血清PGC-1α、GATA-3、IGFBP-3对妊娠期高血压疾病患者并发HELLP综合征的预测价值

Predictive value of serum PGC-1α, GATA-3 and IGFBP-3 for HELLP syndrome in patients with hypertensive disorders complicating pregnancy

摘要:

目的 探究血清过氧化物酶体增殖物激活受体γ辅助激活因子-1α（PGC-1α）、细胞转录因子-3（GATA-3）、胰岛素样生长因子结合蛋白-3（IGFBP-3）对妊娠期高血压疾病患者并发溶血-肝酶升高-血小板减少综合征（HELLP）综合征的预测价值。方法 回顾性分析2021年2月—2024年3月邯郸市第一医院收治的179例妊娠期高血压疾病患者的病例资料，根据妊娠期高血压疾病患者是否并发HELLP综合征分为并发组（13例）与非并发组（166例）。比较并发组与非并发组临床资料及血清PGC-1α、GATA-3、IGFBP-3水平，分析妊娠期高血压疾病患者并发HELLP综合征的影响因素。绘制受试者工作特征（ROC）曲线评估其预测价值。结果 并发组年龄 ≥35岁、孕次 >5次例数占比、BMI、产检次数 ≤3次例数占比均高于非并发组（P <0.05）。并发组血清PGC-1α、GATA-3水平较低（P <0.05），IGFBP-3水平较高（P <0.05）。多因素一般Logistic回归分析结果显示：年龄 ≥35岁［O^R =4.816（95% CI：2.117，10.956）］、血清IGFBP-3水平高［O^R =3.062（95% CI：1.346，6.965）］为妊娠期高血压疾病患者并发HELLP综合征的危险因素（P <0.05）；血清PGC-1α水平高［O^R =0.277（95% CI：0.122，0.630）］、血清GATA-3水平高［O^R =0.262（95% CI：0.115，0.595）］为妊娠期高血压疾病患者并发HELLP综合征的保护因素（P <0.05）。ROC曲线结果显示，血清PGC-1α、GATA-3、IGFBP-3水平及3者联合预测妊娠期高血压疾病患者并发HELLP综合征的敏感性分别为84.62%（95% CI：0.537，0.973）、92.31%（95% CI：0.621，0.996）、84.62%（95% CI：0.537，0.937）、92.31%（95% CI：0.621，0.996），特异性分别为72.89%（95% CI：0.653，0.794）、72.89%（95% CI：0.653，0.794）、83.13%（95% CI：0.764，0.883）、93.98%（95% CI：0.889，0.969）。结论 血清PGC-1α、GATA-3、IGFBP-3水平在预测妊娠期高血压疾病患者并发HELLP综合征中具有重要价值，且3者联合的预测价值更高。

Abstract:

Objective To analyze the predictive value of serum peroxisome proliferator-activated receptor-γ co-activator 1α (PGC-1α), GATA binding protein 3 (GATA-3) and insulin-like growth factor binding protein-3 (IGFBP-3) in patients with hypertensive disorders complicating pregnancy combined with Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome.Methods The clinical data of 179 patients with hypertensive disorders complicating pregnancy admitted to our hospital from February 2021 to March 2024 were retrospectively analyzed. According to whether the patients were complicated by HELLP syndrome, they were divided into a concurrent group (n = 13) and a non-concurrent group (n = 166). The clinical data and serum levels of PGC-1α, GATA-3 and IGFBP-3 were compared between the concurrent group and the non-concurrent group. The factors affecting the occurrence of HELLP syndrome were analyzed, and the receiver operating characteristic (ROC) curve was plotted to assess their predictive values.Results The concurrent group had a higher proportion of patients aged ≥35 years, with more than five pregnancies, a higher BMI, and a greater percentage of cases with ≤3 prenatal visits compared to the non-concurrent group (P < 0.05). The serum levels of PGC-1α and GATA-3 in the concurrent group were lower than those in the non-concurrent group (P < 0.05), and the levels of IGFBP-3 in the concurrent group were higher than those in the non-concurrent group (P < 0.05). The multivariable Logistic regression analysis demonstrated that age ≥35 years [O^R = 4.816 (95% CI: 2.117, 10.956)] and high serum IGFBP-3 levels [O^R = 3.062 (95% CI: 1.346, 6.965) ] were risk factors for HELLP syndrome in patients with hypertensive disorders complicating pregnancy (P < 0.05). High serum levels of PGC-1α [O^R = 0.277 (95% CI: 0.122, 0.630) ] and GATA-3 [O^R = 0.262 (95% CI: 0.115, 0.595) ] were protective factors for HELLP syndrome in patients with hypertensive disorders complicating pregnancy (P < 0.05). The ROC curve analysis suggested that the sensitivities of serum levels of PGC-1α, GADA-3, IGFBP-3 and their combination for predicting the HELLP syndrome in patients with hypertensive disorders complicating pregnancy were 84.62% (95% CI: 0.537, 0.973), 92.31% (95% CI: 0.621, 0.996), 84.62% (95% CI: 0.537, 0.937), and 92.31% (95% CI: 0.621, 0.996), with the specificities being 72.89% (95% CI: 0.653, 0.794), 72.89% (0.653, 0.794), 83.13% (95% CI: 0.764, 0.883), and 93.98% (95% CI: 0.889, 0.969).Conclusion Serum levels of PGC-1α, GATA-3 and IGFBP-3 have significant value in predicting HELLP syndrome in patients with hypertensive disorders complicating pregnancy, and their combination yields higher predictive value.