可溶性内皮糖蛋白及甲状腺素转运球蛋白在重度子痫前期中的表达

发布时间：2018-07-10 19:08

本文选题：重度子痫前期 + 可溶性内皮糖蛋白　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:子痫前期是妊娠期特有疾病,主要表现为妊娠20周后出现的高血压、蛋白尿和其他并发症相结合的疾病,是导致孕妇及围生儿患病及死亡的主要病因之一。因其具有发病重、进展快、母婴预后差等特征,特别是重度子痫前期,故搜寻更简便、更准确、更有效的预测子痫前期的方法,做到早发现、早预防、早干预,成为了近些年产科发展的重中之重。随着研究的不断深入,对各种临床高危风险因素、生物化学标志物、生物物理评估等多个领域的研究也都获得新的进展。目前大量的试验证明,血管内皮细胞激活、功能失调和结构损害是子痫前期病理生理变化的一个重要环节,但这一损伤过程的具体机制尚不明确。据相关研究,可溶性内皮糖蛋白(Soluble endoglin,简称sEng)是一种抗血管生成蛋白质,而甲状腺素转运球蛋白(Transthyretin,简称TTR)可在血管系统中形成淀粉样纤维的沉积,两者在孕妇外周血中的特异表达均会导致血管内皮功能障碍,进而引起相应的临床症状。本研究通过检测正常妊娠妇女及重度子痫前期妇女外周血血清中sEng及TTR水平并进行对比,探讨其在重度子痫前期中的表达及两者联合检测对诊断重度子痫前期发生的价值及意义。方法:本研究随机选取2015年01月01日-2017年01月01日期间我院妇产科住院分娩的重度子痫前期患者30例,将其定为重度子痫前期组,年龄26-39岁,平均年龄32.07±2.59岁,孕周30-37周,平均妊娠周数34.18±2.23周;选取同时期住院的30位不伴有任何妊娠期合并症及并发症的健康孕妇,将其定义为正常妊娠组。年龄25-39岁,平均年龄31.77±3.57岁,孕周37-41周,平均妊娠周数39.79±1.19周。检测的所有患者均为随机抽取,且其年龄与孕周具有均衡性。对所有血清中sEng及TTR水平进行检测,将重度子痫前期组与正常妊娠组血清中sEng及TTR水平进行两两比较,并进行统计学分析,并分别测定两项指标在最佳诊断界值时的特异度、灵敏度以及联合检测时是否会增加对子痫前期的诊断。结果:通过对各组中sEng及TTR水平进行两两比较,结果如下:1.正常妊娠组外周血血清中sEng与重度子痫前期组外周血血清中sEng水平相比较,通过独立样本t检验得出P0.05,说明两组的结果相比较具有差异性,且前者较后者显著降低,该结果具有统计学意义。2.正常妊娠组外周血血清中TTR与重度子痫前期组外周血血清中TTR水平相比较,通过独立样本t检验得出P=0.002且0.05,说明两组的结果相比较具有差异性,且后者较前者显著降低,该结果具有统计学意义。3.通过ROC曲线分析得知(1)sEng诊断重度子痫前期时的曲线下面积AUC=0.794(0.7),说明其诊断效能较好,当最佳诊断界值为47.92pg/ml时,其灵敏度为76.67%,特异度为80%;(2)TTR诊断重度子痫前期时的曲线下面积AUC=0.752(0.7),说明其诊断效能较好,当最佳诊断界值为91.69ug/ml时,其灵敏度为86.67%,特异度为73.33%;(3)两指标联合诊断重度子痫前期时的曲线下面积AUC=0.839(0.7),说明其诊断效能较好;4.sEng、TTR及两者联合诊断重度子痫前期时ROC曲线下面积(AUC)进行两两比较,通过Z检验得出P(AUC1)=0.604(0.05),P(AUC2)=0.297(0.05),P(AUC3)=0.114(0.05),说明任意两组之间的比较结果均无差异性,即无统计学意义,说明sEng、TTR或者两者联合检测均不能提高对重度子痫前期的诊断价值。结论:1.对正常妊娠组和重度子痫前期组中sEng及TTR水平进行比较,结果说明sEng水平越高,而TTR水平越低,其发生重度子痫前期的风险越高;2.sEng、TTR及两者联合检测对重度子痫前期均有很好的诊断效能,但两者联合检测并未提高其诊断价值。因本研究样本量有限,此结果尚需通过大样本试验进行进一步的验证。
[Abstract]:Objective: preeclampsia is a special disease of pregnancy, mainly characterized by hypertension after 20 weeks of pregnancy, a combination of proteinuria and other complications, which is one of the main causes of the illness and death of pregnant and perinatal infants. Simple, more accurate, more effective methods to predict preeclampsia, early detection, early prevention and early intervention have become the most important of obstetric development in recent years. With the deepening of research, new progress has been made in various fields of high risk factors, biochemical markers, biophysical evaluation and so on. Quantitative tests show that vascular endothelial cell activation, dysfunction and structural damage are an important link in the pathophysiological changes in preeclampsia, but the specific mechanism of this damage process is not clear. According to the relevant research, Soluble endoglin (sEng) is a kind of antiangiogenic protein and thyroxine transport. Transthyretin (TTR) can form a deposition of amyloid fibers in the vascular system. The specific expression of both in the peripheral blood of pregnant women leads to vascular endothelial dysfunction and causes the corresponding clinical symptoms. This study was conducted to detect the level of sEng and TTR in the serum of normal pregnant women and women with preeclampsia. The value and significance of the expression in severe preeclampsia and the combination of the two in the diagnosis of severe preeclampsia were compared. Methods: This study randomly selected 30 cases of severe preeclampsia in the Department of Obstetrics and Gynecology of our hospital during the period of 01 months of 2015, 01 -2017, 01 months, and designated it as a severe preeclampsia group. The average age was 26-39 years old, the average age was 32.07 + 2.59 years, the average pregnancy week was 30-37 weeks, the average pregnancy week was 34.18 + 2.23 weeks. 30 healthy pregnant women who were hospitalized at the same time were defined as normal pregnant women. The average age was 25-39 years old, the average age was 31.77 + 3.57 years, and the gestational weeks were 37-41 weeks. The average week of pregnancy was 39.79 + 1.19 weeks. All the patients were randomly selected, and their age and gestational age were balanced. The levels of sEng and TTR in all serum were detected. The levels of sEng and TTR in the sera of the severe preeclampsia group and the normal pregnancy group were compared with 22, and the statistical analysis was carried out, and the specificity of the two indexes at the best diagnostic value was determined respectively. The sensitivity and the combined detection of preeclampsia will increase the diagnosis of preeclampsia. Results: by comparing the levels of sEng and TTR in each group, the results are as follows: 1. sEng in peripheral blood serum of normal pregnancy group is compared with sEng level in peripheral blood serum of severe preeclampsia group, and P0.05 is obtained through independent sample t test, indicating the two groups of sEng. The results were significantly different, and the former was significantly lower than the latter. The results were statistically significant in the peripheral blood serum of.2. normal pregnancy group compared with the TTR level in the peripheral blood serum of severe preeclampsia group, and P=0.002 and 0.05 were obtained by independent sample t test. The results showed that the results of the two groups were different, and the latter was more than the former. The results were significantly reduced, and the results were statistically significant.3. through ROC curve analysis (1) the area under the curve of sEng was AUC=0.794 (0.7) in the diagnosis of severe preeclampsia, indicating that the diagnostic efficiency was good. When the best diagnostic value was 47.92pg/ml, the sensitivity was 76.67%, the specificity was 80%, and (2) TTR was used to diagnose the area AUC= under severe preeclampsia. 0.752 (0.7) showed that the diagnostic efficiency was good. When the best diagnostic value was 91.69ug/ml, the sensitivity was 86.67% and the specificity was 73.33%; (3) two index combined with the diagnosis of AUC=0.839 (0.7) under the curve of severe preeclampsia, indicating that the diagnostic efficiency was better; 4.sEng, TTR and both were combined to diagnose the area under the ROC curve (AUC) in severe preeclampsia. In the 22 comparison, P (AUC1) =0.604 (AUC1) =0.604 (AUC1), P (AUC2) =0.297 (0.05), P (AUC3) =0.114 (0.05) showed no difference between any two groups, that is, there was no statistical significance, indicating sEng, TTR, or both combined detection could not improve the diagnostic value for severe preeclampsia. Conclusion: 1. to normal pregnancy and weight. The sEng and TTR levels in the preeclampsia group were compared. The results showed that the higher the level of sEng, the lower the TTR level, the higher the risk of severe preeclampsia. The combined detection of 2.sEng, TTR and both had a good diagnostic efficiency for severe preeclampsia, but the combination of the two tests did not improve the diagnostic value. The sample size of this study was limited, This result needs further verification by large sample test.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.244

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