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目的探讨孕妇外周血中胎儿DNA水平检测在子痫前期诊断中的应用价值。方法选择30例子痫前期孕妇为子痫前期组(其中轻度18例,重度12例),另选择30例正常孕妇作为对照组,两组孕妇分别于孕20周、孕晚期(子痫前期组孕33周+3、对照组孕34周+3)、分娩后1、3、6 h取外周血,采用荧光定量PCR检测外周血中Y染色体上的性别决定基因(SRY基因)胎儿DNA水平(B超确定两组孕妇所妊娠的胎儿均为男性);放射免疫法检测两组孕妇孕晚期内皮素水平。结果(1)子痫前期组孕20周时的胎儿DNA水平为(316±61)copy/m l,其中轻度、重度患者分别为(266±79)、(396±91)copy/m l;对照组孕妇为(165±43)copy/m l,子痫前期组及轻度、重度患者明显高于对照组,两组比较,差异有统计学意义(P<0.01)。(2)子痫前期组孕晚期胎儿DNA水平为(970±413)copy/m l,其中轻度、重度患者分别为(758±357)、(1285±573)copy/m l,对照组孕妇为(319±99)copy/m l,子痫前期组及轻度、重度患者明显高于对照组,两组比较,差异有统计学意义(P<0.01)。(3)子痫前期组产后1、3、6 h胎儿DNA水平分别为(139±45)、(76±31)、(44±13)copy/m l,其中轻度患者分别为(102±42)、(57±25)、(36±12)copy/m l,重度患者分别为(209±51)、(97±40)、(52±17)copy/m l;对照组分别为(33±13)、(9±5)、0 copy/m l。子痫前期组及轻度、重度患者明显高于对照组,两组比较,差异有统计学意义(P<0.01)。(4)子痫前期组内皮素水平为(80±18)ng/L,其中轻度患者为(74±14)ng/L,重度患者为(89±32)ng/L;对照组为(50±11)ng/L,子痫前期组及轻度、重度患者明显高于对照组,两组比较,差异有统计学意义(P<0.01)。(5)子痫前期组胎儿DNA水平与内皮素水平呈正相关关系(r=0.748,P<0.01)。结论孕妇外周血胎儿DNA水平变化可以作为预测和诊断子痫前期发病与疾病程度的一个指标。
Objective To investigate the value of fetal DNA in pregnant women’s peripheral blood in the diagnosis of preeclampsia. Methods 30 pregnant women with preeclampsia were selected as preeclampsia group (mild 18 cases and severe 12 cases). Another 30 pregnant women were selected as the control group. The pregnant women in the two groups were divided into two groups at pregnant 20 weeks and third trimester (preeclampsia group Pregnant 33 weeks +3, control group pregnant 34 weeks +3), 1, 3 and 6 h after delivery, peripheral blood was taken and the DNA of fetal sex determinant (SRY) fetal DNA in peripheral blood was detected by real-time PCR B ultrasound to determine the two groups of pregnant women fetuses are male); radioimmunoassay to detect the two groups of pregnant women in the third trimester of endothelin levels. Results (1) The fetal DNA level in preeclampsia group was (316 ± 61) copy / ml at the 20th week of pregnancy, with (266 ± 79) and (396 ± 91) copy / ml in mild and severe cases The pregnant women were (165 ± 43) copy / ml, the group of preeclampsia and mild and severe were significantly higher than the control group, the difference was statistically significant (P <0.01). (2) The level of fetal DNA in the third trimester of pregnancy was (970 ± 413) copy / ml in the third trimester of pregnancy. The mild and severe cases were (758 ± 357) and (1285 ± 573) copy / 319 ± 99) copy / ml, preeclampsia group and mild and severe patients were significantly higher than the control group, the difference between the two groups was statistically significant (P <0.01). (3) The fetal DNA levels in preeclampsia group were (139 ± 45), (76 ± 31) and (44 ± 13) copy / ml at 1, 3 and 6 h postpartum, respectively, ), (57 ± 25) and (36 ± 12) copy / ml in severe patients were (209 ± 51), (97 ± 40) and (52 ± 17) copy / ), (9 ± 5), 0 copy / ml. Preeclampsia group and mild and severe patients were significantly higher than the control group, the difference between the two groups was statistically significant (P <0.01). (4) The level of endothelin in preeclampsia group was (80 ± 18) ng / L, with (74 ± 14) ng / L in mild patients and (89 ± 32) ng / L in severe patients; 50 ± 11) ng / L, preeclampsia group and mild and severe patients were significantly higher than the control group, the difference between the two groups was statistically significant (P <0.01). (5) There was a positive correlation between fetal DNA level and endothelin level in preeclampsia group (r = 0.748, P <0.01). Conclusion The changes of fetal DNA in pregnant women can be used as an index to predict and diagnose the incidence and severity of preeclampsia.