本文選題：重度子癇前期 + 可溶性內(nèi)皮糖蛋白�。� 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:子癇前期是妊娠期特有疾病,主要表現(xiàn)為妊娠20周后出現(xiàn)的高血壓、蛋白尿和其他并發(fā)癥相結(jié)合的疾病,是導(dǎo)致孕婦及圍生兒患病及死亡的主要病因之一。因其具有發(fā)病重、進(jìn)展快、母嬰預(yù)后差等特征,特別是重度子癇前期,故搜尋更簡便、更準(zhǔn)確、更有效的預(yù)測子癇前期的方法,做到早發(fā)現(xiàn)、早預(yù)防、早干預(yù),成為了近些年產(chǎn)科發(fā)展的重中之重。隨著研究的不斷深入,對各種臨床高危風(fēng)險因素、生物化學(xué)標(biāo)志物、生物物理評估等多個領(lǐng)域的研究也都獲得新的進(jìn)展。目前大量的試驗證明,血管內(nèi)皮細(xì)胞激活、功能失調(diào)和結(jié)構(gòu)損害是子癇前期病理生理變化的一個重要環(huán)節(jié),但這一損傷過程的具體機(jī)制尚不明確。據(jù)相關(guān)研究,可溶性內(nèi)皮糖蛋白(Soluble endoglin,簡稱sEng)是一種抗血管生成蛋白質(zhì),而甲狀腺素轉(zhuǎn)運球蛋白(Transthyretin,簡稱TTR)可在血管系統(tǒng)中形成淀粉樣纖維的沉積,兩者在孕婦外周血中的特異表達(dá)均會導(dǎo)致血管內(nèi)皮功能障礙,進(jìn)而引起相應(yīng)的臨床癥狀。本研究通過檢測正常妊娠婦女及重度子癇前期婦女外周血血清中sEng及TTR水平并進(jìn)行對比,探討其在重度子癇前期中的表達(dá)及兩者聯(lián)合檢測對診斷重度子癇前期發(fā)生的價值及意義。方法:本研究隨機(jī)選取2015年01月01日-2017年01月01日期間我院婦產(chǎn)科住院分娩的重度子癇前期患者30例,將其定為重度子癇前期組,年齡26-39歲,平均年齡32.07±2.59歲,孕周30-37周,平均妊娠周數(shù)34.18±2.23周;選取同時期住院的30位不伴有任何妊娠期合并癥及并發(fā)癥的健康孕婦,將其定義為正常妊娠組。年齡25-39歲,平均年齡31.77±3.57歲,孕周37-41周,平均妊娠周數(shù)39.79±1.19周。檢測的所有患者均為隨機(jī)抽取,且其年齡與孕周具有均衡性。對所有血清中sEng及TTR水平進(jìn)行檢測,將重度子癇前期組與正常妊娠組血清中sEng及TTR水平進(jìn)行兩兩比較,并進(jìn)行統(tǒng)計學(xué)分析,并分別測定兩項指標(biāo)在最佳診斷界值時的特異度、靈敏度以及聯(lián)合檢測時是否會增加對子癇前期的診斷。結(jié)果:通過對各組中sEng及TTR水平進(jìn)行兩兩比較,結(jié)果如下:1.正常妊娠組外周血血清中sEng與重度子癇前期組外周血血清中sEng水平相比較,通過獨立樣本t檢驗得出P0.05,說明兩組的結(jié)果相比較具有差異性,且前者較后者顯著降低,該結(jié)果具有統(tǒng)計學(xué)意義。2.正常妊娠組外周血血清中TTR與重度子癇前期組外周血血清中TTR水平相比較,通過獨立樣本t檢驗得出P=0.002且0.05,說明兩組的結(jié)果相比較具有差異性,且后者較前者顯著降低,該結(jié)果具有統(tǒng)計學(xué)意義。3.通過ROC曲線分析得知(1)sEng診斷重度子癇前期時的曲線下面積AUC=0.794(0.7),說明其診斷效能較好,當(dāng)最佳診斷界值為47.92pg/ml時,其靈敏度為76.67%,特異度為80%;(2)TTR診斷重度子癇前期時的曲線下面積AUC=0.752(0.7),說明其診斷效能較好,當(dāng)最佳診斷界值為91.69ug/ml時,其靈敏度為86.67%,特異度為73.33%;(3)兩指標(biāo)聯(lián)合診斷重度子癇前期時的曲線下面積AUC=0.839(0.7),說明其診斷效能較好;4.sEng、TTR及兩者聯(lián)合診斷重度子癇前期時ROC曲線下面積(AUC)進(jìn)行兩兩比較,通過Z檢驗得出P(AUC1)=0.604(0.05),P(AUC2)=0.297(0.05),P(AUC3)=0.114(0.05),說明任意兩組之間的比較結(jié)果均無差異性,即無統(tǒng)計學(xué)意義,說明sEng、TTR或者兩者聯(lián)合檢測均不能提高對重度子癇前期的診斷價值。結(jié)論:1.對正常妊娠組和重度子癇前期組中sEng及TTR水平進(jìn)行比較,結(jié)果說明sEng水平越高,而TTR水平越低,其發(fā)生重度子癇前期的風(fēng)險越高;2.sEng、TTR及兩者聯(lián)合檢測對重度子癇前期均有很好的診斷效能,但兩者聯(lián)合檢測并未提高其診斷價值。因本研究樣本量有限,此結(jié)果尚需通過大樣本試驗進(jìn)行進(jìn)一步的驗證。
[Abstract]:Objective: preeclampsia is a special disease of pregnancy, mainly characterized by hypertension after 20 weeks of pregnancy, a combination of proteinuria and other complications, which is one of the main causes of the illness and death of pregnant and perinatal infants. Simple, more accurate, more effective methods to predict preeclampsia, early detection, early prevention and early intervention have become the most important of obstetric development in recent years. With the deepening of research, new progress has been made in various fields of high risk factors, biochemical markers, biophysical evaluation and so on. Quantitative tests show that vascular endothelial cell activation, dysfunction and structural damage are an important link in the pathophysiological changes in preeclampsia, but the specific mechanism of this damage process is not clear. According to the relevant research, Soluble endoglin (sEng) is a kind of antiangiogenic protein and thyroxine transport. Transthyretin (TTR) can form a deposition of amyloid fibers in the vascular system. The specific expression of both in the peripheral blood of pregnant women leads to vascular endothelial dysfunction and causes the corresponding clinical symptoms. This study was conducted to detect the level of sEng and TTR in the serum of normal pregnant women and women with preeclampsia. The value and significance of the expression in severe preeclampsia and the combination of the two in the diagnosis of severe preeclampsia were compared. Methods: This study randomly selected 30 cases of severe preeclampsia in the Department of Obstetrics and Gynecology of our hospital during the period of 01 months of 2015, 01 -2017, 01 months, and designated it as a severe preeclampsia group. The average age was 26-39 years old, the average age was 32.07 + 2.59 years, the average pregnancy week was 30-37 weeks, the average pregnancy week was 34.18 + 2.23 weeks. 30 healthy pregnant women who were hospitalized at the same time were defined as normal pregnant women. The average age was 25-39 years old, the average age was 31.77 + 3.57 years, and the gestational weeks were 37-41 weeks. The average week of pregnancy was 39.79 + 1.19 weeks. All the patients were randomly selected, and their age and gestational age were balanced. The levels of sEng and TTR in all serum were detected. The levels of sEng and TTR in the sera of the severe preeclampsia group and the normal pregnancy group were compared with 22, and the statistical analysis was carried out, and the specificity of the two indexes at the best diagnostic value was determined respectively. The sensitivity and the combined detection of preeclampsia will increase the diagnosis of preeclampsia. Results: by comparing the levels of sEng and TTR in each group, the results are as follows: 1. sEng in peripheral blood serum of normal pregnancy group is compared with sEng level in peripheral blood serum of severe preeclampsia group, and P0.05 is obtained through independent sample t test, indicating the two groups of sEng. The results were significantly different, and the former was significantly lower than the latter. The results were statistically significant in the peripheral blood serum of.2. normal pregnancy group compared with the TTR level in the peripheral blood serum of severe preeclampsia group, and P=0.002 and 0.05 were obtained by independent sample t test. The results showed that the results of the two groups were different, and the latter was more than the former. The results were significantly reduced, and the results were statistically significant.3. through ROC curve analysis (1) the area under the curve of sEng was AUC=0.794 (0.7) in the diagnosis of severe preeclampsia, indicating that the diagnostic efficiency was good. When the best diagnostic value was 47.92pg/ml, the sensitivity was 76.67%, the specificity was 80%, and (2) TTR was used to diagnose the area AUC= under severe preeclampsia. 0.752 (0.7) showed that the diagnostic efficiency was good. When the best diagnostic value was 91.69ug/ml, the sensitivity was 86.67% and the specificity was 73.33%; (3) two index combined with the diagnosis of AUC=0.839 (0.7) under the curve of severe preeclampsia, indicating that the diagnostic efficiency was better; 4.sEng, TTR and both were combined to diagnose the area under the ROC curve (AUC) in severe preeclampsia. In the 22 comparison, P (AUC1) =0.604 (AUC1) =0.604 (AUC1), P (AUC2) =0.297 (0.05), P (AUC3) =0.114 (0.05) showed no difference between any two groups, that is, there was no statistical significance, indicating sEng, TTR, or both combined detection could not improve the diagnostic value for severe preeclampsia. Conclusion: 1. to normal pregnancy and weight. The sEng and TTR levels in the preeclampsia group were compared. The results showed that the higher the level of sEng, the lower the TTR level, the higher the risk of severe preeclampsia. The combined detection of 2.sEng, TTR and both had a good diagnostic efficiency for severe preeclampsia, but the combination of the two tests did not improve the diagnostic value. The sample size of this study was limited, This result needs further verification by large sample test.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.244

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相關(guān)期刊論文 前1條

1 駱碩;胡雪英;馬艷芬;郭曉;朱智紅;;妊娠期高血壓疾病母嬰結(jié)局不良的危險因素及預(yù)防對策[J];實用預(yù)防醫(yī)學(xué);2014年05期

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