重度子痫前期患者血清补体因子D、补体C5a的表达及与肾功能和平均动脉压的相关性分析
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摘要
目的探讨重度子痫前期患者血清补体因子D (CFD)、补体C5a的表达及其与肾功能和平均动脉压的相关性,为临床诊治提供参考依据。方法选取2016年2月-2017年10月在长沙市中医医院接受治疗的重度子痫前期患者62例作为观察组,另选取同期正常单胎足月妊娠孕妇40例作为对照组。比较两组患者血清中尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、胱抑素C (Cys-C)的水平以及肌酐清除率(CCr)、24 h尿蛋白总量、平均动脉压,比较两组患者血清中CFD、补体C5a的水平,采用Pearson相关系数分析重度子痫前期患者血清中CFD、补体C5a的表达与肾功能和平均动脉压的相关性。结果观察组血清中BUN、Cr、UA、Cys-C水平以及24 h尿蛋白总量、平均动脉压均显著高于对照组,CCr显著低于对照组,差异有统计学意义(均P<0. 05);观察组血清中CFD、补体C5a水平显著高于对照组,差异有统计学意义(均P<0. 05);重度子痫前期患者血清中CFD、补体C5a与Cr、UA、Cys-C、24h尿蛋白总量、平均动脉压呈正相关(P<0. 05),与CCr呈负相关(P<0. 05)。结论重度子痫前期患者肾功能明显受损,平均动脉压显著升高,且其血清中CFD、补体C5a水平明显上升,CFD、补体C5a与患者的肾功能和平均动脉压密切相关。
Objective To explore the expressions of serum complement factor D( CFD) and complement C5 a in patients with severe preeclampsia and the relationships with renal function and mean arterial pressure,provide a reference basis for clinical diagnosis and treatment. Methods Sixty-two patients with severe preeclampsia who were treated in Changsha Hospital of Traditional Chinese Medicine from February 2016 to October 2017 were selected as observation group,and 40 normal singleton full-term pregnant women during the same period were selected as control group. The levels of serum urea nitrogen( BUN),creatinine( Cr),uric acid( UA),Cystatin C( Cys-C),creatinine clearance rate( CCr),total amount of 24-hour urine protein,and mean arterial pressure were compared between the two groups,the levels of serum CFD and complement C5 a in the two groups were compared,and the correlation between the expressions of serum CFD and complement C5 a in patients with severe preeclampsia and renal function,mean arterial pressure were analyzed by Pearson correlation coefficient analysis. Results The levels of serum BUN,Cr,UA,Cys-C,and total amount of 24-hour urine protein,and mean arterial pressure in observation group were statistically significantly higher than those in control group,while CCr in observation group was statistically significantly lower than that in control group( P<0. 05). The levels of serum CFD and complement C5 a in observation group were statistically significantly higher than those in control group( P<0. 05). The levels of serum CFD and complement C5 a in patients with severe preeclampsia were positively correlated with Cr,UA,Cys-C,the total amount of 24-hour urine protein,and mean arterial pressure( P< 0. 05),which was negatively correlated with CCr( P<0. 05). Conclusion Renal function of patients with severe preeclampsia is significantly impaired,mean arterial pressure increases significantly,the levels of serum CFD and complement C5 a increase significantly. CFD and complement C5 a are closely related to renal function and mean arterial pressure.
Objective To explore the expressions of serum complement factor D( CFD) and complement C5 a in patients with severe preeclampsia and the relationships with renal function and mean arterial pressure,provide a reference basis for clinical diagnosis and treatment. Methods Sixty-two patients with severe preeclampsia who were treated in Changsha Hospital of Traditional Chinese Medicine from February 2016 to October 2017 were selected as observation group,and 40 normal singleton full-term pregnant women during the same period were selected as control group. The levels of serum urea nitrogen( BUN),creatinine( Cr),uric acid( UA),Cystatin C( Cys-C),creatinine clearance rate( CCr),total amount of 24-hour urine protein,and mean arterial pressure were compared between the two groups,the levels of serum CFD and complement C5 a in the two groups were compared,and the correlation between the expressions of serum CFD and complement C5 a in patients with severe preeclampsia and renal function,mean arterial pressure were analyzed by Pearson correlation coefficient analysis. Results The levels of serum BUN,Cr,UA,Cys-C,and total amount of 24-hour urine protein,and mean arterial pressure in observation group were statistically significantly higher than those in control group,while CCr in observation group was statistically significantly lower than that in control group( P<0. 05). The levels of serum CFD and complement C5 a in observation group were statistically significantly higher than those in control group( P<0. 05). The levels of serum CFD and complement C5 a in patients with severe preeclampsia were positively correlated with Cr,UA,Cys-C,the total amount of 24-hour urine protein,and mean arterial pressure( P< 0. 05),which was negatively correlated with CCr( P<0. 05). Conclusion Renal function of patients with severe preeclampsia is significantly impaired,mean arterial pressure increases significantly,the levels of serum CFD and complement C5 a increase significantly. CFD and complement C5 a are closely related to renal function and mean arterial pressure.
引文
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[16]Song NJ,Kim S,Jang BH,et al.Small Molecule-Induced Complement Factor D(Adipsin)Promotes Lipid Accumulation and Adipocyte Differentiation[J].PLoS One,2016,11(9):e0162228.
[17]Burwick RM,Easter SR,Dawood HY,et al.Complement activation and kidney injury molecule-1-associated proximal tubule injury in severe preeclampsia[J].Hypertension,2014,64(4):833-838.
[18]徐冰凝,赫英东,陈倩.早发型和晚发型重度子痫前期的异常补体激活[J].中国妇产科临床杂志,2015,16(2):119-122.
[19]He Y,Xu B,Song D,et al.Expression of the complement system's activation factors in plasma of patients with early/late-onset severe pre-eclampsia[J].Am J Reprod Immunol,2016,76(3):205-211.
[2]温永芬,鲁照明,涂素华,等.硫酸镁联合酚妥拉明治疗重度子痫前期合并左心衰的效果[J].现代生物医学进展,2016,16(36):7070-7073.
[3]Yuvaci HU,Akdemir N,Bostanci MS,et al.Evaluation of the level of thiol-disulphide homeostasis in patients with mild and severe preeclampsia[J].Pregnancy Hypertens,2016,6(4):394-399.
[4]徐冰凝,赫英东,陈倩,等.补体系统在子痫前期发病中的作用[J].现代妇产科进展,2015,24(8):628-630,633.
[5]布威海丽且姆·阿巴拜科日,依米提·热合曼,阿丽叶古丽·艾皮热,等.CFD基因在宫颈鳞癌及癌前病变组织中的表达水平及意义[J].医学分子生物学杂志,2013,10(2):109-113.
[6]Ye Y,Kong Y,Zhang Y.Complement split products c3a/c5a and receptors:are they regulated by circulating angiotensin II type 1 receptor autoantibody in severe preeclampsia?[J].Gynecol Obstet Invest,2016,81(1):28-33.
[7]Denny KJ,Coulthard LG,Finnell RH,et al.Elevated complement factor C5a in maternal and umbilical cord plasma in preeclampsia[J].J Reprod Immunol,2013,97(2):211-216.
[8]谢幸,苟文丽.妇产科学[M].第8版,北京:人民卫生出版社,2013:64-71.
[9]王咏梅,崔月欣,范立加,等.产前监测血清脂氧素A4和热休克蛋白70水平对诊断子痫前期的临床价值[J].中国现代医学杂志,2017,27(21):109-112.
[10]Piccoli GB,Cabiddu G,Castellino S,et al.A best practice position statement on the role of the nephrologist in the prevention and follow-up of preeclampsia:the Italian study group on kidney and pregnancy[J].J Nephrol,2017,30(3):307-317.
[11]陈凤.重度子痫前期肾功能损害对患者及胎儿预后的影响[J].中国实用神经疾病杂志,2015,18(15):90-91.
[12]赫英东,陈倩.补体系统检测在妊娠期高血压性疾病诊治中的临床价值[J].中华检验医学杂志,2017,40(9):667-671.
[13]He Y,Xu B,Song D,et al.Correlations between complement system's activation factors and anti-angiogenesis factors in plasma of patients with early/late-onset severe preeclampsia[J].Hypertens Pregnancy,2016,35(4):499-509.
[14]Qing X,Redecha PB,Burmeister MA,et al.Targeted inhibition of complement activation prevents features of preeclampsia in m):532-ice[J].Kidney Int,2011,79(3):331-339.
[15]袁程艳,杨晓.补体调节障碍与肾小球疾病[J].临床肾脏病杂志,2013,13(12):532-534.
[16]Song NJ,Kim S,Jang BH,et al.Small Molecule-Induced Complement Factor D(Adipsin)Promotes Lipid Accumulation and Adipocyte Differentiation[J].PLoS One,2016,11(9):e0162228.
[17]Burwick RM,Easter SR,Dawood HY,et al.Complement activation and kidney injury molecule-1-associated proximal tubule injury in severe preeclampsia[J].Hypertension,2014,64(4):833-838.
[18]徐冰凝,赫英东,陈倩.早发型和晚发型重度子痫前期的异常补体激活[J].中国妇产科临床杂志,2015,16(2):119-122.
[19]He Y,Xu B,Song D,et al.Expression of the complement system's activation factors in plasma of patients with early/late-onset severe pre-eclampsia[J].Am J Reprod Immunol,2016,76(3):205-211.