论文部分内容阅读
目的:探讨妊娠期高血压疾病（HDCP）血清内皮细胞特异分子-1（ESM-1）水平及临床意义。方法:选择2019年1—12月浙江省温岭市妇幼保健院HDCP孕妇300例（HDCP组）和同期健康产检孕妇300例（健康对照组）。HDCP组中，妊娠期高血压94例，轻度子痫前期131例，重度子痫前期75例。检测血清ESM-1、血清尿酸和24 h尿蛋白水平。记录HDCP组新生儿窒息、胎儿窘迫、剖宫产、羊水过多、胎膜早破、产后出血的发生率。结果:HDCP组血清ESM-1、血清尿酸、24 h尿蛋白均明显高于健康对照组[（0.42 ± 0.05） μg/L比（0.33 ± 0.04） μg/L、（262.34 ± 23.18） mmol/L比（212.37 ± 22.16） mmol/L和（0.36 ± 0.07） g比（0.11 ± 0.03） g]，差异有统计学意义（n P<0.01）。相关性分析结果显示，HDCP孕妇血清ESM-1与血清尿酸、24 h尿蛋白呈正相关（n r = 0.497和0.512，n P<0.01）。轻度子痫前期和重度子痫前期孕妇血清ESM-1明显高于妊娠期高血压孕妇[（0.44 ± 0.05）和（0.51 ± 0.06） μg/L比（0.38 ± 0.04） μg/L]，重度子痫前期孕妇血清ESM-1明显高于轻度子痫前期孕妇，差异有统计学意义（n P<0.05）。以血清ESM-1中位数（0.41 μg/L）为界将HDCP孕妇分为高ESM-1组（154例）和低ESM-1组（146例）。高ESM-1组新生儿窒息、胎儿窘迫、剖宫产、羊水过多、胎膜早破、产后出血的发生率明显高于低ESM-1组[14.94%（23/154）比6.16%（9/146）、26.62%（41/154）比9.59%（14/146）、46.10%（71/154）比29.45%（43/146）、25.32% （39/154）比3.42%（5/146）、23.38%（36/154）比4.11%（6/146）和20.13%（31/154）比7.53% （11/146）]，差异有统计学意义（n P<0.01）。n 结论:HDCP孕妇血清ESM-1水平明显升高，血清ESM-1水平与HDCP的严重程度和妊娠结局关系密切。“,”Objective:To investigate the serum endothelial cell specific molecule-1 (ESM-1) level and its clinical significance in patients with hypertensive disorders complicating pregnancy (HDCP).Methods:Three hundred pregnant women with HDCP (HDCP group) and 300 pregnant women undergoing health check-ups (healthy control group) from January to December 2019 in Maternity and Child Health Hospital of Wenling City of Zhejiang Province were selected. In HDCP group, hypertension during pregnancy was in 94 cases, mild preeclampsia was in 131 cases, and severe preeclampsia was in 75 cases. The serum ESM-1, serum uric acid and 24-hour urine protein levels were detected. The incidences of neonatal asphyxia, fetal distress, cesarean section, polyhydramnios, premature rupture of membranes and postpartum hemorrhage in the HDCP group were recorded.Results:The serum ESM-1, serum uric acid and 24-hour urine protein in HDCP group were significantly higher than those in healthy control group: (0.42 ± 0.05) μg/L vs. (0.33 ± 0.04) μg/L, (262.34 ± 23.18) mmol/L vs. (212.37 ± 22.16) mmol/L and (0.36 ± 0.07) g vs. (0.11 ± 0.03) g, and the differences were statistical significant ( n P<0.01). The correlation analysis results showed that the serum ESM-1 was positive correlation with serum uric acid and 24-hour urine protein in HDCP pregnant women (n r = 0.497 and 0.512, n P<0.01). The serum ESM-1 in pregnant women with mild preeclampsia and severe preeclampsia were significantly higher than that in pregnant women with hypertension during pregnancy: (0.44 ± 0.05) and (0.51 ± 0.06) μg/L vs. (0.38 ± 0.04) μg/L, the serum ESM-1 in pregnant women with severe preeclampsia was significantly higher than that in pregnant women with mild preeclampsia, and the differences were statistical significant (n P<0.05). With the median serum ESM-1 (0.41 μg/L) as the boundary, pregnant women with HDCP were divided into high ESM-1 group (154 cases) and low ESM-1 group (146 cases). The incidences of neonatal asphyxia, fetal distress, cesarean section, polyhydramnios, premature rupture of membranes and postpartum hemorrhage in high ESM-1 group were significantly higher than those in low ESM-1 group: 14.94% (23/154) vs. 6.16% (9/146), 26.62% (41/154) vs. 9.59% (14/146), 46.10% (71/154) vs. 29.45% (43/146), 25.32% (39/154) vs. 3.42% (5/146), 23.38% (36/154) vs. 4.11% (6/146) and 20.13% (31/154) vs. 7.53% (11/146), and the differences were statistical significant (n P<0.01).n Conclusions:Serum ESM-1 level is elevated in pregnant women with HDCP . Serum ESM-1 level is closely related to the severity of HDCP and pregnancy outcomes.