心臟絲氨酸蛋白酶及血管內(nèi)皮因子在妊娠期高血壓疾病中的表達(dá)及預(yù)測(cè)價(jià)值
發(fā)布時(shí)間：2019-04-29 16:23
【摘要】：目的:通過(guò)檢測(cè)不同孕期孕婦血清中心臟絲氨酸蛋白酶(corin)、血管內(nèi)皮生長(zhǎng)因子(vascular endothelial growth factor,VEGF)、胎盤生長(zhǎng)因子(placenta growth factor,PLGF)及可溶性血管內(nèi)皮生長(zhǎng)因子受體1(soluble vascular endothelial growth factor receptor 1,sFlt-1)水平,研究上述因子在妊娠期高血壓疾病(hypertensive disorders complicating pregnancy,HDCP)患者及正常孕婦中的不同變化,并探討孕早中期上述因子預(yù)測(cè)HDCP發(fā)生的診斷價(jià)值。方法:選取2015年12月-2016年9月就診于蘭州大學(xué)第二醫(yī)院產(chǎn)科門診及住院的單胎妊娠孕婦,橫斷面研究孕早期、孕中期以及孕晚期孕婦血清中上述各因子水平,根據(jù)妊娠結(jié)局,將其分為HDCP組和正常妊娠對(duì)照組。其中篩選出HDCP患者孕早期(孕10~14周)血清標(biāo)本24例為研究組,選取同時(shí)期健康孕婦孕早期血清標(biāo)本24例作為正常對(duì)照組;篩選出HDCP患者孕中期(孕16~24周)血清標(biāo)本55例為研究組,選取同時(shí)期健康孕婦孕中期血清標(biāo)本55例作為正常對(duì)照組;選取HDCP患者孕晚期(孕28周之后)血清標(biāo)本23例為研究組,并選取同時(shí)期健康孕婦孕晚期血清標(biāo)本23例作為正常對(duì)照組。采用ELISA方法測(cè)定各組血清中corin、VEGF、PLGF、sFlt-1水平,應(yīng)用統(tǒng)計(jì)學(xué)方法分析上述因子的組間差異,并應(yīng)用Logistic回歸及ROC曲線評(píng)價(jià)孕早中期各因子單獨(dú)及聯(lián)合檢測(cè)在預(yù)測(cè)HDCP發(fā)生中的診斷價(jià)值。結(jié)果:1.孕早期,HDCP組與對(duì)照組比較,血清corin、VEGF及PLGF水平下降,兩組比較均有統(tǒng)計(jì)學(xué)差異,P0.05;而血清sFlt-1水平、sFlt-1/PLGF比值升高,兩組比較均有統(tǒng)計(jì)學(xué)差異,P0.05。2.孕中期,HDCP組與對(duì)照組比較,血清VEGF、PLGF水平下降,兩組相比均有統(tǒng)計(jì)學(xué)差異,P0.05;而血清corin、sFlt-1水平及sFlt-1/PLGF比值升高,兩組比較均有統(tǒng)計(jì)學(xué)差異,P0.05。3.孕晚期,HDCP組與對(duì)照組比較,血清VEGF、PLGF水平下降,兩組比較均有統(tǒng)計(jì)學(xué)差異,P0.05;而血清corin、sFlt-1水平及sFlt-1/PLGF比值升高,兩組比較均有統(tǒng)計(jì)學(xué)差異,P0.05。4.應(yīng)用Logistic回歸及ROC曲線評(píng)估孕早中期孕婦血清corin、VEGF、PLGF、sFlt-1及sFlt-1/PLGF比值,各血清因子對(duì)HDCP發(fā)生均有預(yù)測(cè)價(jià)值;且孕早期各因子聯(lián)合預(yù)測(cè)概率PRE的AUC下面積為0.851,約登指數(shù)最大為0.625,其對(duì)應(yīng)的敏感度為83.3%,特異度為79.2%,明顯高于各單項(xiàng)檢測(cè)指標(biāo)及sFlt-1/PLGF比值的預(yù)測(cè)價(jià)值;孕中期各因子聯(lián)合預(yù)測(cè)概率PRE的AUC下面積為0.927,約登指數(shù)最大為0.691,其對(duì)應(yīng)的敏感度為87.3%,特異度為82.8%,明顯高于各單項(xiàng)檢測(cè)指標(biāo)及sFlt-1/PLGF的預(yù)測(cè)價(jià)值。結(jié)論:1.孕早、中、晚期HDCP組與對(duì)照組比較孕婦血清corin、VEGF、PLGF、sFlt-1水平均有差異,說(shuō)明上述各因子與HDCP的發(fā)生發(fā)展有關(guān)。2.孕早、中期檢測(cè)孕婦血清corin、VEGF、PLGF、sFlt-1水平對(duì)HDCP的發(fā)生有預(yù)測(cè)價(jià)值,而孕早、中期聯(lián)合檢測(cè)孕婦血清corin、VEGF、PLGF、sFlt-1水平對(duì)預(yù)測(cè)HDCP的發(fā)生與各單因子檢測(cè)相比有更高的敏感性和特異性,結(jié)果更可靠,預(yù)測(cè)價(jià)值更高。
[Abstract]:Objective: to detect vascular endothelial growth factor (vascular endothelial growth factor,VEGF (corin),) and placental growth factor (placenta growth factor, (placenta growth factor,) in serum of pregnant women during different pregnancy. The levels of PLGF) and soluble vascular endothelial growth factor receptor 1 (soluble vascular endothelial growth factor receptor 1, sFlt 1) were measured in patients with hypertensive disorder complicating pregnancy (hypertensive disorders complicating pregnancy,HDCP) and normal pregnant women. The diagnostic value of the above factors in predicting the occurrence of HDCP in early and middle trimester of pregnancy was also discussed. Methods: single-child pregnant women were selected from December 2015 to September 2016 in the outpatient department and in-patient department of the second Hospital of Lanzhou University. The levels of above factors in the serum of pregnant women in early, middle and third trimester of pregnancy were studied on the basis of the outcome of pregnancy. They were divided into HDCP group and normal pregnancy control group. Among them, 24 serum samples of HDCP patients were selected as the study group, and 24 healthy pregnant women were selected as the normal control group during the same period of gestation, and 24 serum samples of the pregnant women were selected as the study group in the first trimester of pregnancy. 55 serum samples of HDCP patients in the second trimester of gestation (16 weeks of gestation) were selected as the study group, and 55 healthy pregnant women in the same period were selected as the normal control group. Serum samples from 23 patients with HDCP (after 28 weeks of gestation) were selected as the study group, and 23 serum samples from healthy pregnant women at the same period were selected as the normal control group. The levels of corin,VEGF,PLGF,sFlt-1 in serum of each group were measured by ELISA method, and the differences of the above factors between groups were analyzed by statistical method. Logistic regression and ROC curve were used to evaluate the diagnostic value of single and combined detection of each factor in the early and middle trimester of pregnancy in predicting the occurrence of HDCP. Results: 1. In the first trimester of pregnancy, the levels of serum corin,VEGF and PLGF in HDCP group were significantly lower than those in control group (P 0.05). The level of serum sFlt-1 and the ratio of sFlt-1/PLGF were significantly higher in the two groups than those in the control group (P 0.05.2). In the second trimester of gestation, the level of serum VEGF,PLGF in HDCP group was significantly lower than that in control group (P 0.05). The levels of serum corin,sFlt-1 and the ratio of sFlt-1/PLGF were significantly higher in the two groups than those in the control group (P0.05.3. 3.) In the third trimester of gestation, the level of serum VEGF,PLGF in HDCP group was lower than that in control group, and there was significant difference between the two groups (P 0.05). The levels of serum corin,sFlt-1 and the ratio of sFlt-1/PLGF were significantly higher in the two groups than those in the control group (P 0.05.4). Logistic regression and ROC curve were used to evaluate the ratio of serum corin,VEGF,PLGF,sFlt-1 and sFlt-1/PLGF in pregnant women in the early and middle trimester of pregnancy. All serum factors had predictive value for the occurrence of HDCP. In the first trimester of pregnancy, the area under the AUC of the combined prediction probability PRE was 0.851, and the maximum Joden index was 0.625. The corresponding sensitivity and specificity were 83.3% and 79.2%, respectively. It was obviously higher than the prediction value of the single detection index and the sFlt-1/PLGF ratio. In the second trimester of pregnancy, the area under the AUC of the combined prediction probability PRE was 0.927, the largest Yodden index was 0.691, the corresponding sensitivity and specificity were 87.3% and 82.8%, respectively, and the relative sensitivity and specificity were 87.3% and 82.8%, respectively. It was significantly higher than the single detection index and the predictive value of sFlt-1/PLGF. Conclusions: 1. The serum corin,VEGF,PLGF,sFlt-1 levels of pregnant women in the early, middle and late stages of HDCP were significantly different from those of the control group, indicating that the above factors were related to the occurrence and development of HDCP. 2. The detection of serum corin,VEGF,PLGF,sFlt-1 levels in pregnant women at early and middle stages is of predictive value to the occurrence of HDCP, while the combined detection of serum corin,VEGF,PLGF, in pregnant women at early and middle stages of pregnancy is of great value. The level of sFlt-1 has higher sensitivity and specificity in predicting the occurrence of HDCP than the single factor detection. The results are more reliable and the prediction value is higher.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.246
[Abstract]:Objective: to detect vascular endothelial growth factor (vascular endothelial growth factor,VEGF (corin),) and placental growth factor (placenta growth factor, (placenta growth factor,) in serum of pregnant women during different pregnancy. The levels of PLGF) and soluble vascular endothelial growth factor receptor 1 (soluble vascular endothelial growth factor receptor 1, sFlt 1) were measured in patients with hypertensive disorder complicating pregnancy (hypertensive disorders complicating pregnancy,HDCP) and normal pregnant women. The diagnostic value of the above factors in predicting the occurrence of HDCP in early and middle trimester of pregnancy was also discussed. Methods: single-child pregnant women were selected from December 2015 to September 2016 in the outpatient department and in-patient department of the second Hospital of Lanzhou University. The levels of above factors in the serum of pregnant women in early, middle and third trimester of pregnancy were studied on the basis of the outcome of pregnancy. They were divided into HDCP group and normal pregnancy control group. Among them, 24 serum samples of HDCP patients were selected as the study group, and 24 healthy pregnant women were selected as the normal control group during the same period of gestation, and 24 serum samples of the pregnant women were selected as the study group in the first trimester of pregnancy. 55 serum samples of HDCP patients in the second trimester of gestation (16 weeks of gestation) were selected as the study group, and 55 healthy pregnant women in the same period were selected as the normal control group. Serum samples from 23 patients with HDCP (after 28 weeks of gestation) were selected as the study group, and 23 serum samples from healthy pregnant women at the same period were selected as the normal control group. The levels of corin,VEGF,PLGF,sFlt-1 in serum of each group were measured by ELISA method, and the differences of the above factors between groups were analyzed by statistical method. Logistic regression and ROC curve were used to evaluate the diagnostic value of single and combined detection of each factor in the early and middle trimester of pregnancy in predicting the occurrence of HDCP. Results: 1. In the first trimester of pregnancy, the levels of serum corin,VEGF and PLGF in HDCP group were significantly lower than those in control group (P 0.05). The level of serum sFlt-1 and the ratio of sFlt-1/PLGF were significantly higher in the two groups than those in the control group (P 0.05.2). In the second trimester of gestation, the level of serum VEGF,PLGF in HDCP group was significantly lower than that in control group (P 0.05). The levels of serum corin,sFlt-1 and the ratio of sFlt-1/PLGF were significantly higher in the two groups than those in the control group (P0.05.3. 3.) In the third trimester of gestation, the level of serum VEGF,PLGF in HDCP group was lower than that in control group, and there was significant difference between the two groups (P 0.05). The levels of serum corin,sFlt-1 and the ratio of sFlt-1/PLGF were significantly higher in the two groups than those in the control group (P 0.05.4). Logistic regression and ROC curve were used to evaluate the ratio of serum corin,VEGF,PLGF,sFlt-1 and sFlt-1/PLGF in pregnant women in the early and middle trimester of pregnancy. All serum factors had predictive value for the occurrence of HDCP. In the first trimester of pregnancy, the area under the AUC of the combined prediction probability PRE was 0.851, and the maximum Joden index was 0.625. The corresponding sensitivity and specificity were 83.3% and 79.2%, respectively. It was obviously higher than the prediction value of the single detection index and the sFlt-1/PLGF ratio. In the second trimester of pregnancy, the area under the AUC of the combined prediction probability PRE was 0.927, the largest Yodden index was 0.691, the corresponding sensitivity and specificity were 87.3% and 82.8%, respectively, and the relative sensitivity and specificity were 87.3% and 82.8%, respectively. It was significantly higher than the single detection index and the predictive value of sFlt-1/PLGF. Conclusions: 1. The serum corin,VEGF,PLGF,sFlt-1 levels of pregnant women in the early, middle and late stages of HDCP were significantly different from those of the control group, indicating that the above factors were related to the occurrence and development of HDCP. 2. The detection of serum corin,VEGF,PLGF,sFlt-1 levels in pregnant women at early and middle stages is of predictive value to the occurrence of HDCP, while the combined detection of serum corin,VEGF,PLGF, in pregnant women at early and middle stages of pregnancy is of great value. The level of sFlt-1 has higher sensitivity and specificity in predicting the occurrence of HDCP than the single factor detection. The results are more reliable and the prediction value is higher.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.246
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 劉思華;張軍;;胎盤生長(zhǎng)因子在臨床疾病相關(guān)作用的研究進(jìn)展[J];心肺血管病雜志;2016年11期
2 韓瑾;張蒙;許遵鵬;潘敏;李東至;廖燦;;孕早期血清胎盤生長(zhǎng)因子在妊娠期高血壓疾病篩查中的應(yīng)用[J];中國(guó)婦幼健康研究;2016年06期
3 高陽(yáng);周紅輝;魏永琴;高志英;;胎盤生長(zhǎng)因子水平與妊娠高血壓疾病嚴(yán)重程度的關(guān)系[J];解放軍醫(yī)學(xué)院學(xué)報(bào);2016年07期
4 鄧?yán)?方碧梅;;妊娠期高血壓疾病的臨床流行病學(xué)分析[J];海南醫(yī)學(xué);2015年17期
5 程妤奮;黃鷹;楊慧琳;楊伶俐;邢秋霞;儲(chǔ)莉鳴;沈麗華;張寶仁;古航;;PAPP-A、PLGF、sFlt-1預(yù)測(cè)妊娠期高血壓疾病發(fā)病風(fēng)險(xiǎn)價(jià)值的研究[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2015年03期
6 郭芳芳;楊潔霞;;胎盤生長(zhǎng)因子與妊娠關(guān)系的研究進(jìn)展[J];中國(guó)婦幼保健;2014年36期
7 許香香;馮一奇;戴建榮;;胎盤蛋白13與胎盤生長(zhǎng)因子聯(lián)合檢測(cè)對(duì)子癇前期患者的早期預(yù)測(cè)意義[J];中國(guó)計(jì)劃生育和婦產(chǎn)科;2014年08期
8 羅曉帆;;孕早期外周血HIF-1α與VEGF水平對(duì)妊娠期高血壓疾病的預(yù)測(cè)價(jià)值[J];河南預(yù)防醫(yī)學(xué)雜志;2014年04期
9 王雪朋;;妊娠期高血壓患者的C-反應(yīng)蛋白與內(nèi)皮素-1和NO水平的相關(guān)性研究[J];中國(guó)煤炭工業(yè)醫(yī)學(xué)雜志;2014年06期
10 葉少珍;魏偉鋒;吳成勇;;妊娠期高血壓疾病患者血液指標(biāo)變化的臨床指導(dǎo)價(jià)值[J];中外醫(yī)學(xué)研究;2014年15期
相關(guān)碩士學(xué)位論文 前1條
1 張s，
本文編號(hào)：2468358
本文鏈接：http://sikaile.net/yixuelunwen/fuchankeerkelunwen/2468358.html
最近更新
教材專著
