Relationship Between Plasma Amino Acid Metabolism And Hypertensive Disorder Complicating Pregnancy

Objective:To detect the plasma amino acid metabolism in patients with hypertensive disorders of pregnancy(HDOP),and to explore the difference and correlation between the plasma amino acid metabolism and that of healthy pregnant women,the levels of plasma amino acids in patients with HDOP were compared with the severity of hypertensive disorder complicating pregnancy.To determine whether amino acids and other risk factors are independent risk factors for hypertensive disorder complicating pregnancy and their predictive value for hypertensive disorder complicating pregnancy.To provide a theoretical basis for the prevention and intervention of HDOP.Methods:60 HDOP patients with gestational age greater than 20 weeks were enrolled in the 2021 from June to June 2022,and 40 healthy pregnant women with gestational age greater than 20 weeks were selected as the control group.Age,height,weight,body mass index(BMI),gestational age,number of births,blood pressure including systolic bleed pressure(SBP)and diastolic blood pressure(DBP),medication history,family history,triglyceride blood samples for Tg and TC,urine samples for random urine protein and 24-hour total urine protein were recorded.LC-MS/MS High-performance liquid chromatography tandem mass spectrometry was used to detect the plasma amino acid metabolism of HDOP group and healthy control group,the differences of plasma amino acid metabolism between the two groups were compared and analyzed.The patients with HDOP were divided into three groups:hypertensive disorder complicating pregnancy group(26 cases),preeclampsia group(20 cases),severe preeclampsia group(10 cases)and preeclampsia group(4 cases).Patients were divided into four groups according to the quartiles of plasma amino acid levels: Group A 1(130.21 μmol/L ≤ glutamate < 138.79 μmol/L),Group A 2(138.79μmol/L ≤ glutamate < 142.12 μmol/L),and Group A 3(142.12 μmol/L ≤ glutamate <168.69 μmol/L),group A(168.69 μmol/l ≤ glutamate < 171.54 μmol/L).The remaining amino acids were divided into B-H groups according to this method.Spearman correlation analysis was used to explore the correlation between the severity of pregnancy-induced hypertension and the level of plasma amino acids.To explore the influence of multiple factors on the occurrence of hypertensive disorder complicating pregnancy(PIH)and whether each factor is an independent factor according to binary Logistic regression.The predictive value of plasma amino acid level for HDOP was determined by ROC curve and AUC value.The association of amino acid levels with random urine protein,24-hour total urine protein,triglyceride and total cholesterol was analyzed by Minitab.Results:1.There were significant differences in gestational age,family history,systolic blood pressure,diastolic blood pressure,random urine protein and 24-hour urine protein between HDOP group and control group(p < 0.05).There were no significant differences in age,BMI,number of pregnancies,number of births,triglyceride and cholesterol.2.Compared with the control group,the plasma levels of glutamate,leucine,serine,threonine,tyrosine,Valine and alanine in the HDOP group were higher than those in the control group,while the plasma levels of arginine were lower than those in the control group,the difference was statistically significant(p < 0.05).There were no significant differences in L-Aspartic Acid,histidine and lysine levels.3.Spearman correlation analysis showed that the severity of HDOP was correlated with the level of amino acid metabolism.The metabolic levels of threonine,leucine,serine,tyrosine,valine and alanine were positively correlated with the severity of HDOP,however,there was a negative correlation between the metabolic level of glutamate(up-regulated)and arginine(down-regulated)(p < 0.05).4.Binary Logistic regression analysis showed that gestational age,family history,alanine and leucine were the risk factors of hypertensive disorder complicating pregnancy,alanine(or = 1.040)and leucine(or = 1.147)were still significantly different(p < 0.05),indicating that alanine and leucine could be the independent influencing factors of HDOP.5.The area under the curve of alanine ROC was 80.9%,and that under the curve of leucine ROC was 85.5%.The cut-off values of alanine Youden index and leucine were 396.74 μmol/L and 93.33 μmol/L,respectively(P < 0.05).6.Random urine protein in the HDOP group was positively correlated with serine,threonine,tyrosine and valine levels,and negatively correlated with arginine,L-Aspartic Acid and glutamate levels,the difference was statistically significant(p <0.05),but there was no significant correlation with the levels of histidine,lysine,alanine and leucine.The 24-hour urinary protein level was positively correlated with the levels of threonine,tyrosine and valine,and negatively correlated with the levels of arginine,L-Aspartic Acid and glutamic acid(p < 0.05),there was no significant correlation with the levels of alanine,leucine,histidine,lysine and serine.There was no significant correlation between TG,TC and amino acid level in blood samples of HDOP group.Conclusion:1.Plasma levels of L-Aspartic Acid,glutamate,leucine,serine,threonine,tyrosine,valine,alanine were increased and arginine was decreased in HDOP patients.The levels of glutamic acid,leucine,serine,tyrosine,valine and alanine were positively correlated with the severity of HDOP,while glutamic acid and arginine were negatively correlated.2.Tyrosine,threonine and valine were positively correlated with random urine protein and 24-hour urine protein,but negatively correlated with arginine,L-Aspartic Acid and glutamate.There was no correlation with alanine,leucine,histidine and lysine.3.Alanine and leucine were independent risk factors for HDOP.When alanine level was 396.74 μmol/L or leucine level was 93.33 μmol/L,it was a cut-in value for the diagnosis of HDOP,it had some clinical value in predicting HDOP(alanine sensitivity 73.7%,specificity 93.7%;leucine sensitivity 73.7%,specificity 87.5%).