孕妇血清可溶性血管内皮生长因子受体-1、叶酸水平与慢性胎儿宫内窘迫的相关性分析

Correlations between maternal serum levels of soluble fms-like tyrosine kinase-1 and folic acid and chronic fetal distress

摘要:

目的 分析孕妇血清可溶性血管内皮生长因子受体-1（sFlt-1）、叶酸水平与慢性胎儿宫内窘迫的相关性。方法 选取2023年6月—2023年12月南通市妇幼保健院接收的103例孕妇。将出现胎儿慢性宫内窘迫的48例孕妇作为观察组，其余55例作为对照组。收集两组孕妇的基本资料及超声检查结果。比较两组胎儿脐动脉血流参数［搏动指数（PI）、阻力指数（RI）、收缩末期最大血流速度/舒张末期最大血流速度（S/D）］，检测两组孕妇分娩前的sFlt-1和叶酸水平，以及新生儿脐动脉血乳酸含量和氧化产物［8-羟基脱氧鸟苷（8-OHDG）、丙二醛（MDA）］。通过Pearson法分析sFlt-1、叶酸与胎儿脐动脉血流参数、新生儿脐动脉血乳酸含量及氧化产物的相关性，利用受试者工作特征（ROC）曲线评价孕妇sFlt-1、叶酸对发生胎儿功能窘迫的预测价值。结果 观察组PI、RI、S/D均高于对照组（P <0.05）。观察组分娩前血清sFlt-1水平高于对照组（P <0.05），叶酸水平低于对照组（P <0.05）。观察组脐动脉血乳酸、8-OHDG和MDA水平均高于对照组（P <0.05）。Pearson相关性分析结果显示，胎儿脐动脉血流参数、新生儿动脉血乳酸和氧化产物均与sFlt-1水平均呈正相关（P <0.05），与叶酸水平呈负相关（P <0.05）。ROC曲线结果表明，孕妇sFlt-1、叶酸联合预测胎儿宫内窘迫的曲线下面积为0.932（95% CI：0.883，0.982），敏感性为89.6%（95% CI：0.773，0.965），特异性为92.7%（95% CI：0.824，0.980）。结论 分娩前检测孕妇血清sFlt-1及叶酸水平对预测胎儿慢性宫内窘迫的发生有重要价值。

Abstract:

Objective To analyze the relationship between maternal serum levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and folic acid and the occurrence of chronic fetal distress.Methods A total of 103 pregnant women admitted to our hospital from July 2023 to December 2023 were selected. Forty-eight cases with chronic fetal distress were set as the observation group, while the other 55 cases were included as the control group. The basic information and ultrasound examination results of the pregnant women were collected. The umbilical artery blood flow parameters [pulsatility index (PI), resistive index (RI), and systolic/diastolic (S/D) ratio] were compared between the two groups. Levels of sFlt-1 and folic acid in pregnant women before delivery, as well as the contents of lactate and oxidative products [8-hydroxydeoxyguanosine (8-OHDG) and malondialdehyde (MDA) ] in blood from umbilical arteries, were measured. Pearson correlation analysis was performed to explore the relationship of sFlt-1 and folic acid with umbilical artery blood flow parameters and the contents of lactate and oxidative products in blood from umbilical arteries. The predictive value of maternal sFlt-1 combined with folic acid for fetal distress was determined using the receiver operating characteristic (ROC) curve.Results The PI, RI and the S/D ratio in the observation group were higher compared with those in the control group (P < 0.05). The level of sFlt-1 before delivery was higher (P < 0.05), but the level of folic acid before delivery was lower (P < 0.05) in the observation group than in the control group. The contents of lactate, 8-OHDG and MDA in blood from umbilical arteries were higher in the observation group compared with those in the control group (P < 0.05). Pearson correlation analysis revealed that the umbilical artery blood flow parameters, and the contents of lactate and oxidative products in blood from umbilical arteries were all positively correlated with maternal sFlt-1 levels before delivery (P < 0.05), and negatively correlated with maternal folic acid levels before delivery (P < 0.05). The ROC curve analysis showed that the area under the curve of combined sFlt-1 and folic acid for predicting chronic fetal distress was 0.932 (95% CI: 0.883, 0.982), with a sensitivity of 89.6% (95% CI: 0.773, 0.965), and a specificity of 92.7% (95% CI: 0.824, 0.980).Conclusion The measurement of maternal serum levels of sFlt-1 and folic acid before delivery has significant values in predicting the occurrence of chronic fetal distress.