抑制素A、激活素A、胎盘生长因子及子宫动脉搏动指数联合预测子痫前期的研究  

Inhibin A、 Activin A、 Placental Growth Factor and Uterine Artery Doppler Pulsatility Index in the Prediction of Pre-eclampsia

作　　者：郁君[1] 史夏琛子[1] 武羿[1] 段涛[1] 

机构地区：[1]同济大学附属第一妇婴保健院,上海200040

出　　处：《中国产前诊断杂志（电子版）》2011年第3期7-14,共8页Chinese Journal of Prenatal Diagnosis(Electronic Version)

摘　　要：目的本文通过检测孕12～16周孕妇血清中抑制素A、激活素A和胎盘生长因子,联合孕中期多普勒超声测定子宫动脉搏动指数(PI),来评价4个指标单独或联合预测子痫前期的价值。方法选取符合条件的于上海市第一妇婴保健院正规产检的孕妇组成队列,在12～16周时采集静脉血,储存于-70℃冰箱内以备检测。队列中出现子痫前期病例后,根据孕周和储血时间于同一队列中选取正常孕妇作为对照组,收集完病例与对照组,利用ELISA方法检测2组的抑制素A、激活素A和胎盘生长因子的浓度。所有孕妇于22～24周行子宫动脉多普勒检查测定PI值。4个指标的结果转化为MoM值,利用统计学方法比较4个指标的组间差异,及接受者工作特征曲线(ROC曲线)和多变量Logistic回归评价4个指标单独及联合后对子痫前期的预测价值。结果随访过程中子痫前期发病31例,对照组有93例。对照组和病例组平均PI的平均MoM值分别为1.02±0.25和1.45±0.31(P<0.001)。抑制素A的平均MoM值为1.08±0.43和1.57±0.34(P<0.001)。激活素A的平均MoM值为1.06±0.42和1.68±0.38(P<0.001)。胎盘生长因子的平均MoM值为1.00±0.26和0.69±0.23(P<0.001)。分别作出抑制素A、激活素A、胎盘生长因子和子宫动脉平均PI的ROC曲线,曲线下面积(AUC)分别为0.796(95%CI,0.712～0.880;P<0.01),0.823(95%CI,0.746～0.899;P<0.01),0.831(95%CI,0.752～0.910;P<0.01)及0.851(95%CI,0.783～0.920;P<0.01)。Logistic回归分析后得出几个指标联合后的ROC曲线。抑制素A、激活素A和PI的曲线下面积为0.907(95%CI,0.830～0.938;P<0.01),特异度为80%时,敏感度为82%。激活素A、胎盘生长因子和PI的曲线下面积为0.925(95%CI,0.852～0.978;P<0.01),特异度为80%时,敏感度为90%。4个指标联合后,曲线下面积为0.941(95%CI,0.891～0.990;P<0.01),特异度为80%时,敏感度为93%。结论在中孕期的早期,子痫前期的母体血清的激活素A、抑制素A、胎盘生长因子�Objective To evaluate whether the measurement of maternal serum inhibin A, activin A and placental growth factor (PlGF) at 12 + 0 to 16 + 0 weeks of gestation alone or in combination with second-trimester uterine artery Doppler pulsatility index (PI) is useful in predicting pre-eclampsia. Methods This was a case-control study of pre-eclampsia. From pregnant women attending their first antenatal examination at 12-16 weeks we collected serum samples and stored them at -70 ℃. All patients also underwent uterine artery Doppler examination to measure the PI at 22-24 weeks’ gestation. We retrieved for analysis frozen samples from women who then developed pre-eclampsia, as well as three control samples per woman, matched for gestational age and storage time. Inhibin A, activin A and PlGF were measured using an enzyme-linked immunosorbent assay (ELISA) by an examiner who was blinded to the pregnancy outcome. Results There were 31 cases with pre-eclampsia and 93 controls. Second-trimester uterine artery PI and marker levels were expressed as median multiples of the median (MoM). The uterine artery PI was increased in pregnancies with pre-eclampsia compared with controls (mean±SD, 1.45±0.31 MoM vs. 1.02±0.25 MoM, P<0.01), as were the level of inhibin A (mean±SD, 1.57±0.34 MoM vs. 1.08±0.43, P<0.001) and the level of activin A (mean±SD, 1.68±0.38 MoM vs. 1.06±0.42 MoM, P<0.001). The level of PlGF was decreased in pre-eclampsia compared with controls (mean±SD, 0.69±0.23 MoM vs. 1.00±0.26 MoM, P<0.001). Receiver-operating characteristics curves were analyzed for controls and cases and areas under the curve (AUC) were 0.796 (95% CI, 0.712~0.880, P<0.01) for inhibin A, 0.823 (95% CI, 0.746~0.899, P<0.01) for activin A, 0.831 (95% CI, 0.752~0.910, P<0.01) for PlGF and 0.851 (95% CI, 0.783~0.920, P<0.01) for uterine artery PI. The combination of activin A, inhibin A and PI using logistic regression analysis yielded an AUC of 0.907 (95% CI, 0.830~0.938, P<0.01) with a sensitivity of 82% and a specificity of 80%. Th

关 键 词：子痫前期 筛查 抑制素A 激活素A 胎盘生长因子 子宫动脉 

分 类 号：R714.245[医药卫生—妇产科学]