Analysis On The Difference Of Fetal Lung Maturity Among GDM,PE And GDM Complicated With PE By SP-A,SP-B,PI And RI

Objective:(1)To comparing the differences of pulmonary surfactant protein A,B(SP-A,SP-B)of fetal umbilical cord blood,pulsation index(PI),resistance index(RI)of fetal pulmonary arteries and the incidences of neonatal respiratory distress syndrome(NRDS)in pregnant women with gestational diabetes mellitus(GDM),preeclampsia(PE)and gestational diabetes mellitus complicated with preeclampsia.(2)To explore the various levels of SP-A,SP-B,PI and RI,and confirm their values and significances in the evaluation of fetal lung maturity(FLM).Methods:The clinical data of patients with GDM,PE and GDM complicated with PE treated at the Second Hospital of Jilin University from January 2018 to October 2019 were selected.GDM group had 61 cases,divided into three groups according to gestational age: after gestational age 37 weeks(N=41),gestational age ranged from 35 to 37 weeks(N=10)and less than gestational age 35 weeks(N=10),and the numbers of NRDS were respectively 0,1 and 6.PE group had 43 cases,divided into three groups according to gestational age: after gestational age 37 weeks(N=22),gestational age ranged from 35 to 37 weeks(N=9)and less than gestational age 35 weeks(N=12),and the numbers of NRDS were respectively 0,2 and 3.GDM complicated with PE group had 33 cases,divided into three groups according to gestational age: after gestational age 37 weeks(N=14),gestational age ranged from 35 to 37 weeks(N=10)and less than gestational age 35 weeks(N=9),and the numbers of NRDS were respectively 1,1 and 6.73 healthy pregnant women,who were hospitalized and delivered at the same time,were randomly selected as the control group and divided into three groups according to gestational age: after gestational age 37 weeks(N=49),gestational age ranged from 35 to 37 weeks(N=11)and less than gestational age 35 weeks(N=13),and the numbers of NRDS were respectively 0,1 and 8.We could use ultrasonic doppler to measure fetal pulmonary PI and RI in a week before delivery and obtain fetal pulmonary cord venous blood at birth.The concentrations of SP-A and SP-B in cord blood were determined by enzyme-linked immunosorbent assay(ELISA).The incidences of NRDS in newborns after delivery were recorded.The distinctions of parameters in different groups under the same gestational weeks and different gestational weeks in the same group,values and significances in the evaluation of FLM were studied.Results:1.Comparison of parameters at different gestational ages in normal groupsKruskal-Wallis H showed that there were significant differences in levels of SP-A,SP-B and PI among after gestational age 37 weeks group,gestational age ranged from 35 to 37 weeks group and less than gestational age 35 weeks group(P<0.05,P<0.05,P<0.05).Wilcoxon showed that the levels of SP-A and SP-B in less than gestational age 35 weeks group were obviously lower than gestational age ranged from 35 to 37 weeks group and after gestational age 37 weeks group(P'<0.0167).The levels of PI in less than gestational age 35 weeks group were obviously higher than gestational age ranged from 35 to 37 weeks group and after gestational age 37 weeks group(P'<0.0167).By one way ANOVA,we could find the obvious differences in RI among the three groups(P<0.05),and the levels of RI in less than gestational age 35 weeks group were obviously higher than gestational age ranged from 35 to 37 weeks group and after gestational age 37 weeks group(P'< 0.0167).There was significant difference in the incidence of NRDS among the three groups by chi-square test(P<0.05).Less than gestational age 35 weeks group was obviously higher than gestational age ranged from 35 to 37 weeks group and after gestational age 37 weeks group(P'<0.0167).There was no difference in levels of SP-A,SP-B,PI,RI and incidence of NRDS between gestational age ranged from 35 to 37 weeks group and after gestational age 37 weeks group(P'>0.0167).2.Comparison of parameters of different gestational ages in GDM groupKruskal-Wallis H showed that there were significant differences in levels of SP-A,SP-B,PI and RI among after gestational age 37 weeks group,gestational age ranged from 35 to 37 weeks group and less than gestational age 35 weeks group(P<0.05,P<0.05,P<0.05,P<0.05).Wilcoxon showed that the levels of SP-A and SP-B in less than gestational age 35 weeks group were obviously lower than gestational age ranged from 35 to 37 weeks group and after gestational age 37 weeks group(P'<0.0167);there was no difference in the levels of SP-A and SP-B between gestational age ranged from 35 to 37 weeks group and after gestational age 37 weeks group(P'>0.0167).The levels of PI and RI in less than gestational age 35 weeks group and gestational age ranged from 35 to 37 weeks group were obviously higher than after gestational age 37 weeks group(P'<0.0167);there was no difference between less than gestational age 35 weeks group and gestational age ranged from 35 to 37 weeks group(P'>0.0167).There was significant difference in the incidence of NRDS among the three groups by chi-square test(P<0.05).Less than gestational age 35 weeks group was obviously higher than gestational age ranged from 35 to 37 weeks group and after gestational age 37 weeks group(P'<0.0167).There was no difference in the incidences of NRDS between gestational age ranged from 35 to 37 weeks group and after gestational age 37 weeks group(P'>0.0167).3.Comparison of parameters of different gestational ages in PE groupKruskal-Wallis H showed that there was no difference in levels of SP-A,SP-B,PI and RI among after gestational age 37 weeks group,gestational age ranged from 35 to 37 weeks group and less than gestational age 35 weeks group(P>0.05,P>0.05,P>0.05,P>0.05).There was no difference in the incidence of NRDS among the three groups by chi-square test(P>0.05).4.Comparison of parameters in different gestational ages in GDM complicated with PE groupKruskal-Wallis H showed that there were significant differences in levels of SP-A,SP-B,PI and RI among after gestational age 37 weeks group,gestational age ranged from 35 to 37 weeks group and less than gestational age 35 weeks group(P<0.05,P<0.05,P<0.05,P<0.05).Wilcoxon showed that the levels of SP-A and SP-B in less than gestational age 35 weeks group were obviously lower than gestational age ranged from 35 to 37 weeks group and after gestational age 37 weeks group(P'<0.0167);there was no difference between gestational age ranged from 35 to 37 weeks group and after gestational age 37 weeks group(P'>0.0167).The levels of PI and RI in less than gestational age 35 weeks group and gestational age ranged from 35 to 37 weeks group were obviously higher than after gestational age 37 weeks group(P'<0.0167);there was no difference between less than gestational age 35 weeks group and gestational age ranged from 35 to 37 weeks group(P'>0.0167).There was significant difference in the incidence of NRDS among the three groups by chi-square test(P<0.05).Less than gestational age 35 weeks group was obviously higher than gestational age ranged from 35 to 37 weeks group and after gestational age 37 weeks group(P'<0.0167).There was no difference in the incidences of NRDS between gestational age ranged from 35 to 37 weeks group and after gestational age 37 weeks group(P'>0.0167).5.Comparison of parameters among four groups in the same gestational ageThere was no difference in the levels of SP-A and SP-B with after gestational age 37 weeks group among control group,GDM group,PE group and GDM complicated with PE group by Kruskal-Wallis H test(P>0.05,P>0.05).Similarly,there was no difference in PI,RI,and the incidences of NRDS(P>0.05,P>0.05,P>0.05).There was no significant difference in the levels of SP-A and SP-B with gestational age ranged from 35 to 37 weeks group among control group,GDM group,PE group and GDM complicated with PE group by one way ANOVA(P>0.05,P>0.05).Kruskal-Wallis H showed that there was no difference in levels of PI in four groups(P>0.05)and there were significant differences in levels of RI in four groups(P<0.05).Wilcoxon showed that the levels of RI in GDM complicated with PE group were higher than control group(P'<0.0083),and there was no difference among the other groups(P'>0.0083).There was no difference in the incidences of NRDS among four groups(P>0.05).There were significant differences in the levels of SP-A and SP-B with less than gestational age 35 weeks group among control group,GDM group,PE group and GDM complicated with PE group by Kruskal-Wallis H(P<0.05,P<0.05).Wilcoxon showed that the levels of SP-A and SP-B in the PE group were higher than control group and GDM group(P'<0.0083),no difference among the other groups(P'>0.0083).Kruskal-Wallis H showed that there was no difference in levels of PI and RI in four groups(P>0.05,P>0.05).There was no difference in the incidences of NRDS among four groups(P>0.05).Conclusion:1.The levels of SP-A and SP-B in umbilical cord blood of normal pregnant women,GDM and GDM complicated with PE were related to gestational ages.The smaller of gestational ages,the less the level.Uniformly,the levels of PI and RI also related the gestational ages.The smaller of gestational ages,the larger the data,which indicated that the fetal lungs were more immature.2.There was no difference in fetal lung development among different gestational ages of pregnancy in patients with PE,which may be related to the state of high intrauterine pressure in patients with PE and promoting the early maturation of fetal lungs.3.There was no difference in the levels of PI,RI and NRDS among healthy pregnant women,GDM,PE,and GDM complicated with PE.Considering concentrations of SP-A and SP-B,only in less than gestational age 35 weeks,the levels in PE group were higher than that in normal group and GDM group,indicating that there was no difference in FLM among four groups.The intrauterine state of high pressure in patients with preeclampsia may have a "promoting" effect on pulmonary surfactant protein,however,this effect was too slight to cause the difference of fetal lung maturity among four groups.