目的 探讨孕妇血浆中可溶性白细胞分化抗原(sCD40)和sCD40配体(sCD40L)水平变化与子痫前期发病及肾功能损害的关系.方法 选择2008年8月-2010年6月在青岛大学医学院附属医院产科分娩的轻度子痫前期孕妇28例(轻度子痫前期组),重度子痫前期孕妇35例(重度子痫前期组);另选同期妊娠结局良好的健康孕妇30例为对照组.比较3组孕妇分娩孕周及血压变化、血小板计数并检测其血常规、C反应蛋白(CRP)、尿常规、24h尿蛋白定量,以及血清尿酸(UA)、肌酐(Cr)、尿素氮(BUN)等生化指标.采用ELISA法检测3组孕妇血浆中sCD40和sCD40L的水平,并对血浆sCD40和sCD40L的水平与各临床指标的相关性进行分析.结果 (1)血常规及l临床指标:重度子痫前期组和轻度子痫前期组孕妇血浆CRP水平(分别为10.8及7.1 mg/L)均明显高于对照组(3.3 mg/L),前后两者分别比较,差异均有统计学意义(P＜0.05);重度子痫前期组高于轻度子痫前期组,两组比较,差异也有统计学意义(P＜0.05).重度子痫前期组孕妇分娩孕周(32.5周)明显低于轻度子痫前期组(37.2周)和对照组(38.6周),分别与对照组比较,差异均有统计学意义(P＜0.01);轻度子痫前期组与对照组比较,差异无统计学意义(P＞0.05).重度子痫前期组孕妇血小板计数(132×109/L)明显低于轻度子痫前期组(212×109/L)和对照组(216×109/L),分别比较,差异有统计学意义(P＜0.01);轻度子痫前期组与对照组比较,差异无统计学意义(P＞0.05).3组孕妇之间血红蛋白水平及白细胞数分别比较,差异均无统计学意义(P＞0.05).(2)血浆sCD40及sCD40L水平:重度子痫前期组、轻度子痫前期组和对照组孕妇血浆sCD40水平分别为133.6、126.5和90.7 ng/L,sCD40L水平分别为12.5、10.4和4.4 ng/L,24h尿蛋白定量分别为4.5、0.8 g和0,UA水平分别为486、289和162 μmol/L,重度子痫前期组以上各指标均明显高于轻度子痫前期组和对照组,差异均有统计学意义(P＜0.01);轻度子痫前期组也明显高于对照组,差异也有统计学意义(P＜0.01).重度子痫前期组孕妇血浆Cr(89 μmol/L)、BUN(5.32 mmol/L)水平高于轻度子痫前期组(分别为66μmol/L及4.49mmol/L)和对照组(分别为57 μmol/L及3.32 mmol/L),分别比较,差异均有统计学意义(P＜0.05);轻度子痫前期组与对照组比较,差异无统计学意义(P＞0.05).(3)相关性分析:轻、重度子痫前期组孕妇血浆sCD40水平与24 h尿蛋白定量呈正相关(r=0.434,P＜0.05),与UA、CRP呈明显正相关(r=0.536、0.528,P＜0.01),与收缩压、舒张压、分娩孕周、Cr、BUN、血小板计数无明显相关(r分别为0.135、0.183、-0.133、0.190、0.167、-0.221,P均＞0.05).轻、重度子痫前期组孕妇血浆sCD40L水平与24 h尿蛋白定量、UA、CRP均呈明显正相关(r分别为0.591、0.445、0.539,P均＜0.01),与收缩压、舒张压、分娩孕周、Cr、BUN、血小板计数无明显相关(r分别为0.178、0.212、-0.292、0.144、0.135、-0.273,P均＞0.05).轻、重度子痫前期组孕妇血浆sCD40L水平与sCD40呈明显正相关(r均为0.707,P＜0.01).对照组孕妇血浆sCD40、sCD40L水平与各项临床指标均无相关性(P＞0.05).结论 子痫前期孕妇血浆中sCD40和sCD40L水平明显升高,可能参与了子痫前期的发病,并导致肾功能损害.sCD40和sCD40L水平变化也与子痫前期的严重程度相关.
目的 探討孕婦血漿中可溶性白細胞分化抗原(sCD40)和sCD40配體(sCD40L)水平變化與子癇前期髮病及腎功能損害的關繫.方法 選擇2008年8月-2010年6月在青島大學醫學院附屬醫院產科分娩的輕度子癇前期孕婦28例(輕度子癇前期組),重度子癇前期孕婦35例(重度子癇前期組);另選同期妊娠結跼良好的健康孕婦30例為對照組.比較3組孕婦分娩孕週及血壓變化、血小闆計數併檢測其血常規、C反應蛋白(CRP)、尿常規、24h尿蛋白定量,以及血清尿痠(UA)、肌酐(Cr)、尿素氮(BUN)等生化指標.採用ELISA法檢測3組孕婦血漿中sCD40和sCD40L的水平,併對血漿sCD40和sCD40L的水平與各臨床指標的相關性進行分析.結果 (1)血常規及l臨床指標:重度子癇前期組和輕度子癇前期組孕婦血漿CRP水平(分彆為10.8及7.1 mg/L)均明顯高于對照組(3.3 mg/L),前後兩者分彆比較,差異均有統計學意義(P＜0.05);重度子癇前期組高于輕度子癇前期組,兩組比較,差異也有統計學意義(P＜0.05).重度子癇前期組孕婦分娩孕週(32.5週)明顯低于輕度子癇前期組(37.2週)和對照組(38.6週),分彆與對照組比較,差異均有統計學意義(P＜0.01);輕度子癇前期組與對照組比較,差異無統計學意義(P＞0.05).重度子癇前期組孕婦血小闆計數(132×109/L)明顯低于輕度子癇前期組(212×109/L)和對照組(216×109/L),分彆比較,差異有統計學意義(P＜0.01);輕度子癇前期組與對照組比較,差異無統計學意義(P＞0.05).3組孕婦之間血紅蛋白水平及白細胞數分彆比較,差異均無統計學意義(P＞0.05).(2)血漿sCD40及sCD40L水平:重度子癇前期組、輕度子癇前期組和對照組孕婦血漿sCD40水平分彆為133.6、126.5和90.7 ng/L,sCD40L水平分彆為12.5、10.4和4.4 ng/L,24h尿蛋白定量分彆為4.5、0.8 g和0,UA水平分彆為486、289和162 μmol/L,重度子癇前期組以上各指標均明顯高于輕度子癇前期組和對照組,差異均有統計學意義(P＜0.01);輕度子癇前期組也明顯高于對照組,差異也有統計學意義(P＜0.01).重度子癇前期組孕婦血漿Cr(89 μmol/L)、BUN(5.32 mmol/L)水平高于輕度子癇前期組(分彆為66μmol/L及4.49mmol/L)和對照組(分彆為57 μmol/L及3.32 mmol/L),分彆比較,差異均有統計學意義(P＜0.05);輕度子癇前期組與對照組比較,差異無統計學意義(P＞0.05).(3)相關性分析:輕、重度子癇前期組孕婦血漿sCD40水平與24 h尿蛋白定量呈正相關(r=0.434,P＜0.05),與UA、CRP呈明顯正相關(r=0.536、0.528,P＜0.01),與收縮壓、舒張壓、分娩孕週、Cr、BUN、血小闆計數無明顯相關(r分彆為0.135、0.183、-0.133、0.190、0.167、-0.221,P均＞0.05).輕、重度子癇前期組孕婦血漿sCD40L水平與24 h尿蛋白定量、UA、CRP均呈明顯正相關(r分彆為0.591、0.445、0.539,P均＜0.01),與收縮壓、舒張壓、分娩孕週、Cr、BUN、血小闆計數無明顯相關(r分彆為0.178、0.212、-0.292、0.144、0.135、-0.273,P均＞0.05).輕、重度子癇前期組孕婦血漿sCD40L水平與sCD40呈明顯正相關(r均為0.707,P＜0.01).對照組孕婦血漿sCD40、sCD40L水平與各項臨床指標均無相關性(P＞0.05).結論 子癇前期孕婦血漿中sCD40和sCD40L水平明顯升高,可能參與瞭子癇前期的髮病,併導緻腎功能損害.sCD40和sCD40L水平變化也與子癇前期的嚴重程度相關.
목적 탐토잉부혈장중가용성백세포분화항원(sCD40)화sCD40배체(sCD40L)수평변화여자간전기발병급신공능손해적관계.방법 선택2008년8월-2010년6월재청도대학의학원부속의원산과분면적경도자간전기잉부28례(경도자간전기조),중도자간전기잉부35례(중도자간전기조);령선동기임신결국량호적건강잉부30례위대조조.비교3조잉부분면잉주급혈압변화、혈소판계수병검측기혈상규、C반응단백(CRP)、뇨상규、24h뇨단백정량,이급혈청뇨산(UA)、기항(Cr)、뇨소담(BUN)등생화지표.채용ELISA법검측3조잉부혈장중sCD40화sCD40L적수평,병대혈장sCD40화sCD40L적수평여각림상지표적상관성진행분석.결과 (1)혈상규급l림상지표:중도자간전기조화경도자간전기조잉부혈장CRP수평(분별위10.8급7.1 mg/L)균명현고우대조조(3.3 mg/L),전후량자분별비교,차이균유통계학의의(P＜0.05);중도자간전기조고우경도자간전기조,량조비교,차이야유통계학의의(P＜0.05).중도자간전기조잉부분면잉주(32.5주)명현저우경도자간전기조(37.2주)화대조조(38.6주),분별여대조조비교,차이균유통계학의의(P＜0.01);경도자간전기조여대조조비교,차이무통계학의의(P＞0.05).중도자간전기조잉부혈소판계수(132×109/L)명현저우경도자간전기조(212×109/L)화대조조(216×109/L),분별비교,차이유통계학의의(P＜0.01);경도자간전기조여대조조비교,차이무통계학의의(P＞0.05).3조잉부지간혈홍단백수평급백세포수분별비교,차이균무통계학의의(P＞0.05).(2)혈장sCD40급sCD40L수평:중도자간전기조、경도자간전기조화대조조잉부혈장sCD40수평분별위133.6、126.5화90.7 ng/L,sCD40L수평분별위12.5、10.4화4.4 ng/L,24h뇨단백정량분별위4.5、0.8 g화0,UA수평분별위486、289화162 μmol/L,중도자간전기조이상각지표균명현고우경도자간전기조화대조조,차이균유통계학의의(P＜0.01);경도자간전기조야명현고우대조조,차이야유통계학의의(P＜0.01).중도자간전기조잉부혈장Cr(89 μmol/L)、BUN(5.32 mmol/L)수평고우경도자간전기조(분별위66μmol/L급4.49mmol/L)화대조조(분별위57 μmol/L급3.32 mmol/L),분별비교,차이균유통계학의의(P＜0.05);경도자간전기조여대조조비교,차이무통계학의의(P＞0.05).(3)상관성분석:경、중도자간전기조잉부혈장sCD40수평여24 h뇨단백정량정정상관(r=0.434,P＜0.05),여UA、CRP정명현정상관(r=0.536、0.528,P＜0.01),여수축압、서장압、분면잉주、Cr、BUN、혈소판계수무명현상관(r분별위0.135、0.183、-0.133、0.190、0.167、-0.221,P균＞0.05).경、중도자간전기조잉부혈장sCD40L수평여24 h뇨단백정량、UA、CRP균정명현정상관(r분별위0.591、0.445、0.539,P균＜0.01),여수축압、서장압、분면잉주、Cr、BUN、혈소판계수무명현상관(r분별위0.178、0.212、-0.292、0.144、0.135、-0.273,P균＞0.05).경、중도자간전기조잉부혈장sCD40L수평여sCD40정명현정상관(r균위0.707,P＜0.01).대조조잉부혈장sCD40、sCD40L수평여각항림상지표균무상관성(P＞0.05).결론 자간전기잉부혈장중sCD40화sCD40L수평명현승고,가능삼여료자간전기적발병,병도치신공능손해.sCD40화sCD40L수평변화야여자간전기적엄중정도상관.
Objective To investigate the variance levels of plasma soluble leukocyte differentiation antigens CD40 (sCD40) and soluble CD40 ligand (sCD40L) in preeclamptic patients with renal damage and its relationship. Methods A total of 63 pregnant women attended the Department of Obstetrics, Affiliated Hospital of Qingdao University Medical College between August 2008 and June 2010. In the present study included 28 pregnant women with mild preeclampsia and 35 patients with severe preeclampsia. Thirty matched normotensive pregnant women were enrolled in the study as the control group. Expression of sCD40 and sCD40L were determined by ELISA. At the same time, the blood routine, C reaction protein ( CRP),urine routine, 24 hours urine protein excretion, and serum uric acid (UA), creatinine (Cr), blood urea nitrogen (BUN) were measured. The correlation analysis was performed between the sCD40/sCD40L and the blood biochemical indexes in 3 groups. Results ( 1 ) The median levels of CRP in severe preeclampsia (10. 8 mg/L)and mild preeclampsia group(7. I mg/L)are significantly higher than that of control group (3. 3 mg/L,P ＜ 0. 05 ); The level of CRP in severe preeclampsia group was also higher than that of mild preeclampsia group ( P ＜ 0. 05 ). The median gestational age at delivery in severe preeclampsia ( 32. 5 weeks)was significantly less than that of mild preeclampsia group ( 37. 2 weeks) and normal group ( 38. 6 weeks,P ＜ 0. 05). However no significant differences were observed between mild preeclampsia group and normal group ( P ＞0. 05 ). The platelet count in severe preeclampsia ( 132 × 109/L) was significantly less than those of mild preeclampsia group (212 × 109/L) and normal group ( 216 × 109/L, P ＜ 0. 01 ), but no significant differences were observed in blood platelet amount between mild preeclampsia group and normal group ( P ＞0. 05 ). There was no significant difference in hemoglobin level and white blood cell in three groups ( P ＞0. 05). (2) The sCD40 plasma concentration in severe, mild preeclampsia and normal group was 133.6,126. 5 and 90. 7 ng/L, respectively. The sCD40 L plasma concentrations were 12. 5, 10. 4 and 4. 4 ng/L respectively in the 3 groups. 24 hours urinary protein quantitative was 4. 5 g/d,0. 8 g/d and 0 in the 3 groups respectively. And the UA level was 486 μ mol/L,289 μmol/L and 162 μmol/L. In the above three groups,the monitoring indicators were significantly higher in women with severe preeclampsia group compared with mild preeclampsia and control groups (P ＜ 0. 01 ), and there were also higher in mild preeclampsia group than that in control groups ( P ＜ 0. 01 ). The level of plasma Cr ( 89 μmol/L) and BUN ( 5. 32 mmol/L) in severe preeclampsia group were higher than those of mild preeclampsia group (66 μmol/L and 4. 49mmol/L) and control group ( 57 μmol/L and 3.32 mmol/L, P ＜ 0. 05 ). There was no significant difference between mild preeclampsia group and normal group (P ＞ 0. 05 ). (3) The correlation analysis indicated that the level of sCD40 has a positive correlation with 24 hours urinary protein quantitative( r = 0. 434, P ＜ 0. 05 ),also significant positive correlation( r =0. 536,0. 528 ,P ＜ 0. 01 ) between the level of sCD40 and UA or CRP in women with preeclampsia. There was no significant correlation between the level of sCD40 and systolic blood pressure, diastolic blood pressure, delivery gestational age, Cr, BUN, and platelet count(r =0. 135,0. 183, -0. 133,0. 190,0. 167, -0. 221 ,all P ＞0. 05 ). There were positive correlation between the level of sCD40L and 24 hours urine protein excretion, either UA or CRP( r =0. 591,0. 445,0. 539 ,all P ＜0. 01 ). No significant correlation was found between sCD40 L and systolic blood pressure, diastolic blood pressure,delivery gestational age, Cr, BUN, and platelet count( r =0. 178,0. 212, -0. 292,0. 144,0. 135, -0. 273,all P ＞0. 05). There was significant positive correlation between plasma sCD40 and sCD40L ( r =0. 707 ,P ＜0. 01 ). There was no relationship between the level of sCD40, sCD40L and the blood biochemical indexes in normotensive pregnant women ( P ＞ 0. 05 ). Conclusions The plasma concentrations of sCD40 and sCD40 L are significantly higher in pregnant women with preeclampsia compared with the control, which may be involved in the development of preeclampsia and contribute to the kidney damage. The variance levels of sCD40 and sCD40L may be also related to the severity of preeclampsia.
