目的 探讨可溶性内皮抑素(sEng)、内皮素-1(ET-1)和凝血功能的变化在早发型重度子痫前期合并器官功能障碍患者中的意义.方法 49例早发型重度子痫前期患者中无器官功能障碍(研究Ⅰ组)26例,合并器官功能障碍(研究Ⅱ组)23例;以同期30例健康孕妇为对照组.采用酶联免疫吸附法(ELISA)测定血中sEng、ET-1水平,常规测定凝血功能,比较3组间各指标的变化及其与器官功能、围生儿结局的关系.结果 ①研究Ⅰ组与研究Ⅱ组sEng、ET-1、纤维蛋白原(Fib)、血小板平均体积(MPV)均高于健康对照组[sEng (μg/L):10.96±3.21、14.17±4.02比7.49±2.73,ET-1(μg/L):41.54±10.37、65.91±12.46比24.56±6.26,Fib(g/L):4.41±1.02、5.35±1.17比3.69±0.82,MPV(fl):11.71±1.21、13.89±1.76比11.03±0.82,均P＜0.05],凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板计数(PLT)均低于健康对照组[PT(s):10.73±1.82、8.37±1.51比12.95±1.91,APTT(s):26.14±4.32、22.69±3.77比30.25±4.71,PLT(×109/L):164.17±50.67、136.43±51.21比201.63±59.83,均P＜0.05],且研究Ⅰ、Ⅱ组相比差异亦有统计学意义(均P＜0.05).②研究组sEng与血压、Fib、24 h尿蛋白、血肌酐(SCr)均呈正相关,与血浆白蛋白(Alb)、PT、12h尿雌激素/肌酐比值(E/C)及胎儿出生体重均呈负相关(均P＜0.01);而ET-1与血压、Fib、24h尿蛋白、SCr、丙氨酸转氨酶(ALT)均呈正相关,与血浆Alb、PT、12h尿E/C、胎儿出生体重均呈负相关(P＜0.05或P＜0.01).③sEng≥16μg/L组伴发心、肾、肺功能障碍、胎盘早剥及围生儿死亡的发生率高于sEng＜16μg/L组(69.23%比11.11%,38.46%比2.78%,38.46%比2.78%,46.15%比2.78%,53.85%比2.78%,均P＜0.01);ET-1≥70μg/L组伴心、肾、肝、肺功能障碍、胎盘早剥及围生儿死亡的发生率均高于ET-1＜70μg/L组(64.28%比11.43%,35.71%比2.86%,28.57%比5.71%,28.51%比5.71%,35.71%比5.71%,42.86%比5.71%,均P＜0.0);PT＜7s、APTT＜20s及PLT＜100×109/L时,多器官功能障碍发生率达90%(9/10),其中1例孕妇死亡.结论 血中sEng、ET-1水平升高及凝血功能紊乱是早发型重度子痫前期合并器官功能障碍患者的明显特征,其水平与患者的病情程度明显相关.
目的 探討可溶性內皮抑素(sEng)、內皮素-1(ET-1)和凝血功能的變化在早髮型重度子癇前期閤併器官功能障礙患者中的意義.方法 49例早髮型重度子癇前期患者中無器官功能障礙(研究Ⅰ組)26例,閤併器官功能障礙(研究Ⅱ組)23例;以同期30例健康孕婦為對照組.採用酶聯免疫吸附法(ELISA)測定血中sEng、ET-1水平,常規測定凝血功能,比較3組間各指標的變化及其與器官功能、圍生兒結跼的關繫.結果 ①研究Ⅰ組與研究Ⅱ組sEng、ET-1、纖維蛋白原(Fib)、血小闆平均體積(MPV)均高于健康對照組[sEng (μg/L):10.96±3.21、14.17±4.02比7.49±2.73,ET-1(μg/L):41.54±10.37、65.91±12.46比24.56±6.26,Fib(g/L):4.41±1.02、5.35±1.17比3.69±0.82,MPV(fl):11.71±1.21、13.89±1.76比11.03±0.82,均P＜0.05],凝血酶原時間(PT)、活化部分凝血活酶時間(APTT)、血小闆計數(PLT)均低于健康對照組[PT(s):10.73±1.82、8.37±1.51比12.95±1.91,APTT(s):26.14±4.32、22.69±3.77比30.25±4.71,PLT(×109/L):164.17±50.67、136.43±51.21比201.63±59.83,均P＜0.05],且研究Ⅰ、Ⅱ組相比差異亦有統計學意義(均P＜0.05).②研究組sEng與血壓、Fib、24 h尿蛋白、血肌酐(SCr)均呈正相關,與血漿白蛋白(Alb)、PT、12h尿雌激素/肌酐比值(E/C)及胎兒齣生體重均呈負相關(均P＜0.01);而ET-1與血壓、Fib、24h尿蛋白、SCr、丙氨痠轉氨酶(ALT)均呈正相關,與血漿Alb、PT、12h尿E/C、胎兒齣生體重均呈負相關(P＜0.05或P＜0.01).③sEng≥16μg/L組伴髮心、腎、肺功能障礙、胎盤早剝及圍生兒死亡的髮生率高于sEng＜16μg/L組(69.23%比11.11%,38.46%比2.78%,38.46%比2.78%,46.15%比2.78%,53.85%比2.78%,均P＜0.01);ET-1≥70μg/L組伴心、腎、肝、肺功能障礙、胎盤早剝及圍生兒死亡的髮生率均高于ET-1＜70μg/L組(64.28%比11.43%,35.71%比2.86%,28.57%比5.71%,28.51%比5.71%,35.71%比5.71%,42.86%比5.71%,均P＜0.0);PT＜7s、APTT＜20s及PLT＜100×109/L時,多器官功能障礙髮生率達90%(9/10),其中1例孕婦死亡.結論 血中sEng、ET-1水平升高及凝血功能紊亂是早髮型重度子癇前期閤併器官功能障礙患者的明顯特徵,其水平與患者的病情程度明顯相關.
목적 탐토가용성내피억소(sEng)、내피소-1(ET-1)화응혈공능적변화재조발형중도자간전기합병기관공능장애환자중적의의.방법 49례조발형중도자간전기환자중무기관공능장애(연구Ⅰ조)26례,합병기관공능장애(연구Ⅱ조)23례;이동기30례건강잉부위대조조.채용매련면역흡부법(ELISA)측정혈중sEng、ET-1수평,상규측정응혈공능,비교3조간각지표적변화급기여기관공능、위생인결국적관계.결과 ①연구Ⅰ조여연구Ⅱ조sEng、ET-1、섬유단백원(Fib)、혈소판평균체적(MPV)균고우건강대조조[sEng (μg/L):10.96±3.21、14.17±4.02비7.49±2.73,ET-1(μg/L):41.54±10.37、65.91±12.46비24.56±6.26,Fib(g/L):4.41±1.02、5.35±1.17비3.69±0.82,MPV(fl):11.71±1.21、13.89±1.76비11.03±0.82,균P＜0.05],응혈매원시간(PT)、활화부분응혈활매시간(APTT)、혈소판계수(PLT)균저우건강대조조[PT(s):10.73±1.82、8.37±1.51비12.95±1.91,APTT(s):26.14±4.32、22.69±3.77비30.25±4.71,PLT(×109/L):164.17±50.67、136.43±51.21비201.63±59.83,균P＜0.05],차연구Ⅰ、Ⅱ조상비차이역유통계학의의(균P＜0.05).②연구조sEng여혈압、Fib、24 h뇨단백、혈기항(SCr)균정정상관,여혈장백단백(Alb)、PT、12h뇨자격소/기항비치(E/C)급태인출생체중균정부상관(균P＜0.01);이ET-1여혈압、Fib、24h뇨단백、SCr、병안산전안매(ALT)균정정상관,여혈장Alb、PT、12h뇨E/C、태인출생체중균정부상관(P＜0.05혹P＜0.01).③sEng≥16μg/L조반발심、신、폐공능장애、태반조박급위생인사망적발생솔고우sEng＜16μg/L조(69.23%비11.11%,38.46%비2.78%,38.46%비2.78%,46.15%비2.78%,53.85%비2.78%,균P＜0.01);ET-1≥70μg/L조반심、신、간、폐공능장애、태반조박급위생인사망적발생솔균고우ET-1＜70μg/L조(64.28%비11.43%,35.71%비2.86%,28.57%비5.71%,28.51%비5.71%,35.71%비5.71%,42.86%비5.71%,균P＜0.0);PT＜7s、APTT＜20s급PLT＜100×109/L시,다기관공능장애발생솔체90%(9/10),기중1례잉부사망.결론 혈중sEng、ET-1수평승고급응혈공능문란시조발형중도자간전기합병기관공능장애환자적명현특정,기수평여환자적병정정도명현상관.
Objective To investigate the expression levels of serum soluble Endoglin (sEng), plasma endothelin-1 (ET-1) and coagulation function in patients suffering from early onset severe preeclampsia with organ dysfunction, and to analyze the clinical significance. Methods Forty-nine early onset severe preeclampsia patients were enrolled in the study group, including 26 cases without organ dysfunction (study group Ⅰ) and 23 cases with organ dysfunction (study group Ⅱ). The control group included 30 cases of health pregnant women during the same period of gestation. The serum levels of sEng and plasma ET-1 were analyzed with enzyme-linked immunosorbent assay (ELISA), coagulation function was determined at the same time, and the relationship between the change in levels of sEng, ET-1, coagulation function and organ function, and also outcome of perinatal infants. Results ① The levels of sEng, ET-1, fibrinogen (Fib) and mean platelet volume (MPV) of the study group Ⅰ and I were significantly higher compared with control group (sEng,μg/L:10.96±3.21, 14.17±4.02vs. 7.49±2.73; ET-1, μg/L: 41.54 ± 10. 37, 65.91± 12.46vs. 24.56±6.26; Fib, g/L:4.41±1.02,5.35±1.17vs. 3.69±0.82; MPV, fl:11. 71± 1.21, 13.89±1.76vs. 11.03±0.82, all P＜ 0.05), and prothrombin time (PT), activated partial thromboplastin time (APTT) and platelet (PLT) were significantly lower compared with control group (PT, s:10.73±1.82, 8.37±1.51vs. 12.95±1.91; APTT, s:26.14±4.32, 22.69±3.77vs. 30.25±4.71; PLT,×109/L; 164.17±50.67, 136.43±51.21vs. 201.63±59.83, all P＜0.05). There were also statistical significances in all the values between study group Ⅰ and I (all P＜0.05). ②There was positive correlation between the sEng level and systolic pressure, diastolic pressure, Fib, urine protein of 24 hours, serum creatinine (SCr); there was negative correlation between the sEng level and albumin (Alb) content, PT, estriol/creatinine (E/C) of 12-hour urine, fetal birth weight (all P＜0.01). There was positive correlation between the level of ET-1 and the systolic pressure, diastolic pressure, Fib, urine protein of 24 hours, SCr, or alanine aminotransferase (ALT); there was negative correlation between the level of ET-1and Alb, PT, E/C of 12-hour urine, or fetal birth weight (P＜0.05 or P＜0.01). ③In the study group, the occurrence rate of the heart, kidney and lung dysfunction, placental abruption and perinatal death of infants increased (69.23％vs. 11.11％, 38.46％vs. 2.78％, 38.46％vs. 2.78％, 46.15％vs. 2.78％, 53.85％vs. 2.78％, all P＜0.01) when the content of sEng≥ 16μg/L compared with sEng＜16μg/L; the occurrence rate of heart, kidney, liver and lung dysfunction, placental abruption and perinatal death of infants increased (64.28％vs. 11.43％, 35.71％vs. 2.86％, 28.57％vs. 5.71％, 28.57％vs. 5.71％,35.71％vs. 5.71％, 42.86％vs. 5.71％, all P＜0.01) when the level of ET-1≥70μg/L compared with ET-1＜70μg/L; the occurrence rate of multiple organ dysfunction syndrome was 90％ (9/10) when PT＜7s, APTT＜20s and PLT＜100×109/L. Conclusion The elevation of levels of serum sEng, plasma ET-1 and coagulation abnomality may contribute to the pathogenesis of the organ dysfunction in early onset severe preeclampsia, and the detection of the above-mentioned indexes has important clinical value.
