子宫动脉多普勒检查及血清COX-2、维生素D水平对子痫前期严重程度的诊断价值分析  

Diagnostic value of uterine artery Doppler examination and serum COX-2 and vitamin D levels on severity of preeclampsia

作　　者：卜雄伟 左婧楠 邵敏静 邸海燕[1] 史凯 司彩凤[1] Bu Xiongwei;Zuo Jingnan;Shao Minjing;Di Haiyan;Shi Kai;Si Caifeng(Department of Functional,the Second Central Hospital of Baoding,Baoding Hebei 072750,P.R.China)

机构地区：[1]保定市第二中心医院功能科,河北保定072750

出　　处：《中国计划生育和妇产科》2024年第3期73-77,83,F0003,共7页Chinese Journal of Family Planning & Gynecotokology

基　　金：2023年保定市科技计划自筹经费项目(项目编号:2341ZF040)。

摘　　要：目的 探讨子宫动脉多普勒检查及血清环氧合酶-2(cyclooxygenase-2,COX-2)、25-羟基维生素D[25(OH)D]对子痫前期(preeclampsia,PE)孕妇疾病严重程度的诊断价值。方法 回顾性分析保定市第二中心医院2018年12月至2022年12月接诊的167例PE孕妇的临床资料,记为研究组,以同期100例正常妊娠孕妇作为对照组。于孕9~12周采集空腹静脉血分离血清,检测血清中凝血功能指标、肝功能指标等实验室指标以及血清COX-2、25(OH)D水平;于孕20~24周采用彩色多普勒超声诊断仪检测血流动力学指标。比较两组临床资料、血清COX-2、25(OH)D水平以及阻力指数(RI)、搏动指数(PI)。采用单因素分析与Logistic回归分析判断PE孕妇疾病严重程度的影响因素,创建受试者工作曲线(ROC)分析子宫动脉多普勒检查及血清COX-2、25(OH)D水平对PE孕妇疾病严重程度的诊断价值。结果 研究组活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、血小板计数(PLT)、血清总蛋白(TP)水平以及25(OH)D水平均显著低于对照组(P<0.05),平均血小板体积(MPV)水平以及血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血清肌酸激酶(CK)、乳酸脱氢酶(LDH)活性、血肌酐(Scr)、尿素氮(BUN)、尿酸(UA)、阻力指数(RI)、搏动指数(PI)、COX-2水平均显著高于对照组(P<0.05);单因素与Logistic回归分析结果显示,高水平RI、PI、COX-2与低水平25(OH)D是PE疾病严重程度的危险因素(P<0.05);ROC曲线显示,血清COX-2、25(OH)D、子宫动脉多普勒检测(RI+PI)、RI+PI+COX-2、RI+PI+25(OH)D、RI+PI+COX-2+25(OH)D的AUC分别为0.735、0.696、0.786、0.881、0.825、0.931,灵敏度分别为61.11%、58.89%、72.22%、81.11%、73.33%、84.44%,特异度分别为79.22%、76.62%、79.22%、84.42%、79.22%、89.61%。结论 PE孕妇血流动力学指标RI、PI和血清COX-2水平显著升高,25(OH)D水平显著降低,子宫动脉多普勒检测联合血清COX-2、维Objective To investigate the diagnostic value of uterine artery Doppler examination,serum cyclooxygenase-2(COX-2) and vitamin D [25(OH)D] on the severity of preeclampsia(PE) in pregnant women.Methods The clinical data of 167 pregnant women with PE received by the Second Central Hospital of Baoding from December 2018 to December 2022 were retrospectively analyzed as the study group,and 100 normal pregnant women during the same period as the control group.Fasting venous blood was collected at 9~12 weeks of gestation to separate serum,and laboratory indicators such as coagulation function indexes and liver function indexes in serum and serum COX-2 and 25(OH)D levels were detected.At 20~24 weeks of pregnancy,color Doppler ultrasound was used to detect hemodynamic indexes.The two groups were compared with clinical data,serum COX-2,25(OH)D levels,resistance index(RI),and pulsation index(PI).Univariate analysis and Logistic regression analysis were used to determine the influencing factors of disease severity in PE pregnant women,and the receiver operating characteristic curve(ROC) was created to analyze the diagnostic value of uterine artery Doppler examination and serum COX-2 and 25(OH)D levels on the severity of PE in pregnant women.Results The activated partial prothrombin time(APTT),prothrombin time(PT),thrombin time(TT),platelet count(PLT),serum total protein(TP) level,and 25(OH)D level in the study group were significantly lower than those in the control group(P<0.05),and the mean platelet volume(MPV),serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),serum creatine kinase(CK),the levels of lactate dehydrogenase(LDH),serum creatinine(Scr),urea nitrogen(BUN),uric acid(UA),resistance index(RI),pulsatile index(PI) level,and COX-2 were significantly higher than those in the control group(P<0.05).The results of univariate and Logistic regression analysis showed that high levels of RI,PI and COX-2 and low levels of 25(OH)D were risk factors for PE disease severity(P<0.05);ROC curves showed that the AUC

关 键 词：子宫动脉多普勒检查 环氧合酶-2 维生素D 子痫前期 预测诊断 

分 类 号：R714.245[医药卫生—妇产科学] R446.6[医药卫生—临床医学]