子宫动脉多普勒超声血流参数评估孕晚期子痫前期产妇病情严重程度的价值
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摘要
目的探讨子宫动脉超声多普勒血流参数对孕晚期子痫前期产妇病情严重程度的评估价值。方法收集2014年1月-2016年12月在该院分娩的孕晚期子痫前期产妇78例作为观察组,另选取同期在该院分娩的健康孕晚期产妇50例作为对照组。应用彩色多普勒超声诊断仪测定两组产妇分娩前子宫动脉血流参数;采用酶联免疫吸附法(ELISA)测定分娩前血清中Th1/Th2细胞因子、氧化应激指标含量;采用放射免疫法测定分娩后胎盘碾磨液中滋养细胞侵袭指标的含量。采用Pearson检验评估子宫动脉超声多普勒血流参数对孕晚期子痫前期产妇炎症反应、氧化应激反应、滋养细胞侵袭能力的评估价值。结果观察组产妇分娩前子宫动脉超声多普勒血流参数血流搏动指数(PI)、阻力指数(RI)、收缩期与舒张期流速比(S/D)均显著高于对照组(P<0.05);观察组产妇分娩前血清中Th1细胞因子白细胞介素-12(IL-12)、干扰素γ(IFN-γ)含量显著高于对照组(P<0.05),Th2细胞因子IL-4、IL-6含量低于对照组(P<0.05);分娩前血清中氧化指标活性氧(ROS)、髓过氧化物酶(MPO)、丙二醛(MDA)含量高于对照组,抗氧化指标谷胱甘肽过氧化物酶(GSH-px)、过氧化氢酶(CAT)含量低于对照组;分娩后胎盘组织碾磨液中滋养细胞侵袭指标Endoglin、血管内皮细胞生长因子(VEGF)、VEGF受体蛋白(Flt-1)、胰岛素样生长因子-1(IGF-1)含量低于对照组(P<0.05)。经Pearson检验发现,孕晚期子痫前期产妇子宫动脉超声血流参数PI、RI、S/D水平与其炎症反应、氧化应激反应、滋养细胞侵袭能力直接相关。结论孕晚期子痫前期产妇存在子宫动脉超声多普勒血流参数水平异常,且其异常程度可客观反映产妇病情严重程度。
Objective To explore the value of uterine artery Doppler ultrasonography blood flow parameters in evaluation of severity of preeclampsia during the third trimester of pregnancy. Methods From January 2014 to December 2016,78 women with preeclampsia during the third trimester of pregnancy were selected from Xiaolan Hospital Affiliated to Southern Medical University as observation group,and50 healthy women during the third trimester of pregnancy were selected from the hospital as control group. Color Doppler ultrasonography was performed to detect uterine artery blood flow parameters before delivery in the two groups. ELISA was used to detect the levels of serum Th1/Th2 cytokines and oxidative stress indexes before delivery. Radioimmunoassay was used to detect the levels of placental trophoblast invasion indexes after delivery. Pearson test was used to evaluate the value of uterine artery Doppler ultrasonography blood flow parameters in evaluation of inflammatory response,oxidative stress reaction,and trophoblast invasion ability in preeclampsia women during the third trimester of pregnancy. Results Pulsatility index( PI),resistance index( RI),and the ratio of peak systolic velocity to end diastolic velocity( S/D)before delivery in observation group were statistically significantly higher than those in control group( P<0. 05). The levels of serum interleukin-12( IL-12) and interferon-γ( IFN-γ) before delivery in observation group were statistically significantly higher than those in control group( P<0. 05). The levels of serum IL-4 and IL-6 before delivery in observation group were statistically significantly lower than those in control group( P<0. 05). Before delivery,the levels of serum reactive oxygen species( ROS),myeloperoxidase( MPO),and malondialdehyde( MDA) in observation group were statistically significantly higher than those in control group( P<0. 05). The levels of serum glutathion peroxidase( GSH-px) and catalase( CAT) in observation group were statistically significantly lower than those in control group( P<0. 05). After delivery,the levels of Endoglin,vascular endothelial cell growth factor,Flt-1,and insulin-like growth factor-1( IGF-1) in observation group were statistically significantly lower than those in control group( P<0. 05). Pearson test showed that PI,RI,and S/D were directly related to inflammatory reaction,oxidative stress reaction,and trophoblast invasion ability in preeclampsia women during the third trimester of pregnancy. Conclusion The levels of uterine artery Doppler ultrasonography blood flow parameters are abnormal in preeclampsia women during the third trimester of pregnancy,and the degree can objectively reflect severity of the disease.
Objective To explore the value of uterine artery Doppler ultrasonography blood flow parameters in evaluation of severity of preeclampsia during the third trimester of pregnancy. Methods From January 2014 to December 2016,78 women with preeclampsia during the third trimester of pregnancy were selected from Xiaolan Hospital Affiliated to Southern Medical University as observation group,and50 healthy women during the third trimester of pregnancy were selected from the hospital as control group. Color Doppler ultrasonography was performed to detect uterine artery blood flow parameters before delivery in the two groups. ELISA was used to detect the levels of serum Th1/Th2 cytokines and oxidative stress indexes before delivery. Radioimmunoassay was used to detect the levels of placental trophoblast invasion indexes after delivery. Pearson test was used to evaluate the value of uterine artery Doppler ultrasonography blood flow parameters in evaluation of inflammatory response,oxidative stress reaction,and trophoblast invasion ability in preeclampsia women during the third trimester of pregnancy. Results Pulsatility index( PI),resistance index( RI),and the ratio of peak systolic velocity to end diastolic velocity( S/D)before delivery in observation group were statistically significantly higher than those in control group( P<0. 05). The levels of serum interleukin-12( IL-12) and interferon-γ( IFN-γ) before delivery in observation group were statistically significantly higher than those in control group( P<0. 05). The levels of serum IL-4 and IL-6 before delivery in observation group were statistically significantly lower than those in control group( P<0. 05). Before delivery,the levels of serum reactive oxygen species( ROS),myeloperoxidase( MPO),and malondialdehyde( MDA) in observation group were statistically significantly higher than those in control group( P<0. 05). The levels of serum glutathion peroxidase( GSH-px) and catalase( CAT) in observation group were statistically significantly lower than those in control group( P<0. 05). After delivery,the levels of Endoglin,vascular endothelial cell growth factor,Flt-1,and insulin-like growth factor-1( IGF-1) in observation group were statistically significantly lower than those in control group( P<0. 05). Pearson test showed that PI,RI,and S/D were directly related to inflammatory reaction,oxidative stress reaction,and trophoblast invasion ability in preeclampsia women during the third trimester of pregnancy. Conclusion The levels of uterine artery Doppler ultrasonography blood flow parameters are abnormal in preeclampsia women during the third trimester of pregnancy,and the degree can objectively reflect severity of the disease.
引文
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[11]周忠义,施蕾,谢晓红.子痫前期孕妇血清胆碱酯酶、炎症因子的变化及意义[J].中国妇幼保健,2015,30(23):3946-3949.
[12]Xuan RR,Niu TT,Chen HM.Astaxanthin blocks preeclampsia progression by suppressing oxidative stress and inflammation[J].Mol Med Rep,2016,14(3):2697-2704.
[13]de Sousa Rocha V,Della Rosa FB,Ruano R,et al.Association between magnesium status,oxidative stress and inflammation in preeclampsia:a case-control study[J].Clin Nutr,2015,34(6):1166-1171.
[14]Huang LL,Su S,Awale R,et al.Expression of anti-inflammatory mediator lipoxin A4 and inflammation responsive transcriptive factors NF-kappa B in patients with preeclampsia[J].Clin Exp Obstet Gynecol,2014,41(5):561-566.
[15]蒋惠玲,胥保梅,许颖.孕妇血清、脐血及胎盘组织中髓过氧化物酶水平和子痫前期发病的关系[J].中国妇幼保健,2016,31(19):3913-3916.
[16]谢晓芳,宋成凤.子痫前期患者ox LDL、8-isoprostane、MDA和MIF的检测及意义[J].南昌大学学报(医学版),2016,56(4):26-29.
[17]李爱金,章伟丽,陈再玲,等.子痫前期胎盘组织氧化应激和炎症反应状态及与新生儿预后的关系[J].实用医学杂志,2013,29(20):3365-3368.
[18]Hilali N,Kocyigit A,Demir M,et al.DNA damage and oxidative stress in patients with mild preeclampsia and offspring[J].Eur J Obstet Gynecol Reprod Biol,2013,170(2):377-380.
[19]车力凡,邵素芳,刘瑶.人血白蛋白联合小剂量肝素治疗重度子痫前期的临床疗效及其对胎盘组织中Endoglin、VEGF、Flt-1表达的影响[J].中国生化药物杂志,2014,34(4):157-160.
[20]张海芬,贾永森,李晓林,等.子痫前期患者胎盘组织中胰岛素样生长因子-1和胎盘生长因子的表达分析[J].中国煤炭工业医学杂志,2013,16(5):725-728.
[21]Jia Y,Li T,Huang X,et al.Dysregulated DNA methyltransferase 3A upregulates IGFBP5 to suppress trophoblast cell migration and invasion in preeclampsia[J].Hypertension,2017,69(2):356-366.
[22]Chen Y,Zhang Y,Deng Q,et al.Wnt5a inhibited human trophoblast cell line HTR8/SVneo invasion:implications for early placentation and preeclampsia[J].J Matern Fetal Neonatal Med,2016,29(21):3532-3538.
[23]Tong C,Feng X,Chen J,et al.G protein-coupled receptor 30regulates trophoblast invasion and its deficiency is associated withpreeclampsia[J].J Hypertens,2016,34(4):710-718.
[24]Cao C,Li J,Li J,et al.Long non-coding RNA Uc.187 is upregulated in preeclampsia and modulates proliferation,apoptosis,and invasion of htr-8/svneo trophoblast cells[J].J Cell Biochem,2017,118(6):1462-1470.
[2]Neto RM,Ramos JG.3D power Doppler ultrasound in early diagnosis of preeclampsia[J].Pregnancy Hypertens,2016,6(1):10-16.
[3]束萍凤,王鹏.子痫前期患者子宫动脉和肾动脉血流动力学评估及其与内皮功能、侵入功能的关系[J].海南医学院学报,2015,21(11):1532-1535.
[4]赵艳萍.彩色多普勒超声测定子痫前期患者子宫动脉S/D、PI、RI及其与病情严重程度的相关性[J].海南医学院学报,2016,22(12):1232-1235.
[5]李清阳,滕海英,黑艳,等.妊娠妇女子痫前期预测指标的临床研究[J].中国妇幼保健,2015,30(25):4295-4298.
[6]张秀群,关海兰.孕早中期血清β-HCG、s Flt-1、s Eng联合子宫动脉多普勒搏动指数预测子痫前期的诊断价值[J].广西医科大学学报,2015,32(3):448-451.
[7]Doˇgan K,Guraslan H,C'ankaya A,et al.Ischemia-modified albumin(IMA):a novel marker for preeclampsia independent of uterine artery notching identified by Doppler ultrasound[J].Hypertens Pregnancy,2015,34(4):516-524.
[8]Mihu CM,Drugan T,Mihu D.Contribution of 3D power Doppler ultrasound to the evaluation of placental circulation in normal pregnancies and pregnancies complicated by preeclampsia[J].J Perinat Med,2012,40(4):359-364.
[9]吕艳关,赵玉杰,魏红.IL-12、IFN-γ、IL-10、IL-4和Th1/Th2在子痫前期孕妇血清中的表达水平及其意义[J].蚌埠医学院学报,2016,41(6):805-808.
[10]宋亦军,刘俊涛.炎症与子痫前期[J].中国计划生育和妇产科,2013,5(6):22-25.
[11]周忠义,施蕾,谢晓红.子痫前期孕妇血清胆碱酯酶、炎症因子的变化及意义[J].中国妇幼保健,2015,30(23):3946-3949.
[12]Xuan RR,Niu TT,Chen HM.Astaxanthin blocks preeclampsia progression by suppressing oxidative stress and inflammation[J].Mol Med Rep,2016,14(3):2697-2704.
[13]de Sousa Rocha V,Della Rosa FB,Ruano R,et al.Association between magnesium status,oxidative stress and inflammation in preeclampsia:a case-control study[J].Clin Nutr,2015,34(6):1166-1171.
[14]Huang LL,Su S,Awale R,et al.Expression of anti-inflammatory mediator lipoxin A4 and inflammation responsive transcriptive factors NF-kappa B in patients with preeclampsia[J].Clin Exp Obstet Gynecol,2014,41(5):561-566.
[15]蒋惠玲,胥保梅,许颖.孕妇血清、脐血及胎盘组织中髓过氧化物酶水平和子痫前期发病的关系[J].中国妇幼保健,2016,31(19):3913-3916.
[16]谢晓芳,宋成凤.子痫前期患者ox LDL、8-isoprostane、MDA和MIF的检测及意义[J].南昌大学学报(医学版),2016,56(4):26-29.
[17]李爱金,章伟丽,陈再玲,等.子痫前期胎盘组织氧化应激和炎症反应状态及与新生儿预后的关系[J].实用医学杂志,2013,29(20):3365-3368.
[18]Hilali N,Kocyigit A,Demir M,et al.DNA damage and oxidative stress in patients with mild preeclampsia and offspring[J].Eur J Obstet Gynecol Reprod Biol,2013,170(2):377-380.
[19]车力凡,邵素芳,刘瑶.人血白蛋白联合小剂量肝素治疗重度子痫前期的临床疗效及其对胎盘组织中Endoglin、VEGF、Flt-1表达的影响[J].中国生化药物杂志,2014,34(4):157-160.
[20]张海芬,贾永森,李晓林,等.子痫前期患者胎盘组织中胰岛素样生长因子-1和胎盘生长因子的表达分析[J].中国煤炭工业医学杂志,2013,16(5):725-728.
[21]Jia Y,Li T,Huang X,et al.Dysregulated DNA methyltransferase 3A upregulates IGFBP5 to suppress trophoblast cell migration and invasion in preeclampsia[J].Hypertension,2017,69(2):356-366.
[22]Chen Y,Zhang Y,Deng Q,et al.Wnt5a inhibited human trophoblast cell line HTR8/SVneo invasion:implications for early placentation and preeclampsia[J].J Matern Fetal Neonatal Med,2016,29(21):3532-3538.
[23]Tong C,Feng X,Chen J,et al.G protein-coupled receptor 30regulates trophoblast invasion and its deficiency is associated withpreeclampsia[J].J Hypertens,2016,34(4):710-718.
[24]Cao C,Li J,Li J,et al.Long non-coding RNA Uc.187 is upregulated in preeclampsia and modulates proliferation,apoptosis,and invasion of htr-8/svneo trophoblast cells[J].J Cell Biochem,2017,118(6):1462-1470.