妊娠期高血压疾病患者血清纤维胶凝蛋白3和免疫补体表达水平与预后的相关性研究

Correlations between expression levels of ficolin-3 and immune complements in serum of patients with hypertensive disorder complicating pregnancy and prognosis of the disease

摘要

目的 探讨妊娠期高血压疾病患者血清纤维胶凝蛋白3(ficolin-3)与免疫补体表达水平及其对妊娠结局的影响,为临床治疗和病情监测提供参考依据。方法 选择2019年1月至2023年1月在我院进行常规产检的517例孕妇作为研究对象,根据妊娠期间是否发生妊娠期高血压疾病,分为妊娠期高血压组(n＝94),子痫前期组(n＝38),以及无妊娠期高血压疾病组(对照组)(n＝385);妊娠期高血压疾病孕产妇依据妊娠结局分为不良妊娠结局组和正常妊娠结局组.测定并比较各组血清ficolin-3与免疫补体(C3、C4)表达水平.采用Pearson相关性分析血清ficolin-3与补体C3、C4表达之间的相关性;采用Spearman相关性分析上述指标与不良妊娠结局的相关性;通过受试者工作特征(ROC)曲线分析血清ficolin-3对不良妊娠结局的诊断价值。结果 子痫前期组分娩孕周小于妊娠期高血压组及对照组(F值为33．565,P＜0．001),且分娩前平均动脉压高于妊娠期高血压组及对照组(F值为478．620,P＜0．001);子痫前期组ficolin-3水平显著高于妊娠期高血压组及对照组,且妊娠期高血压组显著高于对照组(F值为55．171,P＜0．05);子痫前期组补体(C3、C4)表达水平也显著高于妊娠期高血压组及对照组,且妊娠期高血压组显著高于对照组(F值分别为160．568、333．316,均P＜0．05).妊娠期高血压疾病孕产妇中:Pearson相关性分析显示,血清ficolin-3与补体C3、C4均呈正相关性(r＝0．598、0．524,P＜0．05);正常妊娠结局组产妇的血清ficolin-3,补体(C3、C4)表达水平均低于不良妊娠结局产妇(t值分别为8．350、8．226、14．103,P＜0．05);Spearman相关性分析显示,血清ficolin-3表达水平与新生儿不良妊娠结局呈正相关性(r＝0．538、P＜0．05);ROC曲线分析结果显示血清ficolin-3以12．65μg/mL为截断值时,诊断不良结局的灵敏度为82．14％,特异度为73．68％,ROC曲线下面积为0．816(95％CI:0．768~0．864)。结论 妊娠期高血压疾病患者血清ficolin-3、免疫补体C3、C4与不良妊娠结局存在密切关系,可作为预测不良妊娠结局发生的潜在标志物.

Abstract

Objective To analyze correlations of expression levels of ficolin-3 and immune complements in serum of patients with hypertensive disorders complicating pregnancy (HDCP) with prognosis of the disease, so as to provide reference basis for treatment and monitoring of the disease in clinic. Methods 517 pregnant women who received routine prenatal examination in our hospital from January 2019 to January 2023 were selected as study subjects. According to whether the pregnant woman had HDCP or not, they were divided into HDCP group (n=94), preeclampsia group (n=38), and non-HDCP group (control group, n=385). Again, the pregnant women with HDCP were divided into adverse pregnancy outcome group and normal pregnancy outcome group according to pregnancy outcome of the pregnant woman. The expression levels of serum ficolin-3 and immune complements (C3, C4) were detected and compared between the two groups. Pearson correlation analysis was used to analyze correlations between serum ficolin-3 and serum immune compliments (C3, C4). Spearman correlation analysis was used to analyze correlations of ficolin-3 and immune compliments C3, C4 with adverse pregnancy outcomes. Receiver operating characteristic (ROC) curve was used to analyze diagnostic value of serum ficolin-3 for adverse pregnancy outcome. Results The gestational week at delivery of the patients in the preeclampsia group was lesser than that those in the HDCP group and the control group (F=33.565, P<0.001), while the mean arterial pressure before delivery was higher than those in the HDCP group and the control group (F=478.620, P<0.001). The serum ficolin-3 and complements (C3, C4) levels of the patients in the preeclampsia group were significantly higher than those in the HDCP group and the control group, and the serum ficolin-3 and complements (C3, C4) levels in the HDCP group were significantly higher than those in the control group (for ficolin-3: F=55.171, P<0.05; for compliment C3: F=160.568, P<0.05; for compliment C4: F=333.316, P<0.05). Pearson correlation analysis showed that in the HDCP group, the serum ficolin-3 level was positively correlated with serum compliments C3, C4 levels (r=0.598 and 0.524 respectively, both P<0.05). Adverse pregnancy outcomes occurred in 56 of 132 pregnant women with HDCP. And the serum levels of ficolin-3, compliments C3, C4 of the patients in the normal pregnancy outcome group were significantly lower than those in the adverse pregnancy outcome group (t=8.350, 8.226 and 14.103 respectively, all P<0.05). Spearman correlation analysis showed that serum ficolin-3 expression level was positively correlated with neonatal adverse pregnancy outcomes and maternal adverse pregnancy outcomes (r=0.538 and 0.547 respectively, both P<0.05). ROC curve analysis showed that when the cut-off value of the serum ficolin-3 level was 12.65 μg/mL, the sensitivity of serum ficolin-3 for diagnosing adverse outcomes was 82.14%, the specificity was 73.68%, and the area under the ROC curve was 0.816 (95% CI: 0.768-0.864). Conclusion In patients with HDCP, the serum ficolin-3 and compliments C3, C4 are closely correlated with adverse pregnancy outcomes, so these two indexes can be used as potential markers for predicting occurrence of adverse pregnancy outcomes in mothers and infants.

关键词

妊娠期高血压 / 纤维胶凝蛋白3 / 免疫补体 / 妊娠结局 / 相关性

Key words

hypertensive disorder complicating pregnancy / fibrin-3 / immune complement / pregnancy outcome / correlation

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基金资助

保定市科技计划项目(2041ZF136)