母婴血循环中Ang（1-7）水平对早产的影响

摘要

目的：探讨孕晚期母婴血浆血管紧张素（1-7）[Ang（1-7）]和血管紧张素Ⅱ（AngⅡ）浓度对胎儿早产以及宫内发育的影响。方法：前瞻性研究孕产妇309例，以妊娠至37孕周为界，将其分为早产组17例和足月产组292例。采用酶联免疫法检测分娩前母血及产后脐血血浆Ang（1-7）与AngⅡ浓度。分析早产与足月产两组孕妇一般临床资料、妊娠期并发症、新生儿发育指标等。通过校正混杂因素，应用单因素及多因素Logistic回归分析早产危险因素。结果：与足月产组比较，早产组孕妇血浆Ang（1-7）、AngⅡ及Ang（1-7）/AngⅡ质量浓度显著低于足月产组，分别为（399.86±218.93）、（710.34±598.22）ng/L，P＜0.001；（49.87±29.32）、（72.51±60.79）ng/L，P＝0.028；Ang（1-7）/AngⅡ（8.34±1.65）、（9.79±2.83），P＝0.012。与足月产组比较，早产组新生儿脐带血浆Ang （1-7）、AngⅡ质量浓度显著低于足月产组，分别为（486.15±337.34）、（833.34±698.12）ng/L，P＝0.001，（54.75±38.03）、（84.41±69.01）ng/L，P＝0.025，而两组间Ang（1-7）/AngⅡ无显著差异，分别为（9.54±2.55）、（9.85±3.11），P＝0.733。经多重Logistic回归分析，剔除子痫前期等混杂因素影响后，胎膜早破、新生儿Ang（1-7）低浓度是早产的危险因素是早产的危险因素，OR值分别为8.54（95％可信区间：2.73～26.76，P＜0.001）、0.31（95％可信区间：0.14～0.69，P＝0.010）。结论：孕晚期胎儿脐血Ang（1-7）浓度降低有增加早产的风险。%Aim:To investigate the impact of both maternal and neonatal plasma angiotensin (1-7 ) [Ang(1-7)]and angiotensinII (AngⅡ)levels on preterm delivery and intrauterine fetal growth.Meth-ods:309 cases of pregnant women were prospectively participated in this study.The pregnant women were divided into two groups of preterm birth and full-term birth according to the gestational weeks as low-er than 37 weeks (n=1 7)and 37 weeks or more (n=292).Maternal and neonatal plasma Ang(1-7) and AngⅡconcentrations were tested by enzyme-linked immunosorbent assay.The risk factors of preterm birth were done by logistic regression analysis.Results:Compared with full-term birth group,maternal plasma Ang(1-7 ),AngⅡconcentrations and ratio of Ang(1-7 )/AngⅡin preterm group were significant-ly lower.Neonatal plasma Ang(1-7 )and AngⅡlevels of umbilical cord in preterm group were also sig-nificantly lower than those in full-term birth group.However,no significant difference of the ratio of neo-natal plasma Ang(1-7)/AngⅡin umbilical cord was shown.Logistic regression analysis was shown that the risk factors of preterm delivery are premature rupture of membranes (OR=8.54,P<0.001 ),and low level of neonatal plasma Ang(1-7 )(OR=0.31 ,95%CI:0.1 4-0.69 ,P=0.01 0 )after adjusted for the confusing factors,such as preeclampsia.Conclusion:Low neonatal plasma Ang (1-7 )level might have the high risk for preterm delivery.