妊娠高血压视网膜病变影响因素分析及血管内皮功能检测的临床意义

目的:探讨妊娠高血压视网膜病变的影响因素及血管内皮功能检测的临床意义。方法:前瞻性选取2017年1月~2018年12月期间湖北省妇幼保健院收治的150例妊娠高血压视网膜病变患者作为观察组,根据国际通用的Duker-Elder眼底分期标准分为Ⅰ期组69例,Ⅱ期组57例,Ⅲ期组24例。选取同时期该院收治的妊娠高血压无视网膜病变患者40例为对照组。采用酶联免疫吸附法检测血清胰岛素样生长因子(IGF-1)、内皮素-1(ET-1)水平,采用Pearson相关性分析IGF-1和ET-1水平与病变程度的相关性,采用多因素Logistic回归分析妊娠高血压视网膜病变的影响因素。结果:随着Duker-Elder眼底分期的增加,血清ET-1水平呈不断升高趋势,IGF-1水平呈不断下降趋势(P<0.05)。Pearson相关性分析显示,病变程度与血清IGF-1水平呈负相关,而与ET-1水平呈正相关(P<0.05)。单因素分析结果显示,妊娠高血压视网膜病变的发生与病程、孕周、血压、体质量、蛋白尿、红细胞压积有关(P<0.05),而与年龄无关(P>0.05)。Logistic回归分析结果显示,病程>3W、血压≥160/110 mm Hg、体质量>85kg、蛋白尿为+++、红细胞压积>0.35均是妊娠高血压视网膜病变发生的独立危险因素(P<0.05),而孕周>28W则是其保护因素(P<0.05)。结论:妊娠高血压视网膜病变患者存在IGF-1、ET-1的异常表达,且其表达水平与病变程度息息相关。血压、病程、蛋白尿、体质量、红细胞压积均是妊娠高血压视网膜病变发生的独立危险因素,孕周则是其保护因素。

Analysis of Influencing Factors of Retinopathy in Pregnancy-induced Hypertension and Clinical Significance of Detection of Vascular Endothelial Function

ABSTRACT Objective: To investigate the influencing factors of retinopathy in pregnancy-induced hypertension and the clinical significance of the detection of vascular endothelial function. Methods: 150 patients with hypertensive retinopathy of pregnancy who were admitted to Maternal and Child Health Hospital of Hubei Province from January 2017 to December 2018 were prospectively selected as observation group. According to the international standard of Duker-Elder fundus staging, they were divided into phase I group (69 cases), phase II group (57 cases) and phase III group (24 cases). 40 patients with pregnancy-induced hypertension without retinopathy who were admitted to the hospital during the same period were selected as the control group. The serum levels of insulin-like growth factor-1 (IGF-1) and endothelin-1 (ET-1) were detected by enzyme-linked immunosorbent assay, The correlation between the levels of IGF-1 and ET-1 and the severity of retinopathy were analyzed by Pearson correlation analysis, and the influencing factors of retinopathy in pregnancy-induced hypertension were analyzed by multivariate logistic regression. Results: With the increase of Duker-Elder''s fundus staging, the level of serum ET-1 increased, and the level of serum IGF-1 decreased (P<0.05). Pearson correlation analysis showed that the severity of lesion was negatively correlated with level of serum IGF-1, but it was positively correlated with level of serum ET-1 (P<0.05). Univariate analysis showed that the incidence of retinopathy in pregnancy-induced hypertension were related to course of disease, gestational age, blood pressure, body mass, proteinuria and hematocrit (P<0.05), and it was not related with age (P>0.05). Logistic regression analysis showed that Course of disease>3W, blood pressure>160/110 mmHg, body weight >85 kg, proteinuria +++, hematocrit>0.35 were all independent risk factors for retinopathy of pregnancy-induced hypertension (P<0.05), while gestational age>28W was the protective factor (P<0.05). Conclusion: There are abnormal expressions of IGF-1 and ET-1 in patients with pregnancy-induced hypertensive retinopathy, and the expression level is closely related to the degree of retinopathy. The blood pressure, course of disease, proteinuria, body weight and hematocrit are the main risk factors for the occurrence of pregnancy-induced hypertension retinopathy, and the gestational age is the protective factor.