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目的探讨子痫前期(PE)孕妇孕中期血清转甲状腺素蛋白(TTR)的表达及其对妊娠结局的影响。方法收集2012年5月-2016年2月间在该院进行产前检查(产检)及分娩的孕中期PE孕妇68例作为观察组,根据血清TTR含量中位数分为高TTR组、低TTR组各34例;另取同期在该院进行产检及分娩的正常孕妇50例作为对照组。采用酶联免疫吸附法(ELISA)检测血清TTR表达水平;记录各组孕妇的分娩方式、母婴不良结局发生情况。结果观察组孕中期血清TTR表达水平显著低于对照组,差异有统计学意义(t=10.827,P<0.05);低TTR组、高TTR组的自然分娩率低于对照组,产钳助娩、剖宫产率高于对照组,TTR表达水平降低,自然分娩率降低,产钳助娩、剖宫产率上升,差异有统计学意义(χ_(低TTR组vs.对照组)~2=11.286、9.174、10.574;χ_(高TTR组vs.对照组)~2=14.382、10.658、9.816;χ_(低TTR组vs.高TTR组)~2=9.163、12.573、10.729,均P<0.05);低TTR组、高TTR组的子痫、DIC、急性心衰、肝功能损害等母体不良结局发生率均高于对照组,TTR表达水平降低,子痫、DIC、急性心衰、肝功能损害等发生率上升,差异有统计学意义(χ_(低TTR组vs.对照组)~2=9.831、10.729、12.163、8.927;χ_(高TTR组vs.对照组)~2=12.093、9.117、10.564、12.764;χ_(低TTR组vs.高TTR组)~2=12.047、10.652、13.193、8.372,均P<0.05);低TTR组、高TTR组胎死宫内、新生儿窒息、新生儿透明膜病、新生儿心脏发育不全等发生率高于对照组,TTR表达水平降低,胎死宫内、新生儿窒息、新生儿透明膜病、新生儿心脏发育不全等发生率上升,差异有统计学意义(χ_(低TTR组vs.对照组)~2=14.392、9.382、11.173、9.371;χ_(高TTR组vs.对照组)~2=9.173、10.684、14.214、9.872;χ_(低TTR组vs.高TTR组)~2=11.381、9.473、15.382、10.561,均P<0.05)。结论血清TTR表达水平降低是辅助诊断PE患者的可靠指标;TTR表达水平与母婴不良结局发生率间存在负相关关系。
Objective To investigate the expression of serum transthyretin (TTR) in pregnant women with preeclampsia (PE) and its effect on pregnancy outcome. Methods Sixty-eight pregnant women with pre-pregnancy (labor examination) and childbirth during the period from May 2012 to February 2016 were enrolled in this study. According to the median of serum TTR levels, 68 pregnant women were divided into high TTR group, low TTR group Group of 34 cases; another take the same period in the hospital for childbirth and delivery of 50 normal pregnant women as a control group. Serum TTR expression was detected by enzyme-linked immunosorbent assay (ELISA). The mode of delivery and maternal and infant adverse outcomes in each group were recorded. Results The level of TTR expression in the second trimester of pregnancy in observation group was significantly lower than that in control group (t = 10.827, P <0.05). The natural delivery rate in low TTR group and high TTR group was lower than that in control group, The rate of cesarean section was higher than that of the control group, the expression of TTR decreased, the rate of natural delivery decreased, the forceps assisted delivery and the rate of cesarean section increased (χ_ (low TTR vs. control) ~2 = 11.286, Χ_ (high TTR vs. control) ~ 2 = 14.382,10.658,9.816; χ_ (low TTR vs high TTR) ~ 2 = 9.163, 12.573 and 10.729, all P <0.05) TTR group, high TTR group of eclampsia, DIC, acute heart failure, liver dysfunction and other maternal adverse outcomes were higher than the control group, TTR expression decreased, eclampsia, DIC, acute heart failure, liver dysfunction occurred (Χ_ (low TTR vs. control) ~ 2 = 9.831,10.729,12.163,8.927; χ_ (high TTR vs. control) ~ 2 = 12.093,9.117,10.564,12.764 ; χ_ (low TTR group vs. high TTR group) ~ 2 = 12.047,10.652,13.193,8.372, all P <0.05); low TTR group, high TTR group, intrauterine fetal death, neonatal asphyxia, neonatal hyaline membrane disease Newborn heart Incidence of infertility and other higher than the control group, TTR expression decreased, fetal death, neonatal asphyxia, neonatal hyaline membrane disease, neonatal cardiac hypoplasia incidence increased, the difference was statistically significant (χ_ (low TTR Group vs. control group) ~ 2 = 14.392,9.382,11.173,9.371; χ_ (high TTR group vs control group) ~ 2 = 9.173,10.684,14.214,9.872; χ_ (low TTR group vs high TTR group) ~ 2 = 11.381,9.473,15.382,10.561, all P <0.05). Conclusions The decrease of serum TTR expression is a reliable indicator to assist in the diagnosis of PE. There is a negative correlation between the expression of TTR and the incidence of maternal and infant adverse outcomes.