妊娠期高血压疾病患者血浆D-二聚体与亮氨酸氨基肽酶的关系

摘要

目的:探讨妊娠期高血压疾病(hypertensive disorders complicating pregnancy,HDCP)患者血浆D-二聚体与亮氨酸氨基肽酶(leucine aminopeptidase,LAP)的关系以及临床上的应用价值.方法:选取2015年8月—2016年12月在南平市第一医院产检正常的妊娠妇女404例,经体检未孕健康妇女101例.选取同期在南平市第一医院收治的HDCP妇女116例.检测受试者LAP、碱性磷酸酶(ALP)、D-二聚体、尿总蛋白、尿肌酐等,计算尿总蛋白肌酐比(UTPCR).采用单因素方差分析、Pearson相关分析和趋势图分析D-二聚体与LAP、UTPCR等的关系.结果:HDCP组患者收缩压、D-二聚体浓度和UTPCR高于非妊娠期组和正常妊娠各期组,差异有统计学意义(均P<0.05),LAP浓度低于妊娠晚期组(P<0.05).妊娠晚期组的D-二聚体浓度仅与UTPCR值呈正相关(r=0.190,P=0.011).HDCP组患者D-二聚体浓度与孕周和LAP浓度呈负相关(r=-0.505,P=0.000;r=-0.443,P=0.001),与UTPCR值呈正相关(r=0.372,P=0.004).趋势图显示HDCP组患者血浆D-二聚体浓度高于正常妊娠晚期妇女,血浆LAP浓度低于正常妊娠晚期妇女.结论:HDCP患者血浆D-二聚体与LAP相关性较好,联合检测D-二聚体和LAP,结合UTPCR对HDCP早期发现、治疗及预防有重要临床价值.%Objective:To investigate the relationship and the application value of plasma D-dimer and leucine aminopeptidase (LAP) in the hypertensive disorders complicating pregnancy (HDCP). Methods:A number of 404 healthy pregnant women and 101 healthy non-pregnant women were enrolled from the obstetrical examination department of Fujian Medical University Affiliated Nanping First Hospital from August 2015 to December 2016, and a total of 116 HDCP were enrolled from the Obstetrics and Gynecology Department of Nanping First Hospital from August 2015 to December 2016. LAP, alkaline phosphatase (ALP), plasma D-dimer, urine total protein and urine creatinine of all the subjects were detected, and value of urinary total protein/creatinine ratio (UTPCR) was calculated. Single factor analysis of variance, Pearson correlation analysis and Trend chart were performed to test the relationship between plasma D-dimer and LAP, UTPCR. Results:Compared with the healthy non-pregnant women and various stages of healthy pregnant women, systolic blood pressure, D-dimer, UTPCR of HDCP were significantly higher (P<0.05), and LAP of HDCP significantly lower than that of late healthy pregnancy period (P<0.05). Correlation analysis showed that D-dimer of late healthy pregnancy women was only related to urinary protein ( r=0.19, P=0.011), D-dimer of HDCP was strongly correlated to gestational period (r=-0.505, P=0.000), LAP (r=-0.443, P=0.001), UTPCR (r=0.372, P=0.004). Trend graph showed that D-dimer level of HDCP was significantly higher than that of the corresponding period of healthy pregnant women, and LAP level of HDCP was obviously lower. Conclusions:Plasma D-dimer is preferably related to LAP in HDCP, and plasma D-dimer, LAP and UTPCR are the important basises for early detection, treatment and prevention for HDCP.