The relationship between serum lipoprotein a and cystatin C expression and neonatal outcomes in early-onset preeclampsia patients
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摘要: 目的 探究早发型子痫前期患者血清脂蛋白a[Lp(a)]、胱抑素C(CysC)表达与新生儿结局的关系。方法 选择2022年6月—2024年6月医院确诊为早发型子痫前期的147例患者，最终142例完成研究。按病情程度分为：轻度组(91例)和重度组(51例)，所有患者入组时检测血清Lp(a)、CysC水平，比较不同疾病程度组患者血清Lp(a)、CysC水平差异；按新生儿结局分为：新生儿不良结局组(41例)和结局良好组(101组)，比较不同新生儿结局患者一般资料、血清Lp(a)、CysC水平，重点分析血清Lp(a)、CysC表达与新生儿结局的关系。结果 轻度组入组时血清Lp(a)、CysC水平低于重度组(P＜0.05)。最终41例新生儿不良结局，占28.87%(41/142)；较结局良好组，不良结局组病情重度占比高，入组时24 h尿蛋白定量、尿酸(UA)、Lp(a)、CysC水平高，血清脂联素(APN)水平低(P＜0.05)。回归分析结果显示，早发型子痫前期患者新生儿不良结局可能与患者病情严重程度、24 h尿蛋白定量、UA、Lp(a)、CysC、APN表达异常有关(P＜0.05)。早发型子痫前期患者新生儿不良结局与血清Lp(a)、CysC与呈非线性剂量-反应关系(P＜0.05)，当血清Lp(a)≥104.70 mmol/L时，血清CysC≥1.23 mg/L时，新生儿不良结局风险随二者水平升高而增加。基于回归分析结果，构建列线图模型并绘制决策曲线发现，模型预测新生儿不良结局风险的C-index为0.903，模型辨别度良好，且模型整体净受益率高于各指标单独应用，最大净受益率为0.289。结论 早发型子痫前期重症患者血清Lp(a)、CysC表达高于轻症，且这种异常高表达可能提示新生儿不良结局风险，基于血清Lp(a)、CysC，并结合患者病情、24 h尿蛋白定量、UA、APN构建的新生儿不良结局风险预测模型有理想的应用价值。Abstract: Objective To investigate the relationship between serum lipoprotein a[Lp(a)], cystatin C(CysC) expression and neonatal outcomes in patients with early-onset preeclampsia.Methods A total of 147 patients diagnosed with early-onset preeclampsia in hospital from June 2022 to June 2024 were selected. Serum Lp(a) and CysC levels were measured at the time of enrollment, and the differences in serum Lp(a) and CysC levels among patients with different disease severity were compared. Neonatal outcomes were counted. The general data, serum Lp(a) and CysC levels of patients with different neonatal outcomes were compared, and the relationship between serum Lp(a), CysC expression and neonatal outcomes was analyzed.Results Out of 147 patients, 142 ultimately completed the study. The serum levels of Lp(a) and CysC were lower in the mild group than in the severe group at the time of enrollment(P < 0.05). The final 41 cases of adverse outcomes in newborns accounted for 28.87%(41/142). Compared with the good outcome group, the proportion of severe illness was higher in the poor outcome group. At the time of enrollment, 24-hour urinary protein quantification, uric acid(UA), Lp(a) and CysC levels were higher, and serum adiponectin(APN) levels were lower(P < 0.05). The regression analysis results showed that adverse outcomes in newborns of early-onset preeclampsia patients may be related to the severity of the patient's condition, as well as abnormal 24-hour urinary protein quantification, UA, Lp(a), CysC and APN expression(P < 0.05). The adverse outcomes of newborns in early-onset preeclampsia patients showed a non-linear dose-response relationship with serum Lp(a) and CysC levels(P < 0.05). When serum Lp(a) was≥104.70 mmol/L and serum CysC was≥1.23 mg/L, the risk of adverse outcomes in newborns increased with the levels of both. Based on the regression analysis results, a column chart model was constructed and a decision curve was drawn. It was found that the C-index of the model predicting the risk of adverse outcomes in newborns was 0.903, indicating good model discrimination. The overall net benefit rate of the model was higher than that of each indicator applied separately, with a maximum net benefit rate of 0.289.Conclusion The expression of serum Lp(a) and CysC in severe early-onset preeclampsia patients is higher than that in mild cases, and this abnormal high expression may indicate the risk of adverse outcomes in newborns. A neonatal adverse outcome risk prediction model based on serum Lp(a) and CysC, combined with patient condition, 24-hour urine protein quantification, UA and APN has ideal application value.
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Key words:
- preeclampsia /
- early-onset /
- lipoprotein a /
- cystatin C /
- neonatal outcomes
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表 1 早发型子痫前期患者血清Lp(a)、CysC表达情况比较
X±S 组别 例数 Lp(a)/(mmol/L) CysC/(mg/L) 轻度组 91 120.59±87.89 1.25±0.34 重度组 51 168.27±113.46 1.38±0.37 t 2.596 2.212 P 0.011 0.029 
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表 2 不同新生儿结局患者一般资料、血清Lp(a)、CysC水平及其他实验室指标比较
M(P25，P75)，例(%)，X±S 组别 新生儿不良结局组(41例) 新生儿结局良好组(101例) Z/χ2 P 年龄/岁 30.00(24.00，33.00) 30.00(23.00，34.00) 0.169 0.866 确诊疾病孕周/岁 31.00(29.00，33.00) 31.00(29.00，32.50) 0.841 0.400 孕次/次 2.00(1.00，3.00) 2.00(1.00，2.00) 1.033 0.302 产史/例 1.540 0.215 有 25(60.98) 50(49.50) 无 16(39.02) 51(50.50) 入组时体重指数/(kg/m2) 25.43±0.97 25.00±1.27 1.934 0.055 病情严重程度/例 7.884 0.005 轻度 19(46.34) 72(71.29) 重度 22(53.66) 29(28.71) 24 h尿蛋白定量/(g/L) 3.13±1.05 2.11±0.80 4.993 ＜0.001 UA/(μmol/mL) 444.70±110.15 398.70±114.33 2.196 0.030 收缩压/mmHg 154.47±10.69 150.96±9.60 1.910 0.058 舒张压/mmHg 102.46±8.70 99.54±8.75 1.805 0.073 空腹血糖/(mmol/L) 5.06±0.80 4.84±0.64 1.723 0.087 APN/(mg/L) 5.46±0.69 5.98±0.96 3.681 ＜0.001 Lp(a)/(mmol/L) 188.20±112.43 117.22±87.21 3.624 ＜0.001 CysC/(mg/L) 1.44±0.44 1.24±0.31 2.712 0.009
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表 3 早发型子痫前期患者新生儿结局与血清Lp(a)、CysC及其他主要指标关系的回归分析
指标 单因素 多因素 OR 95%CI P OR 95%CI P 病情严重程度 2.875 1.358~6.086 0.006 3.012 1.010~8.984 0.048 24 h尿蛋白定量 2.909 1.827~4.632 ＜0.001 4.192 2.245~7.827 ＜0.001 UA 1.004 1.000~1.007 0.032 1.006 1.001~1.011 0.012 APN 0.47 0.289~0.764 0.002 0.478 0.252~0.909 0.024 Lp(a) 1.007 1.003~1.011 ＜0.001 1.01 1.005~1.016 ＜0.001 CysC 5.037 1.717~14.782 0.003 8.749 1.923~39.810 0.005
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