血浆中D-二聚体、vWF预测早发型子痫前期价值
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摘要
目的:探讨广西桂西地区早发型子痫前期妇女血浆中D-二聚体(D-D)、血管性血友病因子(vWF)水平及临床意义。方法:将本院产前检查妊娠期高血压疾病孕妇179例分为早发型子痫前期孕妇(早发型子痫前期组)69例和单纯妊娠高血压孕妇(妊娠期高血压组)110例,另选择85例正常孕妇作为对照组,于孕10～15~(+6)周时抽取外周脉血,检测各组血浆D-D、vWF水平,ROC曲线分析该两项指标对早发型子痫前期的预测价值。结果:早发型子痫前期组SBP、DBP、新生儿出生体质量、1分钟Apgar评分低于妊娠高血压组和对照组,D-D、vWF含量早发型子痫前期组>妊娠期高血压组>对照组(均P<0.05)。早发型子痫前期组血浆D-D、vWF含量与新生儿出生体质量、1分钟Apgar评分等无相关性(P>0.05),与SBP、DBP呈正相关(P<0.05)。D-D、vWF联合预测早发型子痫前期的AUC(0.898)高于D-D(0.729)、vWF(0.793)单项检测。结论:早发型子痫前期孕妇血浆D-D、vWF显著升高,联合检测对早发型子痫前期有预测价值。
Objective: To explore the levels of plasma D-Dimer(D-D) and vonWillebrand factor(vWF) of pregnant women with early onset preeclampsia in western area of Guangxi city, and to study its clinical significance. Methods: A total of 179 pregnant women with pregnancy induced hypertension were divided into group A(69 early onset preeclampsia) and group B(110 women with pregnancy induced hypertension), and another 85 normal pregnant women were selected into group C. 3 mL of peripheral venous blood of all included women were extracted at 10-15~(+6) gestational?倓weeks, and the levels of plasma D-D and vWF were measured and compared among the three groups. The predict value of plasma D-D and vWF levels for early onset preeclampsia were analyzed by ROC curve. Results: The values of SBP and DBP of women in group A were significant higher than those of women in group B and group C, and the neonatal birth weight and the 1 minute Apgar score were significant lower(P<0.05). The levels of D-D and vWF of women in group A were the highest, but those of women in group C were the lowest(P<0.05). In group A, levels of plasma D-dimer and vWF were no significant related to the neonatal birth weight, 1 minute Apgar score(P>0.05), but were positively correlated with values of SBP and DBP(P<0.05). The AUC of D-D level combined with vWF level for predicting early onset preeclampsia was 0.898, which was significant higher than that of D-D level(0.729) or vWF level(0.793) only. Conclusion: The plasma levels of D-D and vW of pregnant women with early onset preeclampsia significantly increased, and the detection of levels of D-D combined with vWF can improve the predictive value of pregnant women with early onset preeclampsia in western area of Guangxi city.
Objective: To explore the levels of plasma D-Dimer(D-D) and vonWillebrand factor(vWF) of pregnant women with early onset preeclampsia in western area of Guangxi city, and to study its clinical significance. Methods: A total of 179 pregnant women with pregnancy induced hypertension were divided into group A(69 early onset preeclampsia) and group B(110 women with pregnancy induced hypertension), and another 85 normal pregnant women were selected into group C. 3 mL of peripheral venous blood of all included women were extracted at 10-15~(+6) gestational?倓weeks, and the levels of plasma D-D and vWF were measured and compared among the three groups. The predict value of plasma D-D and vWF levels for early onset preeclampsia were analyzed by ROC curve. Results: The values of SBP and DBP of women in group A were significant higher than those of women in group B and group C, and the neonatal birth weight and the 1 minute Apgar score were significant lower(P<0.05). The levels of D-D and vWF of women in group A were the highest, but those of women in group C were the lowest(P<0.05). In group A, levels of plasma D-dimer and vWF were no significant related to the neonatal birth weight, 1 minute Apgar score(P>0.05), but were positively correlated with values of SBP and DBP(P<0.05). The AUC of D-D level combined with vWF level for predicting early onset preeclampsia was 0.898, which was significant higher than that of D-D level(0.729) or vWF level(0.793) only. Conclusion: The plasma levels of D-D and vW of pregnant women with early onset preeclampsia significantly increased, and the detection of levels of D-D combined with vWF can improve the predictive value of pregnant women with early onset preeclampsia in western area of Guangxi city.
引文
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[13] 任春丽,唐兴国,任磊,等.脐血AnnexinV、ET-1、vWF在子痫前期患者的表达及其与胎儿生长受限的关系[J].中国妇幼保健,2014,29(25):4168-4171.
[14] 许靖,李秋平,孔祥永,等.胎盘早剥早产儿脐血与产妇静脉血血管性血友病因子及其裂解酶水平的变化[J].实用儿科临床杂志,2012,27(23):1788-1790.
[15] Stepanian A,Cohen-Moatti M,Sanglier T,et al.VonWillebrand Factor and ADAMTS13:A Candidate Couple for Preeclampsia Pathophysiology[J].ArteriosclerThrombVasc Biol,2011,31(7):1703-1709.
[16] 赵顺锋,高春海,范存士,等.血清 PDGF-BB 和 sFlt-1及 U-Ⅱ检测在子痫前期患者中的应用[J].中华检验医学杂志,2015,(8):528-531.
[2] 李凤秋,杨孜,张爱青,等.妊娠中期初血游离脂肪酸、血脂水平和子宫动脉切迹与子痫前期的关系[J].中华围产医学杂志,2014,17(3):180-185.
[3] 谢幸,苟文丽.妇产科学[M].8版.北京人民卫生出版社2013:64-73.
[4] 郑爱梅.早发型子痫前期发病机制与预测[J].中国妇幼保健,2012,27(22):3527-3530.
[5] 杨丽萍,冯海芹,候俊德,等.可溶性endoslin 及可溶性血管内皮生长因子受体-1 的表达与早发型子痫前期的关系[J].实用医学杂志,2013,29(3):442-443.
[6] 覃志坚,龙显科,王俊利,等.596例壮族人群-地中海贫血基因突变类型分析[J].中国实验诊断学,2011,10(15):1668-1670.
[7] 莫洁玲,周容,黄颖红,等.预防艾滋病母婴传播干预措施的调查研究—以广西农村地区为例[J].医学与哲学,2015,36(23):38-40.
[8] De Oliveira CA,de Sa RA,Velarde LG,et al.Changes in ophthalmic artery doppler indices in hypertensive disorders during pregnancy[J].J Ultrasound Med,2013,32(4):609-616.
[9] Boyd HA,Tahir H,WohlfahrtJ,et al.Associations of personal and family preeclampsia historywith the risk of early-,intermediate- and late-onset preeclampsia[J].Am J Epidemiol,2013,178(11):1611-1619.
[10] PinheiroMde B,Junqueira DR,Coelho FF,et al.D-dimer in preeclampsia:Systematic review and meta-analysis[J].Clin Chim Acta,2012,414:166-170.
[11] Marcq G,Beaugr D,Tournoys A,et al.Evaluation of D-dimer as a marker for severity in pregnancies with preeclampsia[J].GynecolObstetFertil,2014,42(6):393-398.
[12] Aref S,Goda H.Increased VWF antigen levels and decreased ADAMTS13 activity in preeclampsia[J].Hematology,2013,18(4):237-241.
[13] 任春丽,唐兴国,任磊,等.脐血AnnexinV、ET-1、vWF在子痫前期患者的表达及其与胎儿生长受限的关系[J].中国妇幼保健,2014,29(25):4168-4171.
[14] 许靖,李秋平,孔祥永,等.胎盘早剥早产儿脐血与产妇静脉血血管性血友病因子及其裂解酶水平的变化[J].实用儿科临床杂志,2012,27(23):1788-1790.
[15] Stepanian A,Cohen-Moatti M,Sanglier T,et al.VonWillebrand Factor and ADAMTS13:A Candidate Couple for Preeclampsia Pathophysiology[J].ArteriosclerThrombVasc Biol,2011,31(7):1703-1709.
[16] 赵顺锋,高春海,范存士,等.血清 PDGF-BB 和 sFlt-1及 U-Ⅱ检测在子痫前期患者中的应用[J].中华检验医学杂志,2015,(8):528-531.