血清Gal-1、VEGF预测重度子痫前期患者胎盘早剥的价值及危险因素分析

Predictive value of serum Gal-1 and VEGF for placental abruption in severe preeclampsia and identification of associated risk factors

摘要:

目的 探讨血清半乳糖凝集素-1（Gal-1）、血管内皮生长因子（VEGF）检测在评估重度子痫前期（PE）患者胎盘早剥（PA）中的临床价值，并分析其相关危险因素。方法 回顾性分析2023年1月—2025年1月西北妇女儿童医院收治的273例重度PE产妇的临床资料，根据产妇是否发生PA分为早剥组（46例）与无早剥组（227例）。收集上述研究对象的一般临床资料。检测并比较各组产妇血清相关指标水平。采用多因素一般Logistic回归模型分析重度PE患者发生PA的危险因素。采用受试者工作特征（ROC）曲线分析其对重度PE产妇发生PA的预测价值。结果 早剥组间接胆红素、肌酐、尿素氮均高于无早剥组（P <0.05），纤维蛋白原低于无早剥组（P <0.05）；早剥组Gal-1、白细胞介素-12（IL-12）、胎盘生长因子（PLGF）、Fibulin-5、血管生成素-2（Ang-2）均低于无早剥组（P <0.05），VEGF高于无早剥组（P <0.05）。ROC曲线结果显示，Gal-1、VEGF、IL-12、PLGF、Fibulin-5、Ang-2联合预测重度PE产妇发生PA的敏感性为97.8%（95% CI：0.885，0.999），特异性为99.1%（95% CI：0.969，0.999），曲线下面积为0.977（95% CI：0.942，1.000）。多因素一般Logisitc回归分析结果显示：高VEGF水平［O^R =3.025（95% CI：1.216，7.527）］为重度PE患者发生PA的危险因素（P <0.05）；高Gal-1水平［O^R =0.781（95% CI：0.679，0.899）］、高IL-12水平［O^R =0.824（95% CI：0.704，0.963）］、高PLGF水平［O^R =0.953（95% CI：0.912，0.996）］、高Fibulin-5水平［O^R =0.816（95% CI：0.742，0.897）］、高Ang-2水平［O^R =0.570（95% CI：0.343，0.948）］均为重度PE患者发生PA的保护因素（P <0.05）。结论 重度PE合并PA患者血清Gal-1、IL-12、PLGF、Fibulin-5、Ang-2水平显著降低，VEGF水平升高。联合检测上述指标可显著提高PA的预测效能，且高VEGF水平为独立危险因素，而高Gal-1、IL-12、PLGF、Fibulin-5、Ang-2水平为保护因素。

Abstract:

Objective To explore the clinical value of serum galectin-1 (Gal-1) and vascular endothelial growth factor (VEGF) in assessing placental abruption (PA) in patients with severe preeclampsia (PE), and to analyze the associated risk factors.Methods A retrospective analysis was conducted on 231 patients with severe PE admitted to Northwest Women and Children's Hospital between January 2023 and January 2025. Based on the presence or absence of PA, patients were divided into the abruption group (n = 46) and the non-abruption group (n = 185). General clinical data and serum biomarker levels were collected and compared between the two groups. Multivariable logistic regression was used to identify risk factors for PA in severe PE patients. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of each indicator for PA.Results The abruption group showed significantly higher levels of indirect bilirubin, creatinine, and blood urea nitrogen compared to the non-abruption group (P < 0.05), while the fibrinogen level was significantly lower in the abruption group (P < 0.05). Furthermore, the abruption group had significantly lower levels of Gal-1, IL-12, PLGF, Fibulin-5, and Ang-2 (P < 0.05), but a significantly higher level of VEGF (P < 0.05). ROC curve analysis demonstrated that the combined biomarkers for predicting PA in severe PE patients yielded a sensitivity of 97.8% (95% CI: 0.885, 0.999), a specificity of 99.1% (95% CI: 0.969, 0.999), and an area under the curve of 0.977 (95% CI: 0.942, 1.000). Multivariable logistic regression analysis revealed that a high VEGF level was an independent risk factor for PA in severe PE patients [O^R = 3.025 (95% CI: 1.216, 7.527), P < 0.05]. Conversely, high levels of Gal-1 [O^R = 0.781 (95% CI: 0.679, 0.899) ], IL-12 [O^R = 0.824 (95% CI: 0.704, 0.963) ], PLGF [O^R = 0.953 (95% CI: 0.912, 0.996) ], Fibulin-5 [O^R = 0.816 (95% CI: 0.742, 0.897) ], and Ang-2 [O^R = 0.570 (95% CI: 0.343, 0.948) ] were identified as independent protective factors (P < 0.05).Conclusion In patients with severe PE complicated by PA, serum levels of Gal-1, IL-12, PLGF, Fibulin-5, and Ang-2 are significantly decreased, while VEGF levels are elevated. The combined detection of Gal-1, VEGF, and other related biomarkers significantly enhances the predictive efficacy for PA. Elevated VEGF levels represent an independent risk factor, whereas higher levels of Gal-1, IL-12, and other related biomarkers act as protective factors.