血清尾加压素、血小板活化因子在不同严重程度妊娠期高血压疾病患者中的表达及与心功能的相关性

Serum expressions of urotensin Ⅱ and platelet activating factor in patients with different severity of pregnancy-induced hypertension and their correlations with cardiac function

摘要:

目的 研究血清尾加压素（UⅡ）、血小板活化因子（PAF）在不同严重程度妊娠期高血压疾病患者中的表达及与心功能的相关性。方法 选取2017年1月—2020年1月中国人民解放军北部战区总医院妇产科收治的564例妊娠期高血压疾病患者作为研究对象，其中，妊娠高血压254例、轻度子痫前期186例、重度子痫前期124例。另取同期该院100例健康妊娠孕妇作为对照组。比较不同严重程度妊娠期高血压疾病患者、对照组血清UⅡ、PAF水平以及心功能，采用Pearson法分析妊娠期高血压疾病患者血清UⅡ、PAF水平与心功能的相关性，一般多因素Logistic回归分析心脏舒张功能不全的影响因素。结果 重度子痫前期组BMI、收缩压和舒张压均高于对照组、妊娠高血压组、轻度子痫前期组（P <0.05）。4组孕妇心脏形态结构参数［左室舒张末期内径（LVDd）、左室射血分数（LVEF）、心肌收缩峰值速度（Vs）、心肌舒张早期峰值速度（VE）、心肌舒张晚期峰值速度（VA）、二尖瓣环舒张早期运动速度（Ea）、二尖瓣环舒张晚期运动速度（Aa）］比较，差异均有统计学意义（P <0.05），随着疾病严重程度增加，LVDd变大、Aa升高（P <0.05），而LVEF、Vs、VE、VA、Ea降低（P <0.05）。4组孕妇血清UⅡ、PAF水平比较，差异均有统计学意义（P <0.05），随着疾病严重程度增加血清UⅡ、PAF水平升高（P <0.05）。Pearson相关性分析结果显示，UⅡ、PAF分别与LVDd、Aa呈正相关（P <0.05），分别与LVEF、Vs、VE、VA、Ea呈负相关（P <0.05）。一般多因素Logistic回归分析结果表明，BMI ［O^R=1.879（95% CI：1.103，3.203）］、收缩压［O^R=2.071（95% CI：1.378，3.113）］、舒张压［O^R=1.795（95% CI：1.171，2.752）］、血清UⅡ ［O^R=1.721（95% CI：1.329，2.229）］和PAF ［O^R=1.621（95% CI：1.266，2.075）］是心脏舒张功能不全的影响因素（P <0.05）。结论 血清UⅡ、PAF与妊娠期高血压疾病患者严重程度密切相关，其表达水平可反映患者心功能状态，是妊娠期高血压疾病患者左心室功能损伤的独立危险因素。

Abstract:

Objective To study the serum expressions of urotensin Ⅱ (U Ⅱ) and platelet activating factor (PAF) in patients with pregnancy-induced hypertension of different severity and their correlations with cardiac function.Methods A total of 564 patients with pregnancy-induced hypertension treated in our department from January 2017 to January 2020 were selected, among which 254 were gestational hypertension, 186 were mild preeclampsia, and 124 were severe preeclampsia. Another 100 healthy pregnant women in our hospital during the same period were selected as the control group. The serum levels of U Ⅱ and PAF and cardiac function were compared among patients with pregnancy-induced hypertension of different severity and those in the control group. Pearson correlation analysis was performed to investigate the correlations between the serum levels of U Ⅱ and PAF and cardiac function in patients with pregnancy-induced hypertension, and multivariable Logistic regression analysis was carried out to determine factors affecting the diastolic dysfunction.Results The body mass index (BMI), systolic blood pressure and diastolic blood pressure in the severe preeclampsia group were higher than those in the control group, gestational hypertension group, and mild preeclampsia group (P < 0.05). The cardiac morphological and structural parameters [left ventricular end diastolic diameter (LVDd), left ventricular ejection fraction (LVEF), peak systolic velocity (Vs), peak early diastolic velocity (VE), peak late diastolic velocity (VA), early diastolic mitral annular velocity (Ea), and late diastolic mitral annular velocity (Aa)] were different among the four groups (P < 0.05). With the disease severity aggravates, LVDd and Aa were increased (P < 0.05) while LVEF, Vs, VE, VA and Ea were decreased (P < 0.05). The serum levels of U Ⅱ and PAF were also different among the four groups (P < 0.05). With the disease severity aggravates, the serum levels of U Ⅱ and PAF were increased (P < 0.05). Pearson correlation analysis showed that serum levels of U Ⅱ and PAF were positively correlated with LVDd and Aa (P < 0.05), and negatively correlated with LVEF, Vs, VE, VA and Ea, respectively (P < 0.05). Multivariable Logistic regression analysis revealed that BMI [O^R = 1.879 (95% CI: 1.103, 3.203) ], systolic blood pressure [O^R = 2.071 (95% CI: 1.378, 3.113) ], diastolic blood pressure [O^R = 1.795 (95% CI: 1.171, 2.752) ], and serum levels of U Ⅱ [O^R = 1.721 (95% CI: 1.329, 2.229) ] and PAF [O^R = 1.621 (95% CI: 1.266, 2.075) ] were factors affecting the occurrence of cardiac diastolic dysfunction (P < 0.05).Conclusions Serum U Ⅱ and PAF are closely related to the severity of pregnancy-induced hypertension. Their expression levels may reflect the cardiac function and are independent risk factors for left ventricular dysfunction in patients with pregnancy-induced hypertension.