子癇前期母體血清PIGF、sEng濃度對腦流體動力學、腦組織損傷的影響
發(fā)布時間：2018-08-15 18:53
【摘要】：目的 ①闡明P E與正常妊娠母體血清PIGF、sEng濃度及sEng/PIGF比值的差異，評估PIGF、sEng濃度及sEng/PIGF比值在PE預測中的價值。 ②探討PE母體腦動脈、靜脈、腦脊液三大流體系統(tǒng)動力學、流動模式的變化及其腦靜脈、腦脊液循環(huán)的調(diào)節(jié)方式。 ③探討PE母體血清PIGF、sEng濃度對腦流體動力學的影響。 材料與方法 1．研究對象 選取2013年10月~2014年3月廣州醫(yī)科大學附屬第三醫(yī)院產(chǎn)科收治的子癇前期孕婦31例（重度PE17例，輕度PE14例）為研究對象，另招募24例健康育齡期女性及28例正常中晚期妊娠孕婦為對照研究。 2．PC-MRI測量 對31例PE患者（入院當天）及24例健康育齡期女性（2013年7月~2013年9月）行BA、右側(cè)大腦中動脈（MCA）、上矢狀竇（SSS）、SS（直竇）及中腦導水管（CA）的PCMRI流動測量，其中18PE患者例于產(chǎn)后4~8周內(nèi)行PCMRI復查。 3．血清PIGF、sEng濃度檢測 對該31例PE患者于入院第二天早晨空腹靜脈采血5ml，28例中晚期正常妊娠孕婦于門診空腹采靜脈血5ml，離心后取血清置于-800冷藏，并采用ELISA法檢測血清PIGF、sEng濃度。 4．結(jié)果觀察及分析 比較P E與正常妊娠母體血清PIGF、sEng濃度及sEng/PIGF值的差異，采用ROC曲線評估PIGF、sEng濃度及sEng/PIGF濃度比值用于PE診斷的價值；觀察三組各測量血管及CA的時相--峰值流速曲線特征，記錄舒張期及收縮期流速達峰速度和時相點，計算收縮期和舒張期流速達峰時相差，并除以16獲得兩峰值時相差率，比較三組曲線達峰時相差率及流體動力學間的差異；計算SSS與SS的平均流量比值，并比較三組該比值的差異。計算PE母體血清sEng/PIGF濃度比與腦流體動力學的相關性。 結(jié)果 1. PE母體血清PIGF濃度低于正常妊娠，sEng及sEng/PIGF比值濃度高于正常妊娠；重度PE母體血清PIGF濃度低于輕度PE，sEng及sEng/PIGF比值濃度高于輕度PE。 2. sEng/PIGF比值預測PE的臨界值為9.85，靈敏度為93.5%，特異性為100%；sEng濃度預測PE的臨界值為3402.6pg/ml，靈敏度為93.5%，特異性為96.4%；PIGF濃度預測PE的臨界值為359.5pg/ml，靈敏度為82.1%，特異性為90.3%。 3. PE母體BA的MF、MV、PV及血管面積均大于產(chǎn)后復查值；PE母體MCA的MV、PV值大于產(chǎn)后復查值，血管面積小于產(chǎn)后復查值，MF與產(chǎn)后復查無明顯差異。 4. PE母體SSS及SS的血管面積、總MF及SS流量大于產(chǎn)后復查值，流速參數(shù)低于產(chǎn)后復查值，SS/SSS流量比值增大。 5. PE母體CA面積及收縮期、舒張期PV均高于產(chǎn)后復查值，凈流量低于產(chǎn)后復查值。 6. MCA、CA時相-峰值流速曲線兩波峰間時相差率小于產(chǎn)后復查值，BA、SSS及SS時相-峰值流速曲線兩波峰間時相差率大于產(chǎn)后復查值。 7. PE母體產(chǎn)后復查腦血管及CA面積及流體動力學、流動模式與育齡期女性均無差異。 8. PE母體血清sEng/PIGF比值與BA平均流速呈正相關性，sEng/PIGF比值與CA凈流量呈負相關性，sEng/PIGF值與MCA、SSS、SS平均流速無相關性。 結(jié)論 1. PE母體血清sEng濃度、sEng/PIGF濃度比值顯著高于正常妊娠，PIGF顯著低于正常妊娠， PIGF、sEng參與了PE的病理生理過程；血清sEng/PIGF比值可作為預測PE的理想指標，截值為9.85，靈敏度為93.5%，特異性為100%。 2. PE母體顱內(nèi)動脈、靜脈及中腦導水管的流體動力學、流動模式均改變，產(chǎn)后6~8周恢復。 3. PE母體MCA血流灌注正常，BA血流過渡灌注、血管面積增大，提示后循環(huán)系統(tǒng)自我平衡被打破。 4.顱內(nèi)靜脈與腦脊液循環(huán)一起參與了顱內(nèi)循環(huán)的再平衡調(diào)節(jié)，但兩者調(diào)節(jié)方式不同，靜脈呈“高排出”、腦脊液呈“低排出”。 5. PE母體血清sEng/PIGF比值與BA平均流量呈正相關性，而與MCA、顱內(nèi)靜脈平均流量無明顯相關性。 6. PE母體血清sEng/PIGF比值與CA凈流量呈負相關性，PIGF、sEng的比例改變可能影響了腦脊液的生成。 目的： ①闡明PE母體腦血管源性水腫、細胞毒性水腫及腦出血、腦微量出血的發(fā)生率，探討DWI在腦水腫病因鑒別中的價值。 ②探討PE腦組織損傷與血清PIGF、sEng濃度及sEng/PIGF比值的關系，評估sEng濃度及sEng/PIGF比值在PE腦損傷預測中的價值。 ③探討PE腦組織損傷與顱內(nèi)動、靜脈及腦脊液流量的關系。 材料與方法： 1.研究對象 選取2013年10月~2014年3月我院產(chǎn)科收治的子癇前期孕婦31例（重度PE17例，輕度PE14例）為研究對象，其中早發(fā)型PE13例，，晚發(fā)型PE18例。 2.MRI檢查 所有患者于入院當天行BA、RMCA、SSS、SS及CA的PC-MRI流動測量；同時行常規(guī)軸位T1WI、T2WI、T2/FLAIR、DWI、SWI及T2WI矢狀位掃描。 3.PIGF、sEng濃度測量 對該31例PE患者于入院第二天早晨空腹靜脈采血5ml，離心后取血清置于-800冷藏，并采用ELISA法檢測血清PIGF、sEng濃度。 4.數(shù)據(jù)記錄與分析 腦血管源性水腫、細胞毒性水腫及腦出血、腦微量出血的發(fā)病率并比較腦組織損傷的發(fā)病率在重、輕度PE及早發(fā)型、晚發(fā)型PE中的差異；比較血管源性腦水腫、細胞毒性腦水腫灶ADC值與正常腦實質(zhì)的差異，比較顱內(nèi)流體動力學、血清sEng/PIGF濃度比值在腦損傷組與無損傷組間的差異；采用ROC曲線評估血清sEng濃度、sEng/PIGF比值預測腦組織損傷的價值，并計算其臨界值及相應的敏感度、特異性。 結(jié)果： 31例PE患者中血管源性腦水腫8例（25.8%），細胞毒性腦水腫2例（6.5%），腦出血1例（3.2%），腦微量出血0例；17例重度PE中腦損傷10例，14例輕度PE中腦損傷1例，兩者存在顯著統(tǒng)計學差異（P0.01）；早發(fā)型PE13例中腦損傷8例，晚發(fā)型PE18例中腦損傷3例，兩者存在統(tǒng)計學差異（P0.05）。產(chǎn)后4~8周復查，8例血管源性水腫病灶信號均恢復。 腦水腫T1WI呈低信號，T2WI及T2/FAIR呈高信號；血管源性腦水腫DWI呈等、略高信號，ADC圖呈明顯高信號，細胞毒性腦水腫DWI呈明顯高信號，ADC圖呈明顯低信號。血管源性腦水腫病灶平均ADC值顯著高于相應對側(cè)（或周邊）正常腦組織平均ADC值（P0.01）；細胞毒性腦水腫病灶平均ADC值顯著低于相應對側(cè)（或周邊）正常腦組織平均ADC值（P0.01）。 腦損傷組BA、SS平均流量高于無腦損傷組（P0.05）， CA凈流量顯著低于無腦損傷組（P0.01）；腦損傷組MCA、SSS平均流量與無腦損傷組間無明顯差異(P0.05)。SS平均流量與BA平均流量呈正相關（r=0.87，P=0.00），CA凈流量與BA平均流量呈無相關性（r=0.11，P=0.76）。 腦損傷組血清sEng、sEng/PIGF濃度比值顯著高于無腦損傷組（P0.01），PIGF濃度低于無腦損傷組（P0.01）；sEng/PIGF比值預測PE腦損傷的臨界值為20.0，靈敏度為81.8%，特異性為85.0%；sEng濃度預測PE的臨界值為4809.4pg/ml，靈敏度為81.8%，特異性為70.0%。 結(jié)論： 1. PE腦組織損傷以血管源性腦水腫最為常見，常發(fā)生于后循環(huán)供血區(qū)域，細胞毒性腦水腫及腦出血、微出血少見。 2.重度PE腦損傷發(fā)生率高于輕度PE，早發(fā)型PE腦損傷發(fā)生率高于晚發(fā)型PE。 3. DWI能準確鑒別腦水腫的病因，ADC值可反映腦組織損傷的病理生理改變。 4. PE腦組織損傷BA血流灌注顯著高于無腦損傷組，SS靜脈回流相應增加，且與BA流量呈正相關；CA凈流出量減少，與BA流量無相關性。 5.腦損傷組血清sEng濃度、sEng/PIGF濃度比值顯著高于無腦損傷組，血清PIGF、sEng可能參與了腦組織損傷的病理生理過程，sEng/PIGF比值可作為預測PE腦損傷的理想指標，其臨界值為20.0，靈敏度為81.8%，特異性為85.0%。
[Abstract]:objective
(1) To clarify the difference of PIGF, sEng concentration and sEng/PIGF ratio between PE and normal pregnant women, and to evaluate the value of PIGF, sEng concentration and sEng/PIGF ratio in predicting PE.
(2) To investigate the dynamics of the cerebral arteries, veins and cerebrospinal fluid (CSF) in PE mothers and the changes of the flow patterns and the regulation of the circulation of the cerebral veins and cerebrospinal fluid (CSF).
To explore the effect of maternal serum PIGF and sEng concentration on brain fluid dynamics in PE.
Materials and methods
1. object of study
Thirty-one preeclampsia pregnant women (17 severe PE and 14 mild PE) admitted to the Obstetrics Department of the Third Affiliated Hospital of Guangzhou Medical University from October 2013 to March 2014 were selected as the study subjects. Another 24 healthy women of childbearing age and 28 normal pregnant women of middle and late pregnancy were recruited as the control group.
2.PC-MRI measurement
PCMRI flow measurements were performed in 31 PE patients (on admission day) and 24 healthy women of childbearing age (from July 2013 to September 2013), including BA, right middle cerebral artery (MCA), superior sagittal sinus (SSS), SS (straight sinus) and midbrain aqueduct (CA). PCMRI was performed in 18 PE patients within 4 to 8 weeks after delivery.
3. serum PIGF, sEng concentration detection
The fasting venous blood samples were taken from 31 PE patients in the morning of admission and from 28 normal pregnant women in the middle and late stages of pregnancy in the outpatient department. The serum samples were collected after centrifugation and placed in - 800 cold storage. The serum PIGF and sEng concentrations were detected by ELISA.
4. observation and analysis of results
The differences of PIGF, sEng concentration and sEng/PIGF value between PE and normal pregnant women were compared, and the diagnostic value of PIGF, sEng concentration and sEng/PIGF concentration ratio for PE was evaluated by ROC curve; the characteristics of peak velocity curves of blood vessels and CA were observed, the peak velocity and time point of diastolic and systolic velocity were recorded, and the recovery was calculated. The phase difference of peak flow rate between systolic and diastolic phases was obtained by dividing them by 16. The difference of phase difference rate and hydrodynamics between the three groups of curves was compared. The mean flow rate ratio of SSS to SS was calculated and the difference between the three groups was compared.
Result
1. The serum PIGF concentration of PE mothers was lower than that of normal pregnancies, the sEng and sEng/PIGF ratio concentration was higher than that of normal pregnancies, the serum PIGF concentration of severe PE mothers was lower than that of mild PE, and the sEng and sEng/PIGF ratio concentration was higher than that of mild PE.
2. The critical value of predicting PE by sEng/PIGF ratio was 9.85, the sensitivity was 93.5%, the specificity was 100%; the critical value of predicting PE by sEng concentration was 3402.6 pg/ml, the sensitivity was 93.5%, the specificity was 96.4%; the critical value of predicting PE by PIGF concentration was 359.5 pg/ml, the sensitivity was 82.1%, the specificity was 90.3%.
3. MF, MV, PV and vascular area of PE maternal BA were greater than those of postpartum reexamination; MV and PV values of PE maternal MCA were higher than those of postpartum reexamination, and vascular area was smaller than that of postpartum reexamination. There was no significant difference between MF and postpartum reexamination.
4. The blood vessel area, total MF and SS flow rate of PE maternal SSS and SS were greater than that of postpartum reexamination, flow rate parameters were lower than that of postpartum reexamination, and SS/SSS flow rate ratio increased.
5. the CA area and systolic and diastolic PV of maternal PE were all higher than those of postnatal reexamination, and the net flow rate was lower than that of postnatal review.
6. The time difference between the two peaks of MCA and CA time-peak velocity curves was smaller than that of postpartum reexamination. The time difference between the two peaks of BA, SSS and SS time-peak velocity curves was larger than that of postpartum reexamination.
7. There was no significant difference in the flow pattern of cerebrovascular and CA area and fluid dynamics between PE mothers and women of childbearing age.
8. The sEng/PIGF ratio of PE maternal serum was positively correlated with BA average flow rate, while the sEng/PIGF ratio was negatively correlated with CA net flow rate. The sEng/PIGF ratio was not correlated with MCA, SSS and SS average flow rate.
conclusion
1. The serum sEng concentration and sEng/PIGF ratio of PE mothers were significantly higher than those of normal pregnancies, and PIGF was significantly lower than that of normal pregnancies. PIGF and sEng participated in the pathophysiological process of PE. Serum sEng/PIGF ratio could be an ideal index for predicting PE, with a cut-off value of 9.85, a sensitivity of 93.5% and a specificity of 100%.
2. The hydrodynamics and flow pattern of intracranial artery, vein and midbrain aqueduct of PE maternal body were changed, and recovered at 6-8 weeks postpartum.
3. The MCA blood perfusion of PE maternal body was normal, BA blood flow was transitional perfusion, the area of blood vessel was enlarged, suggesting that the self-balance of posterior circulation system was broken.
4. Intracranial veins and cerebrospinal fluid circulation participate in the rebalancing regulation of intracranial circulation, but the two regulation modes are different, the veins are "high discharge" and the cerebrospinal fluid is "low discharge".
5. The sEng/PIGF ratio of PE maternal serum was positively correlated with BA mean flow, but not with MCA and intracranial venous flow.
6. The ratio of sEng/PIGF in PE maternal serum was negatively correlated with CA net flow. The change of the ratio of PIGF and sEng may affect the formation of CSF.
Objective:
To elucidate the incidence of cerebrovascular edema, cytotoxic edema, cerebral hemorrhage and microhemorrhage in PE mothers, and to explore the value of DWI in the etiological differentiation of cerebral edema.
(2) To investigate the relationship between brain injury of PE and serum PIGF, sEng concentration and sEng/PIGF ratio, and to evaluate the value of sEng concentration and sEng/PIGF ratio in predicting brain injury of PE.
(3) to explore the relationship between PE brain tissue damage and intracranial dynamic, venous and cerebrospinal fluid flow.
Materials and methods:
1. object of study
Thirty-one preeclampsia pregnant women (17 cases of severe PE and 14 cases of mild PE) admitted to our obstetric department from October 2013 to March 2014 were selected as the study subjects. Among them, 13 were early-onset PE and 18 were late-onset PE.
2.MRI examination
On the day of admission, all patients underwent PC-MRI flow measurements of BA, RMCA, SSS, SS and CA, and sagittal axial T1WI, T2WI, T2/FLAIR, DWI, SWI and T2WI.
3.PIGF, sEng concentration measurement
The fasting venous blood samples of 31 PE patients were collected for 5 ml in the morning of admission. The serum samples were collected after centrifugation and placed in - 800 cold storage. The serum concentrations of PIGF and sEng were detected by ELISA.
4. data recording and analysis
The incidence of cerebrovascular edema, cytotoxic edema, cerebral hemorrhage and microhemorrhage were compared and the difference of the incidence of severe, mild PE in early and late PE was compared. ROC curve was used to evaluate the value of serum sEng concentration and sEng/PIGF ratio in predicting brain tissue injury, and the critical value and corresponding sensitivity and specificity were calculated.
Result:
There were 8 cases (25.8%) of vascular brain edema, 2 cases (6.5%) of cytotoxic brain edema, 1 case (3.2%) of cerebral hemorrhage and 0 cases of micro-cerebral hemorrhage in 31 PE patients, 10 cases of severe PE middle brain injury and 1 case of mild PE middle brain injury. There were significant differences between them (P 0.01); 8 cases of early PE middle brain injury and 3 cases of late PE middle brain injury. There was statistical difference (P0.05). After 4~8 weeks of postpartum reexamination, 8 cases of angiogenic edema were recovered.
Cerebral edema showed low signal on T1WI, high signal on T2WI and T2/FAIR, vasogenic brain edema DWI, slightly high signal on ADC, cytotoxic brain edema DWI, and low signal on ADC. The average ADC value of cytotoxic brain edema lesions was significantly lower than that of the corresponding contralateral (or peripheral) normal brain tissues (P 0.01).
The average flow of BA and SS in brain injury group was higher than that in non-brain injury group (P 0.05), and the net flow of CA was significantly lower than that in non-brain injury group (P 0.01). There was no significant difference between MCA and SSS in brain injury group and non-brain injury group (P 0.05). The average flow of SS was positively correlated with the average flow of BA (r = 0.87, P = 0.00), and the net flow of CA was not correlated with the average flow of BA (r = 0.11, P = 0.76).
The ratio of sEng and sEng/PIGF in serum of brain injury group was significantly higher than that of non-brain injury group (P 0.01), and the concentration of PIGF was lower than that of non-brain injury group (P 0.01); the critical value of sEng/PIGF for predicting brain injury of PE was 20.0, the sensitivity was 81.8%, and the specificity was 85.0%; the critical value of sEng for predicting PE was 4809.4 pg/ml, the sensitivity was 81.8%, and the specificity was 70.0%.
Conclusion:
1. Vasculogenic brain edema is the most common brain tissue injury in PE. It often occurs in the blood supply area of posterior circulation. Cytotoxic brain edema and cerebral hemorrhage are rare.
2. the incidence of severe PE brain injury was higher than that of mild PE, and the incidence of early onset PE brain injury was higher than that of late onset PE..
3. DWI can accurately identify the cause of cerebral edema. ADC value can reflect the pathophysiological changes of brain tissue injury.
4. The blood flow perfusion of BA in PE brain tissue injury was significantly higher than that in non-brain injury group, and the venous reflux of SS increased correspondingly, and was positively correlated with the flow of BA; the net flow of CA decreased, but was not correlated with the flow of BA.
5. Serum sEng concentration and sEng/PIGF ratio in brain injury group were significantly higher than those in non-brain injury group. Serum PIGF and sEng may be involved in the pathophysiological process of brain injury. The ratio of sEng/PIGF can be used as an ideal index for predicting PE brain injury. The critical value of sEng/PIGF ratio was 20.0, the sensitivity was 81.8%, and the specificity was 85.0%.
【學位授予單位】：廣州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714.244
本文編號：2185100
[Abstract]:objective
(1) To clarify the difference of PIGF, sEng concentration and sEng/PIGF ratio between PE and normal pregnant women, and to evaluate the value of PIGF, sEng concentration and sEng/PIGF ratio in predicting PE.
(2) To investigate the dynamics of the cerebral arteries, veins and cerebrospinal fluid (CSF) in PE mothers and the changes of the flow patterns and the regulation of the circulation of the cerebral veins and cerebrospinal fluid (CSF).
To explore the effect of maternal serum PIGF and sEng concentration on brain fluid dynamics in PE.
Materials and methods
1. object of study
Thirty-one preeclampsia pregnant women (17 severe PE and 14 mild PE) admitted to the Obstetrics Department of the Third Affiliated Hospital of Guangzhou Medical University from October 2013 to March 2014 were selected as the study subjects. Another 24 healthy women of childbearing age and 28 normal pregnant women of middle and late pregnancy were recruited as the control group.
2.PC-MRI measurement
PCMRI flow measurements were performed in 31 PE patients (on admission day) and 24 healthy women of childbearing age (from July 2013 to September 2013), including BA, right middle cerebral artery (MCA), superior sagittal sinus (SSS), SS (straight sinus) and midbrain aqueduct (CA). PCMRI was performed in 18 PE patients within 4 to 8 weeks after delivery.
3. serum PIGF, sEng concentration detection
The fasting venous blood samples were taken from 31 PE patients in the morning of admission and from 28 normal pregnant women in the middle and late stages of pregnancy in the outpatient department. The serum samples were collected after centrifugation and placed in - 800 cold storage. The serum PIGF and sEng concentrations were detected by ELISA.
4. observation and analysis of results
The differences of PIGF, sEng concentration and sEng/PIGF value between PE and normal pregnant women were compared, and the diagnostic value of PIGF, sEng concentration and sEng/PIGF concentration ratio for PE was evaluated by ROC curve; the characteristics of peak velocity curves of blood vessels and CA were observed, the peak velocity and time point of diastolic and systolic velocity were recorded, and the recovery was calculated. The phase difference of peak flow rate between systolic and diastolic phases was obtained by dividing them by 16. The difference of phase difference rate and hydrodynamics between the three groups of curves was compared. The mean flow rate ratio of SSS to SS was calculated and the difference between the three groups was compared.
Result
1. The serum PIGF concentration of PE mothers was lower than that of normal pregnancies, the sEng and sEng/PIGF ratio concentration was higher than that of normal pregnancies, the serum PIGF concentration of severe PE mothers was lower than that of mild PE, and the sEng and sEng/PIGF ratio concentration was higher than that of mild PE.
2. The critical value of predicting PE by sEng/PIGF ratio was 9.85, the sensitivity was 93.5%, the specificity was 100%; the critical value of predicting PE by sEng concentration was 3402.6 pg/ml, the sensitivity was 93.5%, the specificity was 96.4%; the critical value of predicting PE by PIGF concentration was 359.5 pg/ml, the sensitivity was 82.1%, the specificity was 90.3%.
3. MF, MV, PV and vascular area of PE maternal BA were greater than those of postpartum reexamination; MV and PV values of PE maternal MCA were higher than those of postpartum reexamination, and vascular area was smaller than that of postpartum reexamination. There was no significant difference between MF and postpartum reexamination.
4. The blood vessel area, total MF and SS flow rate of PE maternal SSS and SS were greater than that of postpartum reexamination, flow rate parameters were lower than that of postpartum reexamination, and SS/SSS flow rate ratio increased.
5. the CA area and systolic and diastolic PV of maternal PE were all higher than those of postnatal reexamination, and the net flow rate was lower than that of postnatal review.
6. The time difference between the two peaks of MCA and CA time-peak velocity curves was smaller than that of postpartum reexamination. The time difference between the two peaks of BA, SSS and SS time-peak velocity curves was larger than that of postpartum reexamination.
7. There was no significant difference in the flow pattern of cerebrovascular and CA area and fluid dynamics between PE mothers and women of childbearing age.
8. The sEng/PIGF ratio of PE maternal serum was positively correlated with BA average flow rate, while the sEng/PIGF ratio was negatively correlated with CA net flow rate. The sEng/PIGF ratio was not correlated with MCA, SSS and SS average flow rate.
conclusion
1. The serum sEng concentration and sEng/PIGF ratio of PE mothers were significantly higher than those of normal pregnancies, and PIGF was significantly lower than that of normal pregnancies. PIGF and sEng participated in the pathophysiological process of PE. Serum sEng/PIGF ratio could be an ideal index for predicting PE, with a cut-off value of 9.85, a sensitivity of 93.5% and a specificity of 100%.
2. The hydrodynamics and flow pattern of intracranial artery, vein and midbrain aqueduct of PE maternal body were changed, and recovered at 6-8 weeks postpartum.
3. The MCA blood perfusion of PE maternal body was normal, BA blood flow was transitional perfusion, the area of blood vessel was enlarged, suggesting that the self-balance of posterior circulation system was broken.
4. Intracranial veins and cerebrospinal fluid circulation participate in the rebalancing regulation of intracranial circulation, but the two regulation modes are different, the veins are "high discharge" and the cerebrospinal fluid is "low discharge".
5. The sEng/PIGF ratio of PE maternal serum was positively correlated with BA mean flow, but not with MCA and intracranial venous flow.
6. The ratio of sEng/PIGF in PE maternal serum was negatively correlated with CA net flow. The change of the ratio of PIGF and sEng may affect the formation of CSF.
Objective:
To elucidate the incidence of cerebrovascular edema, cytotoxic edema, cerebral hemorrhage and microhemorrhage in PE mothers, and to explore the value of DWI in the etiological differentiation of cerebral edema.
(2) To investigate the relationship between brain injury of PE and serum PIGF, sEng concentration and sEng/PIGF ratio, and to evaluate the value of sEng concentration and sEng/PIGF ratio in predicting brain injury of PE.
(3) to explore the relationship between PE brain tissue damage and intracranial dynamic, venous and cerebrospinal fluid flow.
Materials and methods:
1. object of study
Thirty-one preeclampsia pregnant women (17 cases of severe PE and 14 cases of mild PE) admitted to our obstetric department from October 2013 to March 2014 were selected as the study subjects. Among them, 13 were early-onset PE and 18 were late-onset PE.
2.MRI examination
On the day of admission, all patients underwent PC-MRI flow measurements of BA, RMCA, SSS, SS and CA, and sagittal axial T1WI, T2WI, T2/FLAIR, DWI, SWI and T2WI.
3.PIGF, sEng concentration measurement
The fasting venous blood samples of 31 PE patients were collected for 5 ml in the morning of admission. The serum samples were collected after centrifugation and placed in - 800 cold storage. The serum concentrations of PIGF and sEng were detected by ELISA.
4. data recording and analysis
The incidence of cerebrovascular edema, cytotoxic edema, cerebral hemorrhage and microhemorrhage were compared and the difference of the incidence of severe, mild PE in early and late PE was compared. ROC curve was used to evaluate the value of serum sEng concentration and sEng/PIGF ratio in predicting brain tissue injury, and the critical value and corresponding sensitivity and specificity were calculated.
Result:
There were 8 cases (25.8%) of vascular brain edema, 2 cases (6.5%) of cytotoxic brain edema, 1 case (3.2%) of cerebral hemorrhage and 0 cases of micro-cerebral hemorrhage in 31 PE patients, 10 cases of severe PE middle brain injury and 1 case of mild PE middle brain injury. There were significant differences between them (P 0.01); 8 cases of early PE middle brain injury and 3 cases of late PE middle brain injury. There was statistical difference (P0.05). After 4~8 weeks of postpartum reexamination, 8 cases of angiogenic edema were recovered.
Cerebral edema showed low signal on T1WI, high signal on T2WI and T2/FAIR, vasogenic brain edema DWI, slightly high signal on ADC, cytotoxic brain edema DWI, and low signal on ADC. The average ADC value of cytotoxic brain edema lesions was significantly lower than that of the corresponding contralateral (or peripheral) normal brain tissues (P 0.01).
The average flow of BA and SS in brain injury group was higher than that in non-brain injury group (P 0.05), and the net flow of CA was significantly lower than that in non-brain injury group (P 0.01). There was no significant difference between MCA and SSS in brain injury group and non-brain injury group (P 0.05). The average flow of SS was positively correlated with the average flow of BA (r = 0.87, P = 0.00), and the net flow of CA was not correlated with the average flow of BA (r = 0.11, P = 0.76).
The ratio of sEng and sEng/PIGF in serum of brain injury group was significantly higher than that of non-brain injury group (P 0.01), and the concentration of PIGF was lower than that of non-brain injury group (P 0.01); the critical value of sEng/PIGF for predicting brain injury of PE was 20.0, the sensitivity was 81.8%, and the specificity was 85.0%; the critical value of sEng for predicting PE was 4809.4 pg/ml, the sensitivity was 81.8%, and the specificity was 70.0%.
Conclusion:
1. Vasculogenic brain edema is the most common brain tissue injury in PE. It often occurs in the blood supply area of posterior circulation. Cytotoxic brain edema and cerebral hemorrhage are rare.
2. the incidence of severe PE brain injury was higher than that of mild PE, and the incidence of early onset PE brain injury was higher than that of late onset PE..
3. DWI can accurately identify the cause of cerebral edema. ADC value can reflect the pathophysiological changes of brain tissue injury.
4. The blood flow perfusion of BA in PE brain tissue injury was significantly higher than that in non-brain injury group, and the venous reflux of SS increased correspondingly, and was positively correlated with the flow of BA; the net flow of CA decreased, but was not correlated with the flow of BA.
5. Serum sEng concentration and sEng/PIGF ratio in brain injury group were significantly higher than those in non-brain injury group. Serum PIGF and sEng may be involved in the pathophysiological process of brain injury. The ratio of sEng/PIGF can be used as an ideal index for predicting PE brain injury. The critical value of sEng/PIGF ratio was 20.0, the sensitivity was 81.8%, and the specificity was 85.0%.
【學位授予單位】：廣州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714.244
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