摘要目的 观察正常妊娠时不同孕期血清补体C1 q、C3、C4、B因子的水平,评价血清补体C1q、C3、C4、B因子的水平对子痫前期(PE)的诊断价值以及对PE发生风险的预测价值.方法 于2017年1月至2018年3月选取北京大学第三医院妇产科3组病例.(1)回顾性选取正常妊娠8～14周、20～26周、28～36周孕妇共3组,每组30例,检测其血清补体C1q、C3、C4、B因子的水平并进行比较.(2)选取PE患者115例,包括早发轻度PE 17例、早发重度PE 47例、晚发轻度PE 24例、晚发重度PE 27例和早发组、晚发组同孕期正常妊娠对照各30例,通过方差分析及两两比较,评价血清补体C1q、C3、C4、B因子对PE的诊断价值.(3)通过214例前瞻性巢式病例对照研究,评价妊娠期妇女20～26周血清C1q、B因子的水平对PE发生风险的预测作用.结果 血清C1q水平在未孕及整个孕期保持稳定;C3、B因子水平在孕早期开始升高,孕中期后保持稳定;C4在孕早期升高,之后保持稳定.与对照组相比,4组PE患者血清补体C1q水平均明显降低(中位数分别为169 mg/L、161 mg/L、165 mg/L和163 mg/L;早发、晚发对照组分别为187 mg/L和194 mg/L;U值分别为130.500、426.500、159.500和130.500,P均<0.05);除早发轻度组(1275 mg/L)之外,其他3组患者的血清C3水平均较对照组明显下降(中位数分别为1170 mg/L、1323 mg/L和1223 mg/L;早发、晚发对照组分别为1438 mg/L和1434 mg/L;U值分别为379.000、246.000和160.000,P均<0.05);早发重度和晚发重度PE患者的血清C4水平均较对照组明显下降(中位数分别为140 mg/L和142 mg/L;早发、晚发对照组分别为223 mg/L和235 mg/L;U值分别为329.500、136.500,P均<0.001);早发三组之间、晚发三组之间,血清B因子水平差异均无统计学意义(早发轻、重度组中位数分别为332 mg/L、318 mg/L,早发同孕期对照组为312 mg/L;晚发轻、重度组分别为316 mg/L、314 mg/L,晚发同孕期对照组为303 mg/L;χ2分别为5.990、1.770,P均>0.05).214例具有PE危险因素的妊娠妇女,33例(15.4％)发展为PE.发生PE组的孕妇20～26周血清C1q、C3、C4、B因子水平与未发生PE组相比,差异无统计学意义(C1q:175 mg/L vs.184 mg/L;C3:1523 mg/L vs.1467 mg/L;C4:230 mg/L vs.229 mg/L;FB:344 mg/L vs.320 mg/L;U值分别为2090.000、1575.000、2058.500和1362.000,P均>0.05).发生PE组的孕妇20～26周血清C1q、C3、C4水平与同孕期健康孕妇相比,差异无统计学意义(C1q:175 mg/L vs.190 mg/L;C3:1523 mg/L vs.1428 mg/L;C4:230 mg/L vs.227 mg/L;U值分别为353.000、395.000和493.500,P均>0.05),但血清B因子水平与同孕期健康孕妇相比,差异有统计学意义(344 mg/L vs.306 mg/L;U值为233.500,P=0.007).结论 PE患者血清C1q水平明显降低,可作为PE诊断的潜在指标,但是孕20～26周血清C1q、C3、C4水平不能预测发生PE风险.血清B因子不能作为PE诊断的指标,但是PE患者孕20～26周的血清B因子较正常妊娠升高,提示B因子可能是一个潜在的预测指标.

abstractsObjective To observe the levels of serum complement C 1q, C3, C4 and factor B in different phases during normal pregnancy;To evaluate the diagnostic value and the predictive value of serum complement C1q, C3, C4 and factor B in preeclampsia (PE).Methods Three groups of subjectes were enrolled from January 2017 to March 2018 in Department of Obstetrics and Gynecology , Peking University Third Hospital.(1) 30 pregnant women in each group at 8-14 weeks, 20-26 weeks and 28-36 weeks were retrospectively selected , and the serum levels of complement C 1q, C3, C4 and B factors were measured and compared.(2)Selecting 17 cases of early-onset mild PE, 47 cases of early-onset severe PE, 24 cases of late-onset mild PE, 27 cases of late-onset severe PE, and 30 normal pregnant cases of the same gestational stage as early-onset /late-onset controls , through ANOVA analysis and comparison between two groups , this study evaluated the diagnostic value of serum complement C 1q, C3, C4 and factor B in PE.(3)To evaluate the predictive effect in PE, it analyzed serum C1q and factor B levels of pregnant women at 20-26 gestation weeks through prospective nested case-control study of 214 cases.Results The levels of serum C1q remained stable in the whole pregnancy .The levels of C3 and factor B increased at the early stage of pregnancy and remained stable after the middle stage .C4 increased early in pregnancy and then remained stable.Compared with the control group , the levels of serum C1q in all four types of PE patients were significantly decreased ( median: 169 mg/L, 161 mg/L, 165 mg/L, 163 mg/L;early-onset, late-onset control group:187 mg/L, 194 mg/L;U=130.500, 426.500, 159.500, 130.500, all P<0.05).Serum C3 levels of all the other three types of PE patients were significantly lower than those of the control groups (median:1170 mg/L, 1323 mg/L, 1223 mg/L;early-onset, late-onset control groups: 1438 mg/L, 1434 mg/L;U =379.000, 246.000, 160.000, all P <0.05 ), except for the early-onset mild PE (1275 mg/L).Serum C4 levels of patients with early/late onset severe PE were significantly lower than those of the control groups ( median: 140 mg/L, 142 mg/L;early-onset, late-onset control groups:223 mg/L, 235 mg/L;U =329.500, 136.500, both P <0.001 ) .Serum factor B levels showed no statistical difference among 3 early on-set groups or among 3 late on-set groups ( early-onset group median:332 mg/L,318 mg/L,early-onset control group 312 mg/L;late-onset group median:316 mg/L,314 mg/L, late-onset group 303 mg/L;χ2 =5.990, 1.77, all P>0.05).33 (15.4％) cases developed PE out of 214 pregnant women with PE risk factors .Compared to those who didn′t develop PE , it showed no statistical difference of serum C1q, C3, C4, and factor B levels at 20-26 gestational weeks of the women who subsequently developed PE ( C1q:175 mg/L vs.184 mg/L; C3:1523 mg/L vs.1467 mg/L; C4:230 mg/L vs.229 mg/L;FB:344 mg/L vs.320 mg/L;U=2090.000, 1575.000, 2058.500, 1362.000, all P>0.05).Compared to those of the healthy pregnant controls , it showed no statistical difference of serum C1q, C3 and C4 levels of 20-26 gestational weeks of the women who subsequently developed PE (C1q:175 mg/L vs.190 mg/L; C3:1523 mg/L vs.1428 mg/L; C4:230 mg/L vs.227 mg/L; U=353.000, 395.000, 493.500, all P >0.05),while it showed statistical difference (344 mg/L vs.306 mg/L;U=233.500, P=0.007) for factor B.Conclusions Serum C1q level of PE patients significantly decreased, which can be used as potential indicators of PE diagnosis , but serum C1q, C3, C4 level of 20-26 gestational weeks cannot predict risk of PE .Factor B cannot serve as serum index of PE diagnosis , but its serum levels at 20-26 gestational weeks werer higher than those of normal pregnant controls , factor B may be a potential predictor , but need further verification .