血浆胎盘异铁蛋白在妊娠高血压综合征发病中的作用及其预测价值

目的　探讨血浆胎盘异铁蛋白（placentalisoferritin,PLF）在妊娠高血压综合征（妊高征）发病中的作用及其对妊高征的预测价值。方法　采用前瞻性研究方法，对120例妊娠24～34周最初正常的孕妇，分别应用酶联免疫吸附试验法和Griess法，对其PLF和一氧化氮(NO)代谢产物亚硝酸基/硝酸基（NO2-/NO3-）的水平进行测定，观察孕妇孕期血压的变化并随访妊娠结局。结果　（1）120例正常孕妇中发生妊高征19例（妊高征组），101例孕妇妊娠结局正常（正常组）。妊高征组血浆PLF水平［(285.31±53.73)mg/L］与正常组［(699.05±203.03)mg/L］比较，明显降低。两组比较，差异有极显著性（P<0.01）。妊高征组NO水平［(54.57±32.71)μmol/L］与正常组［(38.89±30.00)μmol/L］比较，明显升高(P<0.05)。血浆PLF水平与血浆NO水平呈负相关（r=0.329，P<0.01）。（2）PLF预测妊高征患者受试者工作曲线的曲线下面积为0.905。以400mg/LPLF为切点预测妊高征时的敏感性、特异性、阳性预测值及阴性预测值，分别为100.00％、85.15％、55.88％、100.00％，Kappa指数为0.645。结论　妊高征患者血浆PLF水平降低，PLF与妊高征的发生有密切关系。血浆PLF水平可作为妊高征的预测指标之一。

The role of plasma placental isoferritin in pathogenesis of preeclampsia and its predictive value for preeclampsia

OBJECTIVE: To investigate the effect of placental isoferritin in pathogenesis of preeclampsia and its predictive value. METHODS: A prospective double-blinded study was performed. There were 120 initial normal pregnant women at earlier third trimester (from 24 to 34 weeks) in this study. Their plasma placental isoferritin and nitric oxide (NO) metabolites (nitrite/nitrate) (NO2-/NO3-) were examined by enzyme linked immunoabsorbent assay (ELISA) and Griess assay respectively. The outcomes of pregnancies were followed up. RESULTS: In 120 initial normal pregnant women, 19 pregnant women occurred preeclampsia (preeclampsia group), and 101 cases were normal (normal group) at follow up. The levels of plasma placental isoferritin (PLF) were significantly decreased in preeclampsia group (285.31 +/- 53.73 mg/L) than that of normal group (699.05 +/- 203.03) mg/L, P < 0.01. The levels of plasma NO were significantly increased in preeclampsia group (54.57 +/- 32.71 mumol/L) than that of normal group (38.89 +/- 30.00) mumol/L, P < 0.05. The significant negative correlation between the plasma placental isoferritin and NO levels was observed(r = 0.329, P < 0.01). At the cut point of 400 mg/L PLF level, the sensitivity, specificity, positive predictive value, negative predictive value and Kappa index of PLF level predicting on the outcomes of pregnancy with preeclampsia were 100%, 85.15%, 55.88%, 100%, 0.645. CONCLUSIONS: The decrease of plasma placental isoferritin levels is associated with preeclampsia, and the endothelial cell damage may be one of its mechanism. The PLF may be an earlier predictor of preeclampsia at 24-34 gestational weeks.