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妊娠高血压及先兆子痫孕妇胎盘发育不全的相关因素分析*
杨鸿雁,梅奇华,王卓,苟海燕,王修会
0
(黔西南州人民医院产科)
摘要:
【摘要】 目的 探讨妊娠高血压(GH)及先兆子痫(PE)孕妇胎盘发育不全的相关因素分析。 方法 选择2017年2月~2019年2月本院收治的23例妊娠期高血压孕妇(GH组)、23例先兆子痫孕妇(PE组)及26例同期就诊的正常孕妇(对照组)为研究对象。采用自由基分析系统4分析活性氧代谢物(d-ROM)和血清生物抗氧化剂(BAP)的血清衍生物。ELISA试剂盒测定可溶性Fms样酪氨酸激酶-1(sFlt-1)和胎盘生长因子(PlGF)的血清浓度。多普勒超声测量肱动脉血流介导的血管舒张(FMD)和颈动脉的内膜中层厚度(IMT)。免疫组织化学分析8-羟基-2′-脱氧鸟苷(8-OHdG)、氧化还原因子-1(ref-1)、缺氧诱导因子-1α(HIF-1α)。 结果 GH组和PE组妊娠期间收缩压和舒张压均显著升高,GH组和PE组分娩后1年收缩压显著升高,且GH组较PE组更高;GH组分娩后1年舒张压显著升高(P<0.05)。GH组和PE组母体血清dROM、BAP浓度显著升高,且GH组BAP浓度较PE组更高(P<0.05);与GH组和对照组比较,PE组的母体血清sFlt-1浓度及sFlt-1/P1GF比例显著升高(P<0.05);GH组和PE组母体血清PlGF浓度显著降低,且PE组较GH组更低(P<0.05)。GH组和PE组中HIF-1α、8-OHdG阳性细胞核的比例显著升高,且PE组与GH组相比更高;与PE组和对照组比较,GH组中ref1阳性细胞核的比例显著升高(P<0.05)。GH组和PE组的FMD显著降低,IMT显著升高,且GH组IMT显著高于PE组(P<0.05)。 结论 PE患者胎盘缺氧变化和DNA氧化损伤严重,并伴有抗血管生成因子的增加,且GH患者的母体器质性血管紊乱比PE患者更为严重。
关键词:  妊娠期高血压  先兆子痫  可溶性Fms样酪氨酸激酶-1  胎盘生长因子  颈动脉内膜中层厚度
DOI:
基金项目:黔西南州科技局科技计划项目(2016-1-49)
Analysis of etiology of placental hypoplasia and maternal organic vascular disorder in pregnant women with pregnancy-induced hypertension and pre-eclampsia
YANG Hongyan,MEI Qihua,WANG Zhuo,GOU Haiyan,WANG Xiuhui
(Department of Obstetrics, Qianxinan People′s Hospital)
Abstract:
【Abstract】 Objective To explore the etiology of placental hypoplasia and maternal organic vascular disorder in pregnant women with pregnancyinduced hypertension and preeclampsia. Methods From February 2017 to February 2019, 23 pregnant women with gestational hypertension (GH group), 23 pregnant women with preeclampsia (PE group) and 26 normal pregnant women (control group) were selected as the study objects. The serum derivatives of active oxygen metabolites (d-ROM) and serum biological antioxidants (BAP) were analyzed by free radical analysis system 4. The serum concentrations of soluble FMS like tyrosine kinase-1 (SFLT-1) and placental growth factor (PlGF) were determined by ELISA. The brachial artery flow mediated vasodilation (FMD) and carotid intima-media thickness (IMT) were measured by Doppler ultrasound. Immunohistochemical analysis of 8-hydroxy 2-′-deoxyguanosine (8-OHdG), redox factor-1 (Ref-1), hypoxia inducible factor 1-α (HIF 1-α). Results The systolic and diastolic blood pressure of GH group and PE group increased significantly during pregnancy. The systolic blood pressure of GH group and PE group increased significantly one year after delivery, and GH group was higher than PE group. The diastolic blood pressure of GH group increased significantly one year after delivery (P<0.05). The concentrations of D ROM and BaP in GH group and PE group were significantly higher than those in PE group (P<0.05). Compared with GH group and control group, the maternal serum SFLT-1 concentration and the ratio of SFLT-1 / p1gf in PE group increased significantly(P<0.05). The serum PlGF concentration of GH group and PE group was significantly lower than that of GH group (P<0.05). The proportion of HIF 1-α, 8-OHdG positive nuclei in GH group and PE group was significantly higher than that in GH group. Compared with PE group and control group, the proportion of ref-1 positive nuclei in GH group increased significantly (P<0.05). The FMD and IMT of GH group and PE group were significantly lower and higher than those of PE group(P<0.05). Conclusion The changes of placental hypoxia and DNA oxidative damage were serious in PE patients, accompanied by the increase of anti angiogenic factors, and the disorder of maternal organic blood vessels in GH patients was more serious than that in PE patients.
Key words:  Pregnancy hypertension  Preeclampsia  sFlt-1  PlGF  IMT

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