Journal of Developmental Medicine(Electronic Version)  2025, Vol. 13 Issue (2): 120-127 DOI: 10.3969/j.issn.2095-5340.2025.02.007 |
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| Evaluation of preeclampsia severity and the risk of maternal and fetal complications based on serum sTNFR-Ⅱ and thromboelastography |
| Lou Juan, Gu Chengmin, Li Yang,et al
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Department of Obstetrics, Maternal and Child Care Center of Qinhuangdao, Hebei, Qinhuangdao 066000, China
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Abstract 【Abstract】 Objective To evaluate the severity of preeclampsia and the risk of maternal and fetal
complications based on serum soluble tumor necrosis factor receptor (sTNFR)-Ⅱ and thrombelastography
(TEG), and provide a favorable reference for improving the prognosis of preeclampsia patients.
Method Seventy pregnant women with preeclampsia who were admitted to the Maternal and Child Care
Center of Qinhuangdao from March 2020 to January 2023 by retrospective study, which were selected
and divided into non-severe preeclampsia group (n=38) and severe preeclampsia group (n=32) based
on the severity of their condition. Additionally, 70 pregnant women with gestational hypertension in the
third trimester (gestational hypertension group) and 70 normal pregnant women in the third trimester
(normal pregnancy group) were also selected as controls. After enrollment, serum levels of sTNFR-II were
measured, and TEG parameters [rate of hemagglutination formation (α angle), coagulation reaction time
(R), coagulation index (CI), blood clot formation time (K), and blood clots maximum amplitude (MA)] were
assessed. Follow-up visits were conducted until the end of pregnancy to monitor the condition of the pregnant women and perinatal complications. The serum sTNFR-Ⅱ levels and TEG parameters were compared among the four groups, and the relationship between serum sTNFR-Ⅱ, TEG parameters, and coagulation indicators of preeclampsia was analyzed. The serum sTNFR-Ⅱand TEG parameters were compared among patients with different prognoses, and the impact of serum sTNFR-Ⅱ and TEG parameters on the diagnosis of maternal and fetal complications and their relationship with maternal and fetal complications were analyzed. Statistical methods included one-way analysis of variance, t-test, χ2 test, and Spearman correlation analysis to describe the correlation between variables. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of TEG parameters for maternal and fetal complications, and risk degree analysis was conducted to explore the relationship between TEG parameters and maternal and fetal complications. Result Serum sTNFR-Ⅱ, α angle, CI and MA in severe preeclampsia group were higher than those in non-severe preeclampsia group, gestational hypertension group and normal pregnancy group, with statistical significance (all P<0.05); The R and K of severe preeclampsia group were lower than those of non-severe preeclampsia group, gestational hypertension group and normal pregnancy group, and the differences were statistically significant (all P<0.05). Serum sTNFR-Ⅱ, TEG parameters α angle, CI, and MA showed a positive correlation with the severity of preeclampsia (r=0.681, 0.584, 0.734, 0.610, respectively; all
P<0.05). R and K values showed a negative correlation with the severity of preeclampsia (r=-0.602, -0.557,respectively; all P<0.05). The incidence of maternal and fetal complications in severe preeclampsia group was higher than that in non-severe preeclampsia group [56.25% (18/32) vs 26.32% (10/38), χ2=6.486, P<0.05]; the serum sTNFR-Ⅱ, α angle, CI and MA in preeclampsia patients with maternal and fetal complications were higher than in those without maternal and fetal complications (all P<0.05). The R and K of preeclampsia patients with maternal and fetal complications were lower than those of patients without maternal and fetal complications (P<0.05). The area under the curve (AUC) values of serum sTNFR-II, α angle, R, CI, K, and MA combined detection for predicting maternal and fetal complications in preeclampsia were the highest, at 0.950 (95% CI: 0.870-0.988) (P<0.05). The relative risk ratio of maternal and fetal complications caused by serum sTNFR-II, α angle, R, CI, K, and MA were 3.240 (95% CI: 1.780-5.897), 2.632 (95% CI: 1.384-5.003), 2.356 (95% CI: 1.381-4.023), 0.326 (95% CI: 0.184-0.578), 4.933 (95% CI: 2.108-11.543), and 0.338(95% CI: 0.175-0.653), respectively (all P<0.001). Conclusion There are significant differences in serum sTNFR-II and TEG parameters in different degrees of preeclampsia, and serum sTNFR-II, α angle, R, CI,K, and MA are closely associated with the severity of preeclampsia. Combined detection has high predictive value for maternal and fetal complications in preeclampsia, and has practical guidance for clinical evaluation of preeclampsia severity and reduction of maternal and fetal complications.
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Received: 08 November 2023
Published: 02 April 2025
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