妊娠期高血压疾病血ET-1与NO水平变化及其对肾动脉血流动力学的影响

目的 探讨妊娠期高血压疾病(HDCP)患者血浆内皮素-1(ET-1)与一氧化氮(NO)水平变化及其对肾功能的影响.方法 将2014年12月至2016 年12月收治的120例HDCP患者纳入本研究,按照病情严重程度不同将120例患者分为妊娠高血压组(45例)和子痫前期组(75例),并将子痫前期组分为轻度组(40例)及重度组(35例);同时随机选择相匹配的40例健康孕妇为对照组.分析各组孕妇血浆ET-1与NO 水平变化及其与肾功能、肾动脉血流动力学的相关性.结果 HDCP的病情越重,血浆ET-1水平明显越高(F=219.70,P<0.01),血浆NO水平明显越低(F=292.00,P<0.01).HDCP的病情越重,血浆BUN(F=8.33,P<0.01)、Scr(F=384.90,P<0.01)、血尿素(F=89.66,P<0.01)及血尿酸水平(F=560.00,P<0.01)均明显越高.四组PSV比较均无明显差异(F=0.02,P=0.99),子痫前期患者的EDV、RI、PI及S/D均明显高于妊娠高血压组和对照组,差异具有统计学意义(P<0.05).ET-1水平与BUN、Scr、血尿素、血尿酸、RI、PI、S/D水平呈正相关(r=1.55~4.54,均P<0.05),与EDV呈负相关(r=-3.80,P=0.04).而NO水平与EDV呈正相关(r=4.25,P=0.02),与BUN、Scr、血尿素、血尿酸、RI、PI、S/D均呈负相关(r=-1.84~-3.94,均P<0.05).ET-1、NO 水平与PSV 均无显著相关性(r值分别为1.60、0.70,均P>0.05).结论 HDCP的病情越重,血浆ET-1水平明显越高,血浆NO水平明显越低,入球小动脉收缩越明显,肾功能损伤越重.

Changes of serum ET-1 and NO levels in patients with hypertensive disorder complicating pregnancy and their effects on renal artery hemodynamics

Objective To investigate the changes of plasma endothelin-1 (ET-1) and nitric oxide (NO) levels in patients with hypertensive disorder complicating pregnancy (HDCP) and their effects on renal function.Methods Altogether 120 patients with HDCP admitted from December 2014 to December 2016 were enrolled in this study.According to severity of disease, they were divided into gestational hypertension group (n=45) and preeclampsia group (n=75), and preeclampsia group was further divided into mild group (n=40) and severe group (n=35).At the same time, 40 healthy pregnant women were randomly selected and matched as control group.Changes of plasma ET-1 and NO levels in pregnant women and their correlation with renal function and renal artery hemodynamics were analyzed.Results The more severe HDCP was, the higher plasma ET-1 level (F=219.70, P<0.01), and the lower plasma NO level (F=292.00, P<0.01).The more severe HDCP was, the higher levels of plasma BUN (F=8.33, P<0.01), Scr (F=384.90, P<0.01), blood urea (F=89.66, P<0.01) and serum uric acid (F=560.00, P<0.01).There was no significant difference in PSV among four groups (F=0.02, P=0.99).EDV, RI, PI and S/D of patients with preeclampsia were significantly higher than those of women in gestational hypertension group and control group, and the differences were statistically significant (P<0.05).Level of ET-1 was positively correlated with BUN, Scr, blood urea, blood uric acid, RI, PI and S/D levels (r value ranged 1.55-4.54, all P<0.05), and negatively correlated with EDV (r=-3.80, P=0.04).However, level of NO was positively correlated with EDV (r=4.25, P=0.02), and negatively correlated with BUN, Scr, blood urea, blood uric acid, RI, PI and S/D levels (r value ranged-1.84--3.94, all P<0.05).There was no significant correlation between ET-1, NO levels and PSV (r value was 1.60 and 0.70, respectively, both P>0.05).Conclusion With aggravation of HDCP, plasma ET-1 levels are significantly higher and plasma NO levels are significantly lower, afferent arteriole constriction more obvious, and renal injury more severe.