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目的研究轻度子癇前期孕妇血管紧张素原(angiotensinogen,AGT)基因M235T多态性及分娩方式,探讨如何降低轻度子癇前期孕妇剖宫产率。方法应用逆转录聚合酶链反应(reverse transcription-polymerase chain reaction,RT-PCR)对75例轻度子癇前期患者和75例正常妊娠妇女的AGT基因M235T多态性进行分析,根据基因型分为TT型和非TT型组,记录4组子宫动脉收缩末期最大血流速度和舒张末期最大血流速度之比(S/D),搏动指数(pulsatility index,PI),阻力指数(resistant index,RI),新生儿出生时体质量,Apgar评分,产后出血量,分娩方式及剖宫产原因。结果 1轻度子癇前期患者的TT基因型比例与其它三组比较有显著性差异(P<0.05)。2剖宫产率与TT型比率呈正相关。3轻度子癇前期TT型患者子宫动脉的S/D值显著高于其它三组(P<0.05),但PI、RI值无差别;轻度子癇前期TT型组新生儿体质量、Apgar评分下降,产后出血量增多,与其它三组比较,差异有统计学意义(P<0.05)。4轻度子癇前期TT型组经阴道分娩的的新生儿窒息率较剖宫产高,差异有统计学意义(P<0.05),而非TT型组无显著变化。5轻度子癇前期剖宫产原因中社会因素占第一位,医源性因素不容忽视。结论 AGT M235T多态性与轻度子痫前期发生有关,T等位基因可能是轻度子癇前期的易感基因。严格掌握剖宫产指征,对轻度子癇前期非TT型患者,可以试产,母婴预后好。
Objective To study the polymorphism of M235T and the mode of delivery in pregnant women with mild preeclampsia and to explore how to reduce the rate of cesarean section in mild preeclampsia. Methods The AGT gene M235T polymorphism in 75 patients with mild preeclampsia and 75 normal pregnant women was analyzed by reverse transcription-polymerase chain reaction (RT-PCR). According to the genotype, (S / D), pulsatility index (PI), and resistant index (RI) of the end-systolic and diastolic phases of the uterine arteries in the 4 groups were recorded. , Body mass at birth, Apgar score, amount of postpartum hemorrhage, mode of delivery, and causes of cesarean section. Results The proportion of TT genotypes in patients with mild preeclampsia was significantly different from the other three groups (P <0.05). 2 cesarean section rate and TT type ratio was positively correlated. The S / D values of uterine artery in patients with mild preeclampsia TT were significantly higher than those in the other three groups (P <0.05), but there was no difference between PI and RI. Neonatal body weight and Apgar score decreased , Postpartum hemorrhage increased, compared with the other three groups, the difference was statistically significant (P <0.05). Compared with cesarean section, the incidence of neonatal asphyxia in vaginal delivery in TT group with mild preeclampsia was significantly higher than that in cesarean section (P <0.05), but not in TT group. 5 mild preeclampsia cesarean section causes of social factors in the first place, iatrogenic factors can not be ignored. Conclusion The AGT M235T polymorphism is associated with the development of mild preeclampsia and the T allele may be the predisposing gene of mild preeclampsia. Strict control of indications for cesarean section, mild preeclampsia non-TT-type patients, you can trial production, good prognosis of mother and child.