【摘要】 目的:研究妊娠期高血压疾病患者母体血浆纤维结合蛋白(fibronectin,Fn)在妊娠期间的序列变化以及对疾病的预测价值。方法:采用前瞻性研究方法,对180例妊娠前正常的孕妇,应用酶联免疫吸附试验(ELISA)的方法,检测母体血Fn在妊娠10~14、20~24、30~34周的水平,观察孕妇孕期的变化并随访妊娠结局;同时选取50例正常未孕妇女作为未孕对照。结果:①180例中有12例发生妊娠期高血压(妊娠期高血压组),10例子痫前期,4例重度、6例轻度(子痫前期组),158例孕妇妊娠结局正常(正常妊娠组)。②正常妊娠孕妇,母体血浆Fn在妊娠10~14、20~24周维持正常未孕水平,而在妊娠30~34周明显升高,均差异有统计学意义(均P<0.01);在妊娠10~14周,子痫前期组、妊娠期高血压组与正常妊娠母体血浆Fn浓度比较差异无统计学意义;在妊娠20~24、30~34周,子痫前期与其他2组比较均差异有统计学意义(均P<0.01),而妊娠期高血压与正常妊娠组比较,均差异无统计学意义(均P>0.05)。③通过ROC曲线分析,母体血浆Fn在妊娠20~24、30~34周预测子痫前期曲线下面积分别为0.858、0.846(均P<0.01),妊娠20~24周最佳切入值为388.65 mg/L,其敏感性、特异性、阳性预测值、阴性预测值、阳性似然比分别为100.00%、78.24%、21.28%、100.00%、4.85;妊娠30~34周最佳切入值为416.95 mg/L,值分别为100.00%、77.06%、20.00%、100.00%、4.25。结论:子痫前期中晚期母体血浆Fn明显升高,而妊娠期高血压保持同期正常妊娠水平;妊娠中晚期母体血浆Fn对预测子痫前期有较好的特异性,妊娠20~24周的预测价值优于妊娠30~34周。更多还原

【Abstract】 Objective:To investigate maternal plasma fibronectin changes during pregnancy for hypertensive disorder complicating and normal pregnancy and determine the predictive value for preeclampsia.Method:One hundred and eighty pregnant women with previously normal blood pressure were prospectively included in the study.Peripheral venous blood samples were obtained at 10-14,20-24 and 30-34 gestational weeks.Plasma levels of fibronectin were measured by enzyme-linked immunoassay technique.Fifty non-pregnancy healthy women were chosen as control.The outcomes of pregnancies were followed up.Result:①Among 180 previously normal women,12 developed gestational hypertension(gestational hypertension group),6 severity and 4 mild preeclampsia(preeclampsia group) 158 remained normal till the end(normal pregnancy group).②The mean maternal plasma fibronectin levels at 10-14 and 20-24 gestational weeks did not exhibit a significant change in normotensive pregnancy women compare to those in non-pregnancy women(P>0.05) but significantly higher at 30-34 gestational weeks(P<0.01).The levels of maternal plasma fibronectin at 20-24 or 30-34 pregnancy weeks in preeclampsia were significantly higher than those in gestational hypertension and healthy normal pregnancy women更多还原