子痫前期与妊娠合并慢性肾脏病孕妇血清同型半胱氨酸、β_2微球蛋白和铁蛋白水平比较
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摘要
目的比较子痫前期(PE)与妊娠合并慢性肾脏病孕妇的血清同型半胱氨酸(Hcy)、β2微球蛋白及铁蛋白水平的差异及其与分娩孕周的相关性。方法收集2017年2月至2018年2月于汉中市中心医院产科住院的孕妇共136例,其中PE孕妇(PE组) 53例,妊娠合并慢性肾脏病孕妇(肾脏病组) 39例,正常孕妇(对照组) 44例,分别检测并比较三组孕妇血清中Hcy、β2微球蛋白及铁蛋白的水平,并分析PE与妊娠合并肾脏病孕妇血清Hcy、β2微球蛋白及铁蛋白水平与分娩孕周的相关性。结果 (1)三组孕妇的血清Hcy、β2微球蛋白、铁蛋白水平比较:肾脏病组孕妇的血清Hcy水平明显高于PE组及对照组[(8.85±1.98)μmol/L vs (6.21±1.31)μmol/L,(4.21±0.98)μmol/L],血清β2微球蛋白水平显著高于PE组及对照组[(4.2±2.3) mg/L vs (2.9±0.8) mg/L,(1.7±0.3) mg/L],血清铁蛋白水平显著低于PE组及对照组[(3.0±0.8) g/L vs (3.7±1.1) g/L,(3.6±0.6) g/L],差异均有显著统计学意义(P<0.01);(2) PE组孕妇血清Hcy、β2微球蛋白及铁蛋白水平与分娩孕周的相关性:PE组分娩孕周与Hcy水平无相关性(P>0.05),与β2微球蛋白水平呈负相关(r=-0.412,P=0.031),与铁蛋白水平正相关(r=0.368,P=0.030);(3)肾脏病组孕妇血清Hcy、β2微球蛋白及铁蛋白水平与分娩孕周的相关性:肾脏病组孕妇分娩孕周与Hcy及β2微球蛋白水平呈负相关(Hcy:r=-0.575,P<0.01;β2微球蛋白:r=-0.602,P<0.01),与铁蛋白水平呈明显正相关(r=0.287,P=0.098)。结论 PE与妊娠合并慢性肾脏病孕妇血清Hcy、β2微球蛋白、铁蛋白的水平存在明显差异,且与分娩孕周相关性不一致,可为PE与妊娠合并慢性肾脏病的诊断提供参考。
Objective To observe the difference of serum homocysteine(Hcy), β2-microglobulin, and ferritin in pre-eclampsia(PE) and pregnancies complicated with chronic kidney disease. Methods A total of 136 cases of pregnant woman delivered in Hanzhong Central Hospital from February 2017 to February 2018 were recruited in this study,including 53 cases of pregnancies with PE(PE group), 39 cases of pregnancies with chronic kidney disease(chronic kidney disease group), and 44 cases of normal pregnancies with normal blood pressure and proteinuria without any complication(control group). Serum homocysteine, β2-microglobulin, and ferritin levels were detected. Correlation tests were conducted between these indicators and delivery weeks. Results(1) Comparison of serum homocysteine, β2-microglobulin and ferritin levels in three groups: serum homocysteine level in chronic kidney disease group was(8.85±1.98) μmol/L, significantly higher than(6.21±1.31) μmol/L in PE group and(4.21±0.98) μmol/L in control group(P<0.01); serum β2-microglobulin in chronic kidney disease group was(4.2±2.3) mg/L, significantly higher than(2.9±0.8) mg/L in PE group and(1.7±0.3)mg/L in control group(P<0.01); serum ferritin in chronic kidney disease group was(3.0±0.8) g/L, significantly lower than(3.7±1.1) g/L in PE group and(3.6±0.6) g/L in control group(P<0.01).(2) The correlation between serum homocysteine, β2-microglobulin, ferritin and delivery weeks in PE group: delivery weeks were not correlated with serum homocysteine(P>0.05), but was negatively correlated with β2-microglobulin(r=-0.412, P=0.031) and positively correlated with ferritin(r=0.368, P=0.030).(3) The correlation between serum homocysteine, β2-microglobulin, ferritin and delivery weeks in chronic kidney disease group: delivery weeks were negatively correlated with serum homocysteine, β2-microglobulin(homocysteine: r=-0.575, β2-microglobulin:r=-0.602, both P<0.01), and positively correlated with ferritin(r=0.287, P=0.098). Conclusion The serum levels of homocysteine, β2-microglobulin, and ferritin in PE and pregnancies with chronic kidney disease are significantly different, which may provide clinical value for the diagnosis of PE and pregnancies with chronic kidney disease in future.
Objective To observe the difference of serum homocysteine(Hcy), β2-microglobulin, and ferritin in pre-eclampsia(PE) and pregnancies complicated with chronic kidney disease. Methods A total of 136 cases of pregnant woman delivered in Hanzhong Central Hospital from February 2017 to February 2018 were recruited in this study,including 53 cases of pregnancies with PE(PE group), 39 cases of pregnancies with chronic kidney disease(chronic kidney disease group), and 44 cases of normal pregnancies with normal blood pressure and proteinuria without any complication(control group). Serum homocysteine, β2-microglobulin, and ferritin levels were detected. Correlation tests were conducted between these indicators and delivery weeks. Results(1) Comparison of serum homocysteine, β2-microglobulin and ferritin levels in three groups: serum homocysteine level in chronic kidney disease group was(8.85±1.98) μmol/L, significantly higher than(6.21±1.31) μmol/L in PE group and(4.21±0.98) μmol/L in control group(P<0.01); serum β2-microglobulin in chronic kidney disease group was(4.2±2.3) mg/L, significantly higher than(2.9±0.8) mg/L in PE group and(1.7±0.3)mg/L in control group(P<0.01); serum ferritin in chronic kidney disease group was(3.0±0.8) g/L, significantly lower than(3.7±1.1) g/L in PE group and(3.6±0.6) g/L in control group(P<0.01).(2) The correlation between serum homocysteine, β2-microglobulin, ferritin and delivery weeks in PE group: delivery weeks were not correlated with serum homocysteine(P>0.05), but was negatively correlated with β2-microglobulin(r=-0.412, P=0.031) and positively correlated with ferritin(r=0.368, P=0.030).(3) The correlation between serum homocysteine, β2-microglobulin, ferritin and delivery weeks in chronic kidney disease group: delivery weeks were negatively correlated with serum homocysteine, β2-microglobulin(homocysteine: r=-0.575, β2-microglobulin:r=-0.602, both P<0.01), and positively correlated with ferritin(r=0.287, P=0.098). Conclusion The serum levels of homocysteine, β2-microglobulin, and ferritin in PE and pregnancies with chronic kidney disease are significantly different, which may provide clinical value for the diagnosis of PE and pregnancies with chronic kidney disease in future.
引文
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[11] KIENAST C, MOYA W, RODRIGUEZ O, et al. Predictive value of angiogenic factors, clinical risk factors and uterine artery Doppler for pre-eclampsia and fetal growth restriction in second and third trimester pregnancies in an Ecuadorian population[J]. J Matern Fetal Neonatal Med, 2016, 29(4):537-543.
[12] TAN MY, POON LC, ROLNIK DL, et al. Prediction and prevention of small-for-gestational-age neonates:evidence from SPREE and ASPRE[J]. Ultrasound Obstet Gynecol, 2018, 52(1):52-59.
[13]郭晗,张云聪,杨硕,等.子痫前期发病机制的研究进展[J].临床检验杂志, 2018, 36(6):439-443.
[14] KHARB S, NANDA S. Patterns of biomarkers in cord blood during pregnancy and preeclampsia[J]. Curr Hypertens Rev, 2017, 13(1):57-64.
[15]孙黎,俞菁,俞琼琰,等.同型半胱氨酸和胱抑素C对先兆子痫的预测价值[J].标记免疫分析与临床, 2016, 23(4):392-394.
[16]余敏,陈道平,文静.老年缺铁性贫血患者体液免疫和细胞免疫功能的变化[J].贵州医科大学学报, 2018, 43(6):698-702.
[17]索海燕,刘增佑,马春艺.高龄孕产妇血清铁蛋白和LDH水平与子痫前期和妊娠结局的关系[J].河北医药, 2017, 39(9):1327-1330.
[18] SHOJI T, NIIHATA K, FUKUMA S, et al. Both low and high serum ferritin levels predict mortality risk in hemodialysis patients without inflammation[J]. Clin Exp Nephrol, 2017, 21(4):685-693.
[2] ABALOS E, CUESTA C, GROSSO AL, et a1. Global and regional estimates of preeclampsia and eclampsia:a systematic review[J]. Eur J Obstet Gynecol Reprod Biol, 2013, 170(1):1-7.
[3]李笑天.子痫前期临床诊断和处理的循证思维[J].中华围产医学杂志, 2018, 21(4):228-232.
[4]张丽洁,张爱华.子痫前期患者的肾脏远期预后随访调查[J].中国血液净化, 2017, 16(6):397-402.
[5] CABIDDU G, CASTELLINO S, GERNONE G. A best practice position statement on pregnancy in chronic kidney disease:the Italian Study Group on Kidney and Pregnancy[J]. J Nephrol, 2016, 29(3):277-303.
[6] SERRANO NC, QUINTERO-LESMES DC, BECERRA-BAYONA S, et al. Association of pre-eclampsia risk with maternal levels of folate, homocysteine and vitamin B12 in Colombia:A case-control study[J]. PLoS One, 2018, 13(12):e0208137.
[7] TUMANYAN SS, TUMANYAN SV, RYMASHEVSKI AN. Predictors of renal dysfunction and its correction in women with preeclampsia and alimentary obesity[J]. Anesteziol Reanimatol, 2015, 60(1):42-44.
[8] GUTIERREZ-AGUIRRE CH, GARCIA-LOZANO JA, TREVINO-MONTEMAYOR OR, et al. Comparative analysis of iron status and other hematological parameters in preeclampsia[J]. Hematology,2017, 22(1):36-40.
[9]中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南(2015)[J].中华妇产科杂志, 2015, 50(10):721-728.
[10] VOGEL JP, SOUZA JP, GVLMEZOGLU AM, et al. Use of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries:an analysis of the WHO Multicountry Survey on Maternal and Newborn Health[J]. Lancet, 2014, 384(9957):1869-1877.
[11] KIENAST C, MOYA W, RODRIGUEZ O, et al. Predictive value of angiogenic factors, clinical risk factors and uterine artery Doppler for pre-eclampsia and fetal growth restriction in second and third trimester pregnancies in an Ecuadorian population[J]. J Matern Fetal Neonatal Med, 2016, 29(4):537-543.
[12] TAN MY, POON LC, ROLNIK DL, et al. Prediction and prevention of small-for-gestational-age neonates:evidence from SPREE and ASPRE[J]. Ultrasound Obstet Gynecol, 2018, 52(1):52-59.
[13]郭晗,张云聪,杨硕,等.子痫前期发病机制的研究进展[J].临床检验杂志, 2018, 36(6):439-443.
[14] KHARB S, NANDA S. Patterns of biomarkers in cord blood during pregnancy and preeclampsia[J]. Curr Hypertens Rev, 2017, 13(1):57-64.
[15]孙黎,俞菁,俞琼琰,等.同型半胱氨酸和胱抑素C对先兆子痫的预测价值[J].标记免疫分析与临床, 2016, 23(4):392-394.
[16]余敏,陈道平,文静.老年缺铁性贫血患者体液免疫和细胞免疫功能的变化[J].贵州医科大学学报, 2018, 43(6):698-702.
[17]索海燕,刘增佑,马春艺.高龄孕产妇血清铁蛋白和LDH水平与子痫前期和妊娠结局的关系[J].河北医药, 2017, 39(9):1327-1330.
[18] SHOJI T, NIIHATA K, FUKUMA S, et al. Both low and high serum ferritin levels predict mortality risk in hemodialysis patients without inflammation[J]. Clin Exp Nephrol, 2017, 21(4):685-693.