超声子宫动脉血流参数联合血清SUA/Scr,ANXA5预测妊娠期高血压疾病患者不良妊娠结局的价值研究

The study on the value of ultrasonic uterine artery blood flow parameters combined with serum SUA/Scr and ANXA5 in predicting adverse pregnancy outcomes in patients with hypertensive disorders of pregnancy

摘要

目的 分析超声子宫动脉血流参数联合血清尿酸/肌酐(SUA/Scr)和膜联蛋白A5(ANXA5)预测妊娠期高血压疾病(HDP)患者不良妊娠结局的价值.方法 选取2022年1月至2023年12月于本院就诊的114例HDP患者作为研究对象,根据是否发生不良妊娠结局将其分为正常妊娠组(n=72)和不良妊娠组(n=42).对所有研究对象行子宫动脉超声检查并记录其子宫动脉搏动指数(PI)、子宫动脉阻力指数(RI)、收缩期峰值流速/舒张期流速(S/D),采用全自动生化分析仪检测SUA/Scr水平,采用酶联免疫吸附法检测血清ANXA5水平.采用Pearson法分析HDP患者PI、RI、S/D与血清SUA/Scr、ANXA5水平的相关性;Logistic回归分析发生不良妊娠结局的影响因素;采用受试者工作特征(ROC)曲线分析PI、RI、S/D联合血清SUA/Scr、ANXA5对HDP患者不良妊娠结局的预测价值.结果 与正常妊娠组相比,不良妊娠组患者收缩压、舒张压、PI、RI、S/D、SUA/Scr明显升高(t值分别为2.947、3.694、4.935、4.356、5.390、8.298,均P<0.05),ANXA5水平明显降低(t值为8.020,P<0.05);HDP患者PI、RI、S/D与血清SUA/Scr呈正相关(r值分别为0.466、0.535、0.448,均P<0.05),与ANXA5呈负相关(r值分别为-0.352、-0.294、-0.277,均P<0.05);PI、RI、S/D、SUA/Scr水平是HDP患者发生不良妊娠结局的危险因素,OR值及其95%CI分别为2.101(1.207~2.659)、1.942(1.081~3.489)、1.911(1.119~3.263)、1.735(1.152~2.613),ANXA5是HDP患者发生不良妊娠结局的保护因素,OR值及其95%CI为0.643(0.438~0.944)(均P<0.05);PI+RI+S/D、SUA/Scr、ANXA5预测HDP发生不良妊娠结局的曲线下面积(AUC)分别为0.849(0.769~0.909)、0.860(0.782~0.918)、0.873(0.797~0.928),三者联合预测的AUC为0.947(0.889~0.980),联合预测效果优于单独预测(Z联合-PI+RI+S/D=2.884,Z联合-SUA/Scr=2.788,Z联合-ANXA5=2.306,P<0.05).结论 PI、RI、S/D联合血清SUA/Scr、ANXA5对HDP患者发生不良妊娠结局的评估具有较高的预测效能,对临床不良妊娠结局的防治具有一定作用.

Abstract

Objective To explore the value of ultrasound uterine artery blood flow parameters combined with serum uric acid/creatinine (SUA/Scr) and annexin A5 (ANXA5) in predicting adverse pregnancy outcomes in patients with hypertensive disorders of pregnancy (HDP). Methods A total of 114 HDP patients who visited the hospital between January 2022 and December 2023 were selected as study subjects. They were divided into a normal pregnancy group (n=72) and an adverse pregnancy outcome group (n=42) based on whether adverse pregnancy outcomes occurred. All subjects underwent uterine artery ultrasound examination, and uterine artery pulsatility index (PI), resistance index (RI), and systolic-to-diastolic flow velocity ratio (S/D) were recorded. Serum SUA/Scr levels were measured using an automatic biochemical analyzer, and serum ANXA5 levels were detected using an enzyme-linked immunosorbent assay (ELISA). Pearson correlation analysis was performed to assess the correlations between PI, RI, S/D, and serum SUA/Scr and ANXA5 levels in HDP patients. Logistic regression analysis was used to identify the factors influencing adverse pregnancy outcomes. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of PI, RI, S/D combined with serum SUA/Scr and ANXA5 for adverse pregnancy outcomes in HDP patients. Results Compared with the normal pregnancy group, the adverse pregnancy outcome group showed significantly increased systolic and diastolic blood pressure, PI, RI, S/D, and SUA/Scr levels (t=2.947, 3.694, 4.935, 4.356, 5.390, and 8.298, respectively, all P<0.05), while ANXA5 levels were significantly lower (t=8.020, P<0.05). In HDP patients, PI, RI, and S/D were positively correlated with serum SUA/Scr (r=0.466, 0.535, and 0.448, respectively, all P<0.05) and negatively correlated with ANXA5 (r=-0.352, -0.294, and -0.277, respectively, all P<0.05). PI, RI, S/D, and SUA/Scr levels were found to be risk factors for adverse pregnancy outcomes in HDP patients, with odds ratios (OR) and 95% confidence intervals (CI) of 2.101 (1.207-2.659), 1.942 (1.081-3.489), 1.911 (1.119-3.263), and 1.735 (1.152-2.613), respectively. ANXA5 was found to be a protective factor for adverse pregnancy outcomes in HDP patients, with an OR of 0.643 (0.438-0.944) (all P<0.05). The area under the ROC curve (AUC) for PI+RI+S/D, SUA/Scr, and ANXA5 in predicting adverse pregnancy outcomes in HDP patients were 0.849 (0.769-0.909), 0.860 (0.782-0.918), and 0.873 (0.797-0.928), respectively. The combined prediction AUC was 0.947 (0.889-0.980), which was superior to the individual prediction (Z_combined-PI+RI+S/D=2.884, Z_combined-SUA/Scr=2.788, Z_combined-ANXA5=2.306, P<0.05). Conclusion The combination of PI, RI, S/D with serum SUA/Scr and ANXA5 demonstrates high predictive efficacy for adverse pregnancy outcomes in HDP patients. This approach plays an important role in the prevention and management of adverse pregnancy outcomes in clinical practice.

关键词

妊娠期高血压疾病 / 超声子宫动脉血流参数 / 尿酸/肌酐 / 膜联蛋白A5 / 不良妊娠结局

Key words

hypertensive disorders of pregnancy / ultrasound uterine artery blood flow parameters / uric acid/creatinine / annexin A5 / adverse pregnancy

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基金资助

河北省2024年度医学科学研究课题(20232160)