子痫前期孕妇外周血sFlt-1、PIGF、PP-13、sEng的表达及其与子宫动脉血流的相关性研究

摘要

Objective To investigate the expression of soluble Fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PIGF), placental protein 13 (PP-13), soluble endothelial factor (sEng) in serum of preeclampsia pregnant women and their correlation with pulsatility index(PI), resistance index (RI), uterine artery systolic and diastolic flow velocity ratios (S/D), which was to provide new ideas for clinical diagnosis and treatment of preeclampsia. Methods 80 healthy pregnant women, 42 women with preeclampsia (PE) and 45 women with gestational hypertention(GH) who underwent routine prenatal examination were enrolled from June 2015 to June 2017 in Affiliated Hospital of Guangdong Medical University. The expression levels of sFlt-1, PIGF, PP13 and sEng in serum were detected by electrochemiluminescence immunoassay, and the PI, RI and S/D ratios of uterine artery were observed from Doppler ultrasound. Results The Levels of sFlt-1, sEng were significant higher in PE group than GH group (P ＜0. 01), so do with PI, RI, and S/D. The indicators were significant higher in GH group than control group (P ＜ 0. 05). While the expressions of PIGF and PP13 in PE group were lower than those in GH group, and those in GH were lower than those in control group (all P ＜0. 05). Serum PIGF expression was negatively correlated with RI (r = - 0. 114, P = 0. 025), and serum sFlt-1 expression was positively correlated with RI (r = 1. 75, P =0. 031); PI, RI, S/D of preeclampsia pregnant women were not correlated with sEng and PP-13 (all P ＞0. 05). RI level of preeclampsia pregnant women was negatively correlated with gestational weeks and neonatal weight (r = - 0. 257, P = 0. 001; r = - 0. 687, P = 0. 035). Conclusion sFlt-1 may be involved in the influence of uterine artery blood flow in preeclampsia and its mechanism may be related to the endothelial dysfunction of uterine artery caused through up-regulation of sFlt-1 mediated by inhibition of PIGF secretion.%目的 探讨子痫前期孕妇血清可溶性Fms样酪氨酸激酶1(sFlt-1)、胎盘生长因子(PIGF)、胎盘蛋白13(PP-13)、可溶性内皮因子(sEng)的表达及其与子宫动脉S/D、PI、RI的相关性,为临床诊治子痫前期提供新的思路.方法 选择2015年6月—2017年6月在广东医科大学附属医院行常规产前检查并诊断为妊娠期高血压疾病的孕妇,分别为子痫前期组(42例)和妊娠期高血压组(45例);同期单胎健康孕妇为对照组(80例).采用电化学发光免疫分析法检测血清中sFlt-1、PIGF、PP13、sEng表达水平,多普勒超声检测子宫动脉PI,RI、S/D比值.结果 子痫前期组sFlt-1、sEng、PI、RI、S/D水平均显著高于妊娠期高血压组(均P＜0.01),妊娠期高血压组高于对照组(均P＜0.05);而子痫前期组PIGF、PP13表达均低于妊娠期高血压组,妊娠期高血压组均低于对照组(均P＜0.05).血清PIGF表达与RI呈负相关(r=-0.114,P=0.025),血清sFlt-1表达与RI呈正相关(r=1.75,P=0.031);子痫前期孕妇PI,RI、S/D与sEng、PP-13无相关性(P均＞0.05).子痫前期孕妇RI水平与分娩孕周、新生儿体重呈负相关(r=-0.257,P=0.001;r=-0.687,P=0.035).结论 研究提示sFlt-1可能参与影响子痫前期子宫动脉血流,其机制可能是通过上调sFlt-1介导抑制PIGF的分泌引起子宫动脉内皮功能障碍有关.