Study On The Correlation Between Pregnancy-related Protein A And Carotid Artery Stiffness In Patients With Severe Preeclampsia

Objective:Combined with carotid artery ultrasound and QIMT technique,we assess carotid artery wall stiffness and investigate its association with the PAPP-A level in sufferers with SPE.Our study aimed to identify likely elements for incipient lesions in carotid artery elasticity in patients with SPE.Methods:Pregnant females who consulted the First Hospital of Shanxi Medical University were included as the research subjects from October 2019 to December 2021.The case group was 59 patients diagnosed with severe preeclampsia,with an average age of(30.14±4.43)years.The control group was 42 pregnant women with normal pregnancies,whose age and gestational weeks matched the case group,and the average age was(28.71±3.32)years.We performed bilateral carotid artery ultrasound for all subjects.We measured the Ds,Dd,and IMT in the middle of the bilateral common carotid artery.Furthermore,we calculated the stiffness index of the carotid artery wall,including the carotid artery dilation coefficient(DC),stiffness index(SI),and Young’s modulus of elasticity(YEM).All study subjects’ general clinical data and medical history were recorded and reviewed.We asked participants to fast for more than 12 hours.Also,a blood sample is collected early morning on the ultrasound day to measure serum PAPP-A levels.The differences between the above two groups were compared.And we used bivariate correlation analysis of the carotid vascular wall stiffness index with general clinical data,PAPP-A,IMT,Ds,and Dd.Use multiple linear regression for further research.Results:(1)The SPE group had greater physique weight,body mass index,SBP,DBP,gestational times,and parity frequency in the SPE patients were more remarkable than the NP group(all P<0.05).We found no significant difference in age,height,heart rate,and gestational weeks for both study subjects(all P>0.05).(2)The SPE group had more increasing measurements of PAPP-A than the NP group.(P<0.05).(3)Treatment in the SPE group and comparison with pregnancy complications in both group: 22 patients(37.3%)in the SPE group received antihypertensive and antispasmolytic therapy.In the SPE group,19 cases(32.2%)had gestational diabetes,27patients(45.8%)of subclinical hypothyroidism,and 19 instances(32.2%)of mild anemia substantially differed from the NP group(all P<0.05).At the same time,the remaining pregnancy complications(renal dysfunction,hypoproteinemia,liver dysfunction,HELLP syndrome)were not significantly different(all P>0.05).(4)The left and right carotid artery IMT,Ds,Dd,and carotid artery wall stiffness indexes were not significantly compared(all P>0.05).The right side carotid artery parameters of the SPE group and NP group were compared: except for the DC lower than the NP group,the other parameters SPE group were higher than the NP group(all P<0.05).The SI levels of the two groups have been now not notably distinctive(P>0.05).(5)In the SPE group,DC positively correlates with PAPP-A,diastolic blood pressure,and hypertension duration of pregnancy(r values have been 0.314,0.318,0.279,all P<0.05),and negatively correlates with age(r value was-0.355,P<0.01);YEM has negatively correlates with PAPP-A,IMT,diastolic blood pressure,and hypertension pregnancy duration(r values have been-0.277,-0.394,-0.421,-0.259,all P<0.05),positively correlates with Dd and age(r values were 0.339 and 0.268,all P<0.05).(6)The values of "receiving antihypertensive and antispasmolytic therapy," "complicated with gestational diabetes," "with mild anemia," "with subclinical hypothyroidism," and "combined with hypoproteinemia" were assigned to 1.Those who did not receive antihypertensive and antispasmolytic therapy and had no pregnancy complications were assigned a value of 0.Multiple linear regression analysis showed that in the SPE group,the independent influencing elements of DC were PAPP-A,age,diastolic blood pressure,as well as the persistence time of hypertension(β values were 0.331,-0.322,0.254,0.278,all P<0.05),while the independent influencing elements of YEM were PAPP-A,diastolic blood pressure,Dd,and the persistence time of hypertension(β values were-0.384,-0.383,0.342,and-0.305,all P<0.01).Conclusion:In patients with severe preeclampsia,carotid artery dilation decreased,tube wall stiffness increased,DC positively correlated with PAPP-A,and YEM negatively correlated with PAPP-A.For patients suffering from severe preeclampsia,PAPP-A is one of the influencing elements of early carotid artery elastic changes.