[1]王倩,杜丹丽.血清基质金属蛋白酶-3和胱抑素C水平对早发型子痫前期患者妊娠结局的预测价值[J].新乡医学院学报,2023,40(12):1121-1125.[doi:10.7683/xxyxyxb.2023.12.004]
　WANG Qian,DU Danli.Relationship between serum matrix metalloproteinase-3 and cystatin C levels and pregnancy outcome in pregnant women with early-onset preeclampsia[J].Journal of Xinxiang Medical University,2023,40(12):1121-1125.[doi:10.7683/xxyxyxb.2023.12.004]
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血清基质金属蛋白酶-3和胱抑素C水平对早发型子痫前期患者妊娠结局的预测价值
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
40卷
期数:
2023年12
页码:
1121-1125
栏目:
临床研究
出版日期:
2023-12-05

文章信息/Info

Title:
Relationship between serum matrix metalloproteinase-3 and cystatin C levels and pregnancy outcome in pregnant women with early-onset preeclampsia
作者:
王倩; 杜丹丽
(蚌埠医学院第一附属医院妇产科，安徽　蚌埠　233000)
Author(s):
WANG Qian; DU Danli
(Department of Obstetrics，the First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,Anhui Province,China)
关键词:
早发型子痫前期;  基质金属蛋白酶3;  胱抑素C;  妊娠结局;  预测价值
Keywords:
early-onset preeclampsia; matrix metalloproteinase 3; cystatin C; pregnancy outcome; predictive value
分类号:
R714.25
DOI:
10.7683/xxyxyxb.2023.12.004
文献标志码:
A
摘要:
目的　探讨早发型子痫前期患者血清基质金属蛋白酶-3（MMP-3)和胱抑素C（Cys C）水平及二者联合对早发型子痫前期不良妊娠结局的预测价值。
方法　选择2021年11月至2022年8月蚌埠医学院第一附属医院产科收治的早发型子痫前期患者31例为早发型子痫前期组，并选择同时期来本院产科门诊产检的44例正常妊娠孕妇为正常妊娠组。根据妊娠结局是否伴有新生儿Apgar评分≤7分、胎儿宫内窘迫、胎儿生长受限、子痫发作、胎盘早剥等情况将早发型子痫前期组患者分为妊娠结局良好组（n=13）和妊娠结局不良组（n=18）。采用酶联免疫吸附法检测早发型子痫前期组和正常妊娠组孕妇血清MMP-3和Cys C水平，分析血清MMP-3和Cys C水平与早发型子痫前期及其妊娠结局的关系。采用受试者操作特征（ROC）曲线评估血清MMP-3、Cys C水平及二者联合对早发型子痫前期患者不良妊娠结局的预测价值。
结果　早发型子痫前期组患者血清MMP-3和Cys C水平均高于正常妊娠组(P<0.05）。妊娠结局不良组患者血清MMP-3和Cys C水平均高于妊娠结局良好组(P<0.05）。ROC曲线显示，血清MMP-3预测早发型子痫前期患者发生不良妊娠结局的曲线下面积（AUC）、灵敏度、特异度和约登指数分别为 0.885、83.3%、84.6%、0.679，血清Cys C预测早发型子痫前期患者发生不良妊娠结局的AUC、灵敏度、特异度和约登指数分别为0.859、83.3%、76.9%、0.603，二者联合检测预测早发型子痫前期患者发生不良妊娠结局的AUC、灵敏度、特异度、约登指数分别为0.923、72.2%、100%、0.722。
结论　早发型子痫前期患者血清中MMP-3、Cys C水平呈高表达，血清MMP-3、Cys C水平与早发型子痫前期患者的妊娠结局有关，二者联合检测对早发型子痫前期患者不良妊娠结局有一定的预测效能。
Abstract:
Objective　To investigate the predictive value of serum matrix metalloproteinase-3 (MMP-3) and cystatin C (Cys C) levels and their combination for adverse pregnancy outcomes in patients with early-onset preeclampsia.
Methods　Thirty-one patients with early-onset preeclampsia admitted to the Department of Obstetrics in the First Affiliated Hospital of Bengbu Medical College from November 2021 to August 2022 were selected as the early-onset preeclampsia group,and 44 pregnant women with normal pregnancies who came to our hospital for labor and delivery during the same period were selected as the normal pregnancy group.Patients in the early-onset preeclampsia group were categorized into good pregnancy outcome group (n=13) and poor pregnancy outcome group (n=18) based on whether the pregnancy outcome was accompanied by a neonatal Apgar score of ≤7,intrauterine distress,fetal growth restriction,eclampsia seizures,and placental abruption.The levels of serum MMP-3 and cystatin C were detected by enzyme linked immunosorbent assay.The relationship between serum MMP-3,Cys C level and early-onset preeclampsia and pregnancy outcome were analyzed.The value of seurm MMP-3,cystatin C level and their combination in predicting adverse pregnancy outcomes in patients with early-onset preeclampsia were evaluated by using receiver operating characteristic.
Results　The levels of serum MMP3 and Cys C in the early-onset preeclampsia group were higher than those in the normal pregnancy group (P<0.05).The levels of serum MMP-3 and Cys C in the poor pregnancy outcome group were higher than those in the good pregnancy outcome group (P<0.05).The area unde the curve (AUC),sensitivity,specificity,Youden index of serum MMP-3 in predicting adverse pregnancy outcome in patients with early-onset preeclampsia were 0.885,83.3%,84.6%,0.679,respectively.The AUC,sensitivity,specificity,Youden index of serum Cys C in predicting adverse pregnancy outcome in patients with early-onset preeclampsia were 0.859,83.3%,76.9%,0.603,respectively.The AUC,sensitivity,specificity,Youden index of combined detection of serum MMP-3 and Cys C in predicting adverse pregnancy outcome in patients with early-onset preeclampsia were 0.923,72.2%,100%,0.722,respectively.
Conclusion　The serum MMP-3 and Cys C levels are overloaded in patients with early-onset preeclampsia,and the serum MMP-3 and serum Cys C levels are related to the pregnancy outcome of patients with early-onset preeclampsia.The combined detection of the two indexes can predict the adverse pregnancy outcome of early-onset preeclampsia to some extent.

参考文献/References:

［1］　PHIPPS E A,THADHANI R,BENZING T,et al.Pre-eclampsia:pathogenesis,novel diagnostics and therapies［J］.Nat Rev Nephrol,2019,15(5):275-289.
［2］　JENA M K,SHARMA N R,PETITT M,et al.Pathogenesis of preeclampsia and therapeutic approaches targeting the placenta［J］.Biomolecules,2020,10(6):953.
［3］　DIMITRIADIS E,ROLNIK D L,ZHOU W,et al.Pre-eclampsia［J］.Nat Rev Dis Primers,2023,9(1):8.
［4］　王一男,李笑天.子痫前期临床表现异质性与发病机制的关联性［J］.中国实用妇科与产科杂志,2022,38(2):138-141.
WANG Y N,LI X T.The relationship between clinical heterogeneity and pathogenesis of preeclampsia［J］.Chin J Pract Gynecol Obstetr,2022,38(2):138-141.
［5］　卢锦芳,朱惠娟,何绮桃,等.围产期系统护理管理对早发型重度子痫前期患者子痫并发症及母婴结局的影响［J］.黑龙江医药,2022,35(5):1225-1227.
LU J F,ZHU H J,HE Q T,et al.Effects of perinatal system nursing management on eclampsia complications and maternal and infant outcomes in patients with early-onset severe preeclampsia［J］.Heilongjiang Med J,2022,35(5):1225-1227.
［6］　DROGE L A,EIDMANN J,AIGNER A,et al.Relevance of maternal sodium level for preeclampsia-associated adverse pregnancy outcomes［J］.Pregnancy Hypertens,2021,25:110-115.
［7］　张璋,孙翠翠,黎晓曦.子痫前期患者血清妊娠相关血浆蛋白-A和血管内皮生长因子水平与妊娠结局的关系［J］.新乡医学院学报,2023,40(2):140-145.
ZHANG Z,SUN C C,LI X X.Relationship between serum pregnancy associated plasma protein-A,vascular endothelial growth factor levels and pregnancy outcome in patients with preeclampsia［J］.J Xinxiang Med Univ,2023,40(2):140-145.
［8］　王红艳,白桂芹.子痫前期的分类［J］.中华产科急救电子杂志,2021,10(4):197-200.DOI:10.3877/cma.j.issn.2095-3259.2021.04.002
WANG H Y,BAI G Q.Classification of preeclampsia［J］.Chin J Obstet Emer,2021,10(4):197-200.DOI:10.3877/cma.j.issn.2095-3259.2021.04.002
［9］　ANEMAN I,PIENAAR D,SUVAKOV S,et al.Mechanisms of key innate immune cells in early-and late-onset preeclampsia［J］.Front Immunol,2020,11:1864.
［10］　刘冬榕,庄泽槟,郭少燕,等.子痫前期的发病机制及中医药防治研究进展［J］.广东药科大学学报,2022,38(2):131-137.
LIU D R,ZHUANG Z P,GUO S Y,et al.Research progress on pathogenesis and prevention of preeclampsia with traditional Chinese medicine［J］.J Guangdong Pharm Univ,2022,38(2):131-137.
［11］　杨洁琼,张丛,狄文.蜕膜化缺陷在子痫前期发病机制中的研究进展［J］.国际妇产科学杂志,2021,48(5):490-493.
YANG J Q,ZHANG C,DI W.Research progress of decidualization defect in the pathogenesis of preeclampsia［J］.J Int Obstet Gynecol,2021,48(5):490-493.
［12］　陆明佳,王成凤,景燕,等.miR-181a 调控 sirt1 对缺氧条件下大鼠脑微血管内皮细胞增殖和凋亡的影响［J］.河北医药,2022,44(9):1285-1290.
LU M J,WANG C F,JING Y,et al.Effects of miR-181a regulation of sirt1 on proliferation and apoptosis of cerebral microvascular endothelial cells in rats under hypoxia［J］.Hebei Med J,2022,44(9):1285-1290.
［13］　王丽,赵朵朵.硝苯地平和低分子肝素钙联合治疗对早发型重度子痫前期患者氧化应激、血压及母婴结局的影响［J］.新乡医学院学报,2023,40(3):249-252.
WANG L,ZHAO D D.Effect of nifedipine combined with low molecular weight heparin calcium on oxidative stress,blood pressure and maternal and infant outcome in patients with early-onset severe preeclampsia［J］.J Xinxiang Med Univ,2023,40(3):249-252.
［14］　PRIOR S,KIM A,YOSHIHARA T,et al.Mitochondrial respiratory function induces endogenous hypoxia［J］.PLoS One,2014,9(2):e88911.
［15］　雷玲,李力.子痫前期发病机制研究进展［J］.国外医学（妇产科学分册）,2006,33(5):342-345.
LEI L,LI L.Research progress on pathogenesis of preeclampsia［J］.Foreign Med Sci(Gynecol Obstetrics ),2006,33(5):342-345.
［16］　唐君,何斌,韩代文,等.超声软指标联合血清 β-hCG、uE3、AFP 检测在孕中期唐氏综合征产前筛查中的应用价值［J］.中国优生与遗传杂志,2020,28(7):826-829,885.
TANG J,HE B,HAN D W,et al.Application value of ultrasound soft index combined with serum β-hCG,uE3 and AFP detection in prenatal screening of Down syndrome during the second trimester［J］.Chin J Birth Health Heredity,2020,28(7):826-829,885.
［17］　王海娇,王毅,何红美,等.Th1/Th2促进早发性重度子痫前期胎盘滋养细胞焦亡［J］.陆军军医大学学报,2022,44(3):246-252.
WANG H J,WANG Y,HE H M,et al.Th1/Th2 promotes pyroptosis of placental trophoblast in early onset severe preeclampsia［J］.J Army Med Univ,2022,44(3):246-252.
［18］　ACHILLEAS D,SKANDALIS S S,CHRYSOSYOMI K N K.Extracellular matrix structure［J］.Adv Drug Deliv Rev,2016,1(97):4-27.
［19］　WHITLEY G S J,CARTWRIGHT J E.Cellular and molecular regulation of spiral artery remodelling:lessons from the cardiovascular field［J］.Placenta,2010,31(6):465-474.
［20］　SMALL H Y,MORGAN H,BEATTIE E,et al.Abnormal uterine artery remodelling in the stroke prone spontaneously hypertensive rat［J］.Placenta,2016,37:34-44.
［21］　COOLMAN M,DE MAAT M,VAN HEERDE W L,et al.Matrix metalloproteinase-9 gene-1562C/T polymorphism mitigates pree-clampsia［J］.Placenta,2007,28(7):709-713.
［22］　LASKOWSKA M.Altered maternal serum matrix metalloproteinases MMP-2,MMP-3,MMP-9,and MMP-13 in severe early-and late-onset preeclampsia［J］.Biomed Res Int,2017,2017:6432426.
［23］　蒋玲祥,吴朝勇,夏桂玉.重度子痫前期孕妇血清胱抑素 C 及补体 C1q 变化及临床意义［J］.浙江临床医学,2018,20(3):478-480.
JIANG L X,WU C Y,XIA G Y.Changes of serum cystatin C and complement C1q in pregnant women with severe preeclampsia and its clinical significance［J］.Zhejiang Clin Med J,2018,20(3):478-480.
［24］　YALCIN S,ULAS T,EREN M A,et al.Relationship between oxidative stress parameters and cystatin C levels in patients with severe preeclampsia［J］.Medicina,2013,49(3):19.
［25］　RISCH M,PURDE M T,BAUMANN M,et al.High first-trimester maternal blood cystatin C levels despite normal serum creatinine predict pre-eclampsia in singleton pregnancies［J］.Scand J Clin Lab Invest,2017,77(8):634-643.
［26］　夏宏林,郝维敏,钟平,等.血清胱抑素 C 对子痫前期早期肾损伤的诊断价值［J］.现代妇产科进展,2016,25(8):614-616.
XIA H L,HAO W M,ZHONG P,et al.Diagnostic value of serum cystatin C in early renal injury of preeclampsia［J］.Current Adv Obstetr Gynecol,2016,25(8):614-616.
［27］　黄菁,郑美玲,王玉珏,等.尿肾损伤分子1、血清胱抑素C和尿中性粒细胞明胶酶相关性脂质运载蛋白预测子痫前期发病和早期肾损伤的价值［J］.中国医科大学学报,2016,45(5):460-463.
HUANG J,ZHENG M L,WANG Y J,et al.Urinary kidney injury molecule 1,serum cystatin C and urinary neutrophil gelatinase-associated lipid carrier protein in predicting the onset of preeclampsia and early kidney injury［J］.J Chin Med Univ,2016,45(5):460-463.
［28］　常青,赵昆.孕妇血清胎盘生长因子胱抑素C水平检测在诊断子痫前期的应用分析［J］.山西医药杂志,2021,50(6):1019-1021.
CHANG Q,ZHAO K.Application of serum placental growth factor cystatin C in the diagnosis of preeclampsia in pregnant women［J］.Shanxi Med J,2021,50(6):1019-1021.
［29］　BELLOS I,FITROU G,DASKALAKIS G,et al.Serum cystatin-C as predictive factor of preeclampsia:a meta-analysis of 27 observational studies［J］.Pregnancy Hypertens,2019,16:97-104.

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更新日期/Last Update: 2023-12-05