The Expression And Significance With Soluble CD40l In Peripheral Blood And Umbilical Cord Blood Of Patients With Severe Preeclampsia And The Correlation Research With The Clinical Index

Objective To investigate the relationships between concentrations of sCD40L level inperipheral blood and umbilical cord blood and severe preeclampsia.Discusses the possiblepathophysiological mechanism and clinical significance in preeclampsia. At the sametime, discusses the relationship between sCD40L and blood coagulation function, renalfunction, hypersensitive c-reactive protein (hs-CRP)and birth weight.Methods According to gestational age is divided into early-onset (presented at <34weeks of gestation) and late onset (presented at≥34weeks of gestation). A total of60women with sPE and60normal pregnant women as control participated in this study.Patients with sPE were divided into early-onset sPE group (n=30, presented at <34weeksof gestation), and lated-onset sPE group (n=30, presented at≥34weeks of gestation), with30normal pregnant women as early control group1(<34weeks of gestation) and30aslate control group2(≥34weeks of gestation). Enzyme linked immunosorbent (ELISA)method was used to detect serum sCD40L level; automatic five classification of bloodcells analyzer was used to detect serum PLT and MPV; automatic blood coagulationanalyzer was used to detect serum APTT, PT and FIB; automatic biochemical analyzerwas used to determine liver (Cr), uric acid (UA); scattering turbidimetric method wasused to detect serum hs-CRP.Results（1）Peripheral blood and umbilical cord blood serum sCD40L level of early andlate-onset sPE were higher than control group1and control group2, difference wasstatistically significant (P<0.01); And significant difference was found between early andlate-onset PE(P<0.01); but no difference between the control group1and control group2(P>0.05).（2）Peripheral blood serum hs-CRP levels of early and late-onset sPE were higherthan control group1and control group2, difference was statistically significant (P<0.01); And no significant difference was found between early and late-onset sPE(P>0.05); nodifference between the control group1and control group2(P>0.05).（3）In peripheral blood, serum sCD40L and hs-CRP were indexes of diagnosis ofsevere preeclampsia, the area under ROC curve of sCD40L was0.926(P=0.000), largerthan that of hs-CRP0.785(P=0.000); the best threshold levels in the diagnosis of severepreeclampsia sCD40L and hs-CRP were4.58ng/mL and2.85mg/L, the correspondingsensitivity was86.7%and80%respectively, speciality rate was85%and66.7%respec-tively, the positive predictive value was85.2%and70.6%respectively, the negative pre-dictive value was86.4%and76.9%respectively, Youden index were0.717and0.467;combined determination of sCD40L, SP and determination of24h urine protein with thehighest positive rate of91.7%for the diagnosis of severe preeclampsia patients.（4）Peripheral plasma PLT,APTT, PT and FIB levels of early and late-onset PE werelower than control group1and control group2, and MPV levels were higher, differencewas statistically significant (P<0.01); And significant difference was found between earlyand late-onset sPE(P<0.05), but no difference between the control group1and controlgroup2(P>0.05).（5）Levels of peripheral blood serum Cr and UA of the early and late-onset sPE werehigher than control group, while the glomerular filtration rate (GFR) was lower than thesame period in the control group, the difference with statistical significance (P<0.05); for24h urine protein, significant difference was found between early and late-onset sPE (P<0.05); for Cr, UA and GFR of early-onset PE, no statistically significant difference wasfound when compared with the late-onset PE, and control group1and control group2(P>0.05).（6）Peripheral blood serum sCD40L was negtively correlated with PLT,APTT, PT,FIB and GFR levels of early-onset sPE group and late-onset sPE group, and positivelycorrelated with SP, hs-CRP, MPV, Cr and24h urine protein, the differences were statis-tically significant (P<0.01); while the control group with no obvious correlation, thedifference was not statistically significant (P>0.05).（7）Umbilical cord blood serum sCD40L level was negatively correlated with birthweight of early and late-onset severe preeclampsia group (P<0.01); while the control group with no obvious correlation (P>0.05).Conclusion（1）Peripheral blood and umbilical cord blood sCD40L expression levels ofsevere preeclampsia patients suggesting that they may be involved in the pathophysiolo-gical process of preeclampsia.（2）Hs-CRP levels were elevated in severe preeclampsia patients, suggests that infla-mmation may participate in the occurrence and development of preeclampsia.（3）Blood coagulation index changes was severe preeclampsia patients, suggests thatblood coagulation dysfunction may be associated with the pathogenesis of preeclampsia.（4）Elevated peripheral blood serum sCD40L levels of severe preeclampsia patientswere related with hs-CRP and blood coagulation function, suggest they may may be invo-lved in the immune and inflammation pathological physiological process.（5）Peripheral blood serum sCD40L was of great value in the diagnosis of severe pre-eclampsia, and when used to judge the severe preeclampsia, its sensitivity and specificdegree was better than hs-CRP. Combined determination of sCD40L, SP and determina-tion of24h urine protein can improve the sensitivity of early detection of severepreeclampsia.