生殖医学杂志

目的 探究妊娠期高血压疾病(HDP)患者子宫动脉血流参数及血清人类白细胞抗原-G(HLA-G)、正五聚蛋白-3(PTX-3)水平对患者妊娠结局的预测价值。方法 选取2022年3月至2024年3月于我院收治的278例HDP患者作为研究对象(HDP组),并以同期278例健康孕妇作为对照组；同时，根据不同妊娠结局将HDP组患者分为不良结局组(61例)及良好结局组(217例)。采用彩色多普勒超声诊断仪检测患者子宫动脉收缩期血流最大速度(S)及子宫动脉舒张期血流最大速度(D),计算S/D、子宫动脉阻力指数(RI)及子宫动脉搏动指数(PI);采用酶联免疫吸附(ELISA)法检测受检者血清HLA-G、PTX-3水平，比较不同妊娠结局HDP患者一般资料、子宫动脉血流参数及血清HLA-G、PTX-3水平；采用多因素Logistic回归分析HDP患者不良妊娠结局的影响因素；采用受试者工作特征(ROC)曲线分析子宫动脉血流参数联合血清HLA-G、PTX-3对HDP患者不良妊娠结局的预测价值。结果 HDP组血清HLA-G水平显著低于对照组，PTX-3水平显著高于对照组(P<0.05)。HDP患者中，不良结局组的S/D、RI、PI及血清PTX-3水平显著高于良好结局组，血清HLA-G水平显著低于良好结局组(P<0.05)。Logistic回归分析结果显示，S/D、RI、PI及血清HLA-G、PTX-3水平是HDP患者不良妊娠结局的影响因素(P<0.05)。ROC结果显示，子宫动脉血流参数联合血清HLA-G、PTX-3水平预测HDP患者不良妊娠结局效能[曲线下面积(AUC)=0.976,95%CI(0.950,0.991)]显著高于S/D(Z=4.550)、RI(Z=5.617)、PI(Z=4.799)、HLA-G(Z=4.368)及PTX-3(Z=4.695)单独预测(P<0.001)。结论 子宫动脉血流参数及血清HLA-G、PTX-3水平与HDP患者妊娠结局相关，血流参数联合血清HLA-G、PTX-3水平预测HDP患者不良妊娠结局的效能较好。

Objective:To investigate the predictive value of uterine artery blood flow parameters as well as serum levels of human leukocyte antigen-G(HLA-G)and pentraxin-3(PTX-3)for pregnancy outcomes in patients with hypertensive disorder of pregnancy(HDP).Methods:A total of 278 HDP patients admitted to Northern Theater Command General Hospital from March 2022 to March 2024 were recruited as the study subjects(HDP group),and 278 healthy pregnant women during the same period were selected as the control group. At the same time, the patients in the HDP group were categorized into the group with poor outcomes(61 cases)and the group with good outcomes(217 cases)according to the different pregnancy outcomes. Color Doppler ultrasound diagnostic equipment was used to detect the maximum systolic blood flow velocity(S)and diastolic blood flow velocity(D)of the uterine artery in patients, S/D,uterine artery resistance index(RI),and uterine artery pulsatility index(PI)was calculated. Enzyme linked immunosorbent assay(ELISA)was used to detect serum HLA-G and PTX-3 levels in subjects, and the general characteristics, uterine artery blood flow parameters, and serum HLA-G and PTX-3 levels were compared among HDP patients with different pregnancy outcomes. Multivariate logistic regression was used to analyze the influencing factors of adverse pregnancy outcomes in HDP patients, and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of uterine artery blood flow parameters combined with serum HLA-G and PTX-3 for adverse pregnancy outcomes in HDP patients.Results:Serum HLA-G level was significantly lower and PTX-3 level was significantly higher in the HDP group than those in the control group(P<0.05). S/D,RI,PI and serum PTX-3 level were significantly higher and serum HLA-G level was significantly lower in the poor outcome group than those in the good outcome group(P<0.05). Logistic regression analysis showed that S/D,RI,PI,and serum HLA-G and PTX-3 levels were influential factors of adverse pregnancy outcomes in HDP patients(P<0.05). The ROC results showed that the area under the curve(AUC)of uterine artery flow parameters combined with serum HLA-G and PTX-3 levels to predict adverse pregnancy outcomes in patients with HDP[0.976,95%CI(0.950,0.991)] was higher than those predicted by S/D(Z=4.550),RI(Z=5.617),PI(Z=4.799),HLA-G(Z=4.368)and PTX-3(Z=4.695)respectively(P<0.001).Conclusions:Both uterine artery blood flow parameters and serum HLA-G and PTX-3 levels are correlated with pregnancy outcomes in HDP patients. The combination of blood flow parameters and serum HLA-G and PTX-3 levels has a good predictive effect on adverse pregnancy outcomes in HDP patients.