目的: 探讨炎症指标、凝血及生化指标在妊娠期高血压疾病中的水平及临床意义。方法: 选取2019年8月至2021年8月在包头医学院第一附属医院分娩孕妇223人为研究对象,其中包括对照组113例健康孕妇,病例组110例妊娠期高血压疾病患者。比较病例组与对照组单核细胞与淋巴细胞比值(monocyte to lymphocyte ratio,MLR),凝血酶原时间(prothrombin time,PT)、部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)、纤维蛋白原(fibrinogen,FIB),血尿素氮(blood urea nitrogen,BUN)、肌酐(creatinine,Cr)、尿酸(uric acid,UA)指标的差异。结果: 病例组与对照组年龄与孕周比较,差异具有统计学意义(P＜0.05 )。病例组与对照组比较临床指标的MLR、BUN、Cr、UA、TT、PT水平差异有统计学意义(P＜0.05 ),APTT、FIB水平差异无统计学意义(P＞0.05)。年龄、MLR、BUN、Cr、UA、TT与妊娠期高血压疾病的发病率成正相关,PT与妊娠期高血压疾病发病率呈负相关,差异具有统计学意义(P＜ 0.05)。APTT、FIB水平与妊娠期高血压疾病发病率无显著相关性(P＞0.05)。结论: 妊娠期高血压疾病患者机体的炎症、凝血水平较正常妊娠高,同时生化指标异常。通过对炎症、凝血、生化指标进行检测,为临床诊治提供重要依据。
Objective: To investigate the levels and clinical significance of inflammatory indexes, coagulation and biochemical indexes in hypertensive disorders of pregnancy. Methods: A total of 223 pregnant women who gave birth in the First Affiliated Hospital of Baotou Medical College from August 2019 to August 2021 were selected as the research subjects, including 113 healthy pregnant women in the control group and 110 patients with gestational hypertension in the case group. The differences in monocyte to lymphocyte ratio (MLR), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), blood urea nitrogen (BUN), creatinine (Cr) and uric acid (UA) between the case group and the control group were compared. Results: There were significant differences in age and gestational age in the general clinical data between the case group and the control group (P＜0.05). There were significant differences in the levels of MLR, BUN, Cr, UA, TT and PT between the case group and the control group (P＜0.05); while there was no significant difference in APTT and FIB levels between the case group and the control group (P＞0.05). Age, MLR, BUN, Cr, UA, TT were positively correlated with the occurrence of gestational hypertension, and PT was negatively correlated with the occurrence of gestational hypertension, and the differences were statistically significant (P＜0.05); while APTT and FIB levels were not associated with the occurrence of gestational hypertension (P＞0.05). Conclusion: The levels of inflammation and coagulation in patients with gestational hypertension are higher than those in normal pregnancy, and the renal function indexes are abnormal. Through the detection of inflammation, coagulation and renal function indexes, it provides an important basis for clinical diagnosis and treatment.
[1] Sutton ALM, Harper LM, Tita ATN. Hypertensive disorders in pregnancy[J]. Obstet gynecol clin north Am, 2018, 45(2): 333-347.
[2] Borzychowski AM, Sargent IL, Redman CW. Inflammation and pre-eclampsia[J]. Semin Fetal Neonatal Med, 2006, 11(5): 309-316.
[3] 方章华, 秦田瑞, 邓晨晨, 等. 凝血、血小板及生化指标对重度子痫前期的辅助诊断价值研究[J]. 实用妇产科杂志, 2020, 36(12): 936-940.
[4] 任丹玉, 王永红. 凝血功能指标和血小板参数对子痫前期及其严重程度的辅助诊断价值研究[J]. 中国全科医学, 2019, 22(22): 2698-2704.
[5] Liu J, Wu P, Lai S, et al. Preoperative monocyte-to-lymphocyte ratio predicts for intravesical recurrence in patients with urothelial carcinoma of the upper urinary tract after radical nephroureterectomy without a history of bladder cancer [J]. Clin Genitourin Cancer, 2021, 19(3): e156-e165.
[6] Liu P, Li P, Peng Z, et al. Predictive value of the neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-neutrophil ratio, and neutrophil-to-monocyte ratio in lupus nephritis [J]. Lupus, 2020, 29(9): 1031-1039.
[7] Li X, Wu J, Mao W. Evaluation of the neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and red cell distribution width for the prediction of prognosis of patients with hepatitis B virus-related decompensated cirrhosis [J]. J Clin Lab Anal, 2020, 34(11): e23478.
[8] 杨孜, 张为远. 妊娠期高血压疾病诊治指南(2015)[J]. 中华产科急救电子杂志, 2015, 4(4): 206-213.
[9] Savitz DA, Danilack VA, Elston B, et al. Pregnancy-induced hypertension and diabetes and the risk of cardiovascular disease, stroke, and diabetes hospitalization in the year following delivery [J]. Am J Epidemiol, 2014, 180(1): 41-44.
[10] Mathai M. To reduce maternal mortality, we must know and respond to women's personal stories [J] . BJOG, 2018, 125(9):1144.
[11] 李玉明, 杨宁. 《妊娠期高血压疾病血压管理专家共识(2019)》解读[J]. 中华高血压杂志, 2020, 28(8): 714-716.
[12] 郭媛媛. 妊娠期高血压疾病患者孕期血脂水平与妊娠结局的相关性分析[D]. 银川:宁夏医科大学, 2021.
[13] Spong CY, Mercer BM, D'Alton M, et al. Timing of indicated late-preterm and early-term birth [J]. Obstet Gynecol, 2011, 118(2): 323-333.
[14] 中华医学会围产医学分会, 中华医学会妇产科学分会产科学组. 妊娠并发症和合并症终止妊娠时机的专家共识[J]. 中华围产医学杂志, 2020, 23(11): 721-732.
[15] Allaire AD, Ballenger KA, Wells SR, et al. Placental apoptosis in preeclampsia[J]. Obstet Gynecol, 2000, 96(2): 271-276.
[16] 张振宇, 王婧, 李海波. MLR、NLR对子痫前期诊断价值的研究[J]. 交通医学, 2018, 32(5): 424-427,430.
[17] 高洁, 罗玫, 马唯. 妊娠期高血压疾病患者孕早期外周血中性粒细胞、单核细胞与淋巴细胞比值的观察[J].中华全科医师杂志, 2019, (9): 851-855.
[18] Garovic VD, White WM, Vaughan L, et al. Incidence and long-term outcomes of hypertensive disorders of pregnancy [J]. J Am Coll Cardiol, 2020, 75(18): 2323-2334.
[19] Lopes van Balen VA, van Gansewinkel TAG, de Haas S, et al. Maternal kidney function during pregnancy: systematic review and meta-analysis [J]. Ultrasound Obstet Gynecol, 2019, 54(3): 297-307.
[20] Ekun OA, Olawumi OM, Makwe CC,et al. Biochemical assessment of renal and liver function among preeclamptics in lagos metropolis [J]. Int J Reprod Med, 2018, 2018: 1594182.
[21] Shakarami A, Ghafarzadeh M, Yari F, et al. Association between maternal serum uric acid and preeclampsia. Arch Physiol Biochem, 2020, 10: 1-4.
[22] Lam C, Lim KH, Kang DH, et al. Uric acid and preeclampsia [J]. Semin Nephrol, 2005, 25(1): 56-60.
[23] 陈燕, 孙文琴, 刘明其. 不同妊娠时期凝血功能指标的变化和检验价值分析[J]. 上海医学, 2020, 43(10): 584-586.
[24] 邹赛赛, 林丽丽, 木若文. GH孕妇血小板相关指标与凝血功能指标的变化对母婴结局的影响[J]. 中国妇幼健康研究, 2018, 29(10): 1307-1310.
