早发型重度子痫前期合并器官功能障碍患者可溶性内皮抑素、内皮素-1与凝血功能的变化及意义  

Serum soluble Endoglin, plasma endothelin-1 and coagulation function in early onset severe preeclampsia with organ dysfunction

作　　者：张立军[1] 韩玉环[1] 韩玉植[1] 

机构地区：[1]天津医科大学第二医院妇产科,300211

出　　处：《中国危重病急救医学》2010年第6期371-374,共4页Chinese Critical Care Medicine

基　　金：基金项目：天津市自然科学基金资助项目（09JCYBJC13000）

摘　　要：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%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, fet

关 键 词：早发型重度子痫前期 可溶性内皮抑素 内皮素-1 凝血 器官功能障碍 

分 类 号：R714.245[医药卫生—妇产科学]