摘要
目的探讨孕早期母体血清妊娠相关血浆蛋白-A(PAPP-A)、胎盘生长因子(PLGF)、同型半胱氨酸(Hcy)联合子宫动脉血流动力学指标、平均动脉压对子痫前期的预测价值。方法共有1142名孕妇在2020年9月1日—2021年9月30日在该院产科门诊建档而纳入研究,所有孕妇均在孕早期行血清PAPPA、PLGF、Hcy检验,并通过超声检查测定子宫动脉搏动指数(Ut API-),常规测量孕妇血压,并计算平均动脉压(MAP),随访并依据孕妇孕期是否发生子痫前期(PE)分为病例组(n=81例)和对照组(n=1061例),对比分析二组孕早期的血清PAPP-A、PLGF、Hcy及Ut API-、MAP差异,通过绘制受试者工作特征曲线(ROC曲线)分析各指标单用与联用对PE的预测效能。结果与对照组相比,病例组的血清PAPP-A、PLGF的MOM值更低,Hcy、Ut API-、MAP的MOM值更高(P<0.05)。ROC曲线显示血清PAPP-A、PLGF、Hcy,以及Ut API-、MAP单用对PE均有一定的预测价值,其中PLGF单用预测PE的AUC值最高(0.782),其次为PAPP-A(0.750),再次为Ut API-(0.735),Hcy和MAP的AUC值相对低一些,分别为0.692和0.652。多项指标联合预测PE的ROC曲线显示:PAPP-A+PLGF+Hcy预测PE的AUC值为0.887,敏感度、特异度分别为86.58%和80.33%,Ut API+MAP-预测PE的AUC值为0.786,敏感度、特异度分别为70.35%和78.54%,五项联合预测PE的AUC值为0.921,敏感度、特异度分别为82.34%和91.49%。相比血清学指标联合和Ut API+MAP-联合,五项联合对PE的预测特异度明显提高(P<0.05)。结论孕早期进行母体血清PAPP-A、PLGF、Hcy检测,并联合Ut API+MAP-可有效预测子痫前期的发生。
Objective To investigate the predictive value of maternal serum PAPP-A,PLGF,Hcy and uterine artery hemodynamics in preeclampsia.Methods A total of one thousand,one hundred and forty-two pregnant women were enrolled in the study from September 1,2020 to September 30,2021 at our obstetric clinic.Serum PAPP-A,PLGF and Hcy were detected in all pregnant women in early pregnancy,and uterine artery hemodynamic indexes by ultrasound and MAP were detected as well.According to the occurrence of PE,they were divided into case group(81 cases)and control group(1169 cases).The differences of PAPP-A,PLGF,Hcy,UtA-PI and MAP between the two groups were compared and analyzed.Results Compared with the control group,the MOM values of PAPP-A and PIGF in the case group were lower,and the mom values of Hcy,UtAPI and map were higher(P<0.05).ROC curve showed that serum PAPP-A,PLGF,Hcy,UtA-PI and MAP alone had certain predictive value for PE.The AUC value of PLGF alone in predicting PE was the highest(0.782),followed by PAPP-A(0.750),and UtA-PI(0.735).The AUC values of Hcy and MAP were relatively lower(0.692 and 0.652,respectively).The ROC curve showed that the AUC value of PAPP-A+PIGF+Hcy was 0.887,the sensitivity and specificity were 86.58%and 80.33%respectively.The AUC of UtA-PI+MAP was 0.786,the sensitivity and specificity were 70.35%and 78.54%,respectively.The AUC value of the five indexes was 0.921,the sensitivity and specificity were 82.34%and 91.49%respectively.Compared with the combination of serological indexes and uterine artery hemodynamic indexes,the diagnostic specificity of the combination of the five indexes for PE was significantly improved(P<0.05).Conclusion Maternal serum PAPP-A,PLGF,Hcy detection in early pregnancy,combined with UtA-PI and MAP can effectively predict the occurrence of preeclampsia.
作者
郭敏
胡小娜
杨玉侠
熊杰
GUO Min;HU Xiaona;YANG Yuxia;XIONG Jie(Depart-ment of Obstetrics,Tangshan Maternal and Child Health Hospital,Tangshan 063000,China)
出处
《中国煤炭工业医学杂志》
2023年第3期234-239,共6页
Chinese Journal of Coal Industry Medicine
基金
河北省2023年度医学科学研究课题计划(编号:20231747)。
