| Objective To explore the clinical value of serum endothelial cell-specific molecule-1(ESM-1) combined with soluble vascular endothelial growth factor receptor-1(sFlt-1) in predicting the pregnancy outcome of gestational hypertension patients, with a view to providing a reference for timely intervention and improving pregnancy outcomes in clinical practice. Methods A total of 160 patients with hypertensive disorder complicating pregnancy in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei Province from January 2023 to June 2024 were selected. All patients were given individualized treatment and followed up to delivery. The levels of serum ESM-1 and sFlt-1 in patients with different pregnancy outcomes were compared. According to the median levels of serum ESM-1 and sFlt-1, they were divided into the low ESM-1 subgroup(n=80) and high ESM-1 subgroup(n=80), low sFlt-1 subgroup(n=80) and high sFlt-1 subgroup(n=80). The clinical data and pregnancy outcomes were compared in different serum ESM-1 and sFlt-1 subgroups. The relationship between serum ESM-1 and sFlt-1 levels and pregnancy outcomes was analyzed using logistic regression analysis. The predictive value of serum ESM-1 and sFlt-1 for pregnancy outcomes was analyzed using receiver operating characteristic(ROC) curve analysis. Results The levels of serum ESM-1 and sFlt-1 in patients with poor pregnancy outcomes were higher than those in patients with good pregnancy outcomes(P<0.05).There were significant differences in pre-pregnancy BMI, SBP, DBP, and disease severity between the low ESM-1 subgroup and the high ESM-1 subgroup, as well as between the low sFlt-1 subgroup and the high sFlt-1 subgroup(P<0.05). The rate of adverse pregnancy outcomes in the high ESM-1 subgroup was higher than that in the low ESM-1 subgroup, and the rate of adverse pregnancy outcomes in the high sFlt-1 subgroup was higher than that in the low sFlt-1 subgroup(P<0.05). Both serum ESM-1 and sFlt-1 were independent risk factors for pregnancy outcome(P<0.05); high ESM-1, sFlt-1, and high ESM-1×high sFlt-1 were independent risk factors for pregnancy outcome(P<0.05), and the interaction between high ESM-1 and high sFlt-1 showed a positive interaction in pregnancy outcome before and after adjusting for other factors(interaction index=1.391, 1.419)(P<0.05). The AUC of serum ESM-1 and sFlt-1 for predicting pregnancy outcome was 0.754 and 0.749, respectively, with the best cutoff values of 1.87 μg/L and 1 954.71 pg/mL. The sensitivity was 70.27% and 67.57%, respectively, and the specificity was 70.73% and 74.80%, respectively. Based on model 2, a combined prediction model for serum ESM-1 and sFlt-1 was constructed [Log(P)=-0.157+0.367×ESM-1+0.373×sFlt-1], and the AUC for predicting pregnancy outcome was 0.887, with a sensitivity of 81.08% and a specificity of 86.99%. This indicated that the combined prediction value was significantly better than the individual prediction value(Z=2.596, 2.241, P=0.009, 0.025). Conclusion Serum ESM-1 and sFlt-1 are closely related to the pregnancy outcome of patients with gestational hypertension, providing a reference for early clinical prediction of pregnancy outcome and targeted intervention plans for patients with gestational hypertension, in order to improve pregnancy outcome.. |
