氧化反应因子对妊娠期高血压疾病患者胎儿宫内缺氧的影响

Effects of oxidative stress factors on fetal intrauterine hypoxia in patients with hypertensive disorders of pregnancy

摘要

目的 分析氧化反应因子对妊娠期高血压疾病(HDCP)孕妇胎儿宫内缺氧风险的影响,为宫内缺氧的预测提供价值。方法 收集2023年4月至2024年2月在沧州市人民医院确诊为HDCP的孕妇作为研究对象(n=90),另选同期产检及分娩正常的孕妇作为对照组(n=30).进一步根据HDCP类型将上述孕妇分为妊娠期高血压组(n=30)、子痫前期组(n=30)和重度子痫前期组(n=30).比较病例组和对照组孕妇氧化反应因子[血清血红素加氧酶-1(HO-1)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)]水平、不同病情严重程度的HDCP患者血清HO-1、SOD、GSH-PX水平以及胎儿宫内缺氧和无宫内缺氧的HDCP患者血清HO-1、SOD、GSH-PX水平.采用受试者工作特征(ROC)曲线分析血清HO-1、SOD、GSH-PX水平预测HDCP患者胎儿宫内缺氧的发生情况。结果 HDCP组血清HO-1、SOD、GSH-PX水平均显著低于对照组(t值分别为9.932、5.451、5.114,P<0.05);妊娠期高血压组、子痫前期组、重度子痫前期组的血清HO-1、SOD、GSH-PX水平依次降低(F值分别为85.729、20.368、40.717,P<0.05);胎儿宫内缺氧组血清HO-1、SOD、GSH-PX水平均显著低于无宫内缺氧组(t值分别为6.632、5.799、5.435,P<0.05).ROC曲线分析显示血清HO-1、SOD、GSH-PX评估HDCP患者是否发生胎儿宫内缺氧的曲线下面积(AUC)分别为0.828(95%CI:0.735~0.920)、0.878(95%CI:0.799~0.957)、0.819(95%CI:0.729~0.908);三者联合评估的AUC为0.993(95%CI:0.927~1.000),敏感度为94.50%,特异性为91.20%,三者联合优于血清HO-1、SOD、GSH-PX各自单独评估。结论 血清HO-1、SOD、GSH-PX可联合预测HDCP患者发生胎儿宫内缺氧的风险.临床诊治时,可通过监测HO-1、SOD和GSH-PX水平评估患者胎儿宫内缺氧的发生风险.

Abstract

Objective To analyze the impact of oxidative reaction factors on the risk of intrauterine hypoxia in pregnant women with hypertensive disease of pregnancy (HDCP), and provide value for the prediction of intrauterine hypoxia. Methods Pregnant women diagnosed with HDCP at Cangzhou People's Hospital from April 2023 to February 2024 were collected as research subjects (n=90), and pregnant women who had normal prenatal examinations and delivery during the same period were selected as the control group (n=30). The above-mentioned pregnant women were further divided into gestational hypertension group (n=30), preeclampsia group (n=30) and severe preeclampsia group (n=30) according to HDCP type. Comparing the levels of oxidative reaction factors [serum heme oxygenase-1 (HO-1), superoxide dismutase (SOD), glutathione peroxidase (GSH-PX)] among pregnant women in the case group and the control group, Serum HO-1, SOD, and GSH-PX levels in HDCP patients with different severity of illness, as well as serum HO-1, SOD, and GSH-PX levels in HDCP patients with fetal intrauterine hypoxia and without intrauterine hypoxia. The receiver operating characteristic (ROC) curve was used to analyze serum HO-1, SOD, and GSH-PX levels to predict the occurrence of fetal intrauterine hypoxia in HDCP patients. Results Serum HO-1, SOD, and GSH-PX levels in the HDCP group were significantly lower than those in the control group (t=9.932, 5.451, 5.114, respectively, P<0.05); gestational hypertension group, preeclampsia group, and severe eclampsia The serum HO-1, SOD, and GSH-PX levels in the early stage group decreased successively (F=85.729, 20.368, 40.717, respectively, P<0.05); the serum HO-1, SOD, and GSH-PX levels in the fetal intrauterine hypoxia group were average. Significantly lower than the group without intrauterine hypoxia (t=6.632, 5.799, 5.435 respectively, P<0.05). ROC curve analysis showed that the area under the curve (AUC) of serum HO-1, SOD, and GSH-PX to evaluate whether HDCP patients develop intrauterine hypoxia were 0.828 (95%CI:0.735-0.920) and 0.878 (95%CI:0.799-0.957), 0.819 (95%CI:0.729-0.908); the AUC of the three combined evaluations was 0.993 (95%CI:0.927-1.000), the sensitivity was 94.50%, and the specificity was 91.20%, the combination of the three was better than the individual evaluation of serum HO-1, SOD, and GSH-PX. Conclusion Serum HO-1, SOD, and GSH-PX can jointly predict the risk of intrauterine hypoxia in HDCP patients. During clinical diagnosis and treatment, the risk of intrauterine hypoxia in patients can be assessed by monitoring HO-1, SOD and GSH-PX levels.

关键词

氧化反应 / 妊娠期高血压 / 胎儿宫内缺氧 / 临床意义

Key words

oxidation reaction / hypertension during pregnancy / fetal intrauterine hypoxia / clinical significance

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基金资助

沧州市科技计划自筹经费项目(222106052)