋白、白蛋白和24h尿蛋白定量,进行对照分析及相关性分析。结果①妊高征组的剖宫产率、围产儿死亡率明显高于对照组,早产儿出生明显增多,而新生儿出生体重低于正常对照组;②妊高征组血清总蛋白和白蛋白含量明显低于正常对照组,24h尿蛋白定量明显高于正常对照组;③校正孕龄后的相关性分析表明,白蛋白与新生儿体重有明显正相关性,随着24h尿蛋白量的增加,新生儿体重渐降低,两者呈明显负相关性。结论妊高征患者低蛋白血症及尿蛋白的丢失与其病情及围产儿预后密切相关,可以作为妊高征的临床监测指标,指导正确诊断、治疗和处理,适时终止妊娠,达到降低孕产妇及围生儿的死亡率,改善母婴预后的目的。

Increased apoptosis in third - trimester placental tissue from gestations complicat-ed by PIH

Objective: To investigate a possible role of apoptosis in the pathophysiologic mechanisms of PIH (pregnancy-induced hypertension syndrome).Methods: In this study, placental samples were obtained from 16 uncomplicated third-trimester pregnancies and from 16 cases of PIH.We used light microscopy, electron microscopy to identify apoptosis.Light microscopy was used to quantify their incidence of apoptosis.Electron microscopy was used to confirm the occurrence of apoptosis.Results: Apoptosis has been conclusively demonstrated within human third-trimester placental tissue.Medians and interquartile ranges of normal placenta (n=16) was 0.12% (0.08%-0.19%); Medians and interquartile ranges of PIH group (n=16) was 0.37% (0.15%-0.49%).Compared to normal placentas, the incidence of apoptosis was higher in placentas from gestations complicated by PIH (P<0.05, T'-test).Conclusion: Placental apoptosis increases significantly in PIH, and it may play a role in the pathophysiologic mechanisms of this syndrome.

丹皮酚对高血压病血瘀证患者血清干预的人脐静脉内皮细胞膜联蛋白V与肌动蛋白结合的影响

目的:研究丹皮酚对高血压病血瘀证患者血清损伤后的血管内皮细胞(VEC)的膜联蛋白V与肌动蛋白结合的表达的影响,进一步探讨丹皮酚保护VEC的作用机制。方法:运用CCK-8法检测丹皮酚不同浓度25、50、100、250、500、1 000mg/L对人脐静脉内皮细胞活性的影响;选用250mg/L浓度的丹皮酚预干预细胞模型,运用免疫印记杂交技术检测丹皮酚组与对照组膜联蛋白V与肌动蛋白结合的表达。结果:丹皮酚不同浓度对细胞活性的影响:不同浓度组之间比较,差异无统计学意义。250mg/L丹皮酚干预后对与肌动蛋白结合的膜联蛋白V表达的影响:模型对照组、丹皮酚组与肌动蛋白结合的膜联蛋白V的表达逐渐降低,其中每组与肌动蛋白结合的膜联蛋白V的表达呈现血瘀证组、非血瘀证组、正常组逐渐降低的趋势。血瘀证组,丹皮酚组与模型对照组比较,差异有统计学意义(P<0.05)。结论:丹皮酚具有保护人脐静脉内皮细胞完整性的作用,其机制可能是通过降低肌动蛋白G/F含量比值的方式,减少膜联蛋白V与肌动蛋白的结合,促进肌动蛋白的重装。