妊娠中、晚期血清瘦素、β-hCG及ADAM12水平的变化及其与子痫前期发生的关系  

Maternal Serum Leptin,β-hCG ADAM12 Levels between Second and Third Trimester of Pregnancies and Prediction of Preeclampsia

作　　者：颜建英[1] 林元[1] 张东妹[1] 崔小妹[1] 刘青闽[1] 陈素清[1] 黄晓燕[1] 宋建榕[1] 薛慧丰[1] 

机构地区：[1]福建医科大学福建省妇幼保健院教学医院妇产科,福建省福州市350001

出　　处：《国际妇产科学杂志》2013年第6期517-520,533,共5页Journal of International Obstetrics and Gynecology

基　　金：福建省自然科学基金(2012J01313)

摘　　要：目的：探讨妊娠中、晚期妇女血清瘦素、人绒毛膜促性腺激素β亚单位（β-hCG）及解整合素-金属蛋白酶12（ADAM12）的水平变化及这些指标对子痫前期（PE）发生的预测价值.方法：选择2007年6月-2008年5月在福建省妇幼保健院定期产检和住院分娩的189例妊娠妇女,分别测定妊娠中期（20～24周）和妊娠晚期（30～34周）血清瘦素、β-hCG、ADAM12的浓度,其中25例发展为PE者为病例组,164例正常妊娠者为正常组.根据受试者工作特征（ROC）曲线确定预测界限值.结果：①妊娠中期病例组血清β-hCG、ADAM12浓度显著高于正常组（P＜0.001）.②妊娠晚期病例组血清瘦素、β-hCG、ADAM12浓度明显高于正常组（P＜0.001）.③病例组妊娠晚期血清瘦素、β-hCG及ADAM12水平均较妊娠中期升高（P＜0.05）,正常组妊娠晚期血清瘦素水平较妊娠中期升高（P＜0.001）,而血清β-hCG与ADAM12水平2组间差异无统计学意义（P＞0.05）.④妊娠中期以血清β-hCG≥32 μg/L、血清ADAM12≥818 μg/L为预测界值,两者联合阳性预测值为82.61%,高于单项阳性预测值（P＜0.05）.两者联合ROC曲线下面积与单项ROC曲线下面积比较差异无统计学意义（P＞0.05）.⑤妊娠晚期以血清瘦素≥23 μg/L、血清β-hCG≥37 μg/L及血清ADAM12≥900 μg/L为预测界值,三者联合阳性预测值达92.31%,高于单项阳性预测值（P＜0.05）.三者联合ROC曲线下面积大于单项β-hCG及瘦素ROC曲线下面积（P＜0.05）,但与单项ADAM12曲线下面积差异无统计学意义（P＜0.05）.⑥联合妊娠中、晚期血清β-hCG预测PE发生的阳性率为81.25%;联合妊娠中、晚期血清ADAM12预测PE发生的阳性率为90.48%,均比单一指标的阳性预测值高.结论：检测妊娠中、晚期妇女血清β-hCG及ADAM12水平可作为PE发生的有效预测指标;联合多项指标并动态监测可进一步提高对PE发生的阳性预测值及准确率.Objective：To examine maternal serum concentrations of leptin,beta-human chorionic gonadotropin （β-hCG） and ADAM12 between second and third trimester of pregnancy, and investigate whether an appropriate combination of those markers may be an effective means of screening for preeclampsia （PE）. Methods：Samples from 189 pregnant women who presented to Fujian Maternity and Child Health Hospital for prenatal care from June 2007 to May 2008 were included in this prospective study,of which 25 were subsequently developed PE as case group and 164 were normal pregnant women as control group. The maternal serum was conducted between their second（between 20th to 24th week of pregnancy） and third（between 30th to 34th week of pregnancy） trimester of pregnancy. The cutoff point was determined using a receiver operating characteristic curve. Results： ①The second trimester level of serum β-hCG and ADAM 12 in case group were significantly higher than normal group （P〈0.001）.②The third trimester level of serum leptin, β-hCG and ADAM12 in case group were significantly higher than normal group （P〈 0.001 ）.③ The third trimester level of serum leptin, β-hCG and ADAM 12 in case group were significantly higher than their second trimester level （P〈 0.05）. The third trimester level of serum leptin in normal group was significantly higher than their second trimester level （P〈0.001）. ④The cutoff concentration of β-hCG was 32 μg/L and ADAM12 was 818 μg/L in second trimester of pregnancies. Combining the values of β-hCG and ADAM12 to form a screening test would detect an estimated 82.61% of affected pregnancies. There was no statistically significant difference between combining β-hCG and ADAM 12 AUC and single β-hCG or ADAM 12 AUC （P〉 0.05 ）.⑤The cutoff concentration of leptin was 23 μg/L, β-hCG was 37 μg/L and ADAM 12 was 900μg/L in the third trimester of pregnancies. Combining the values of leptin, β-hCG and ADAM12 to form a screening test would detect an estimated 9

关 键 词：先兆子痫 瘦素 绒毛膜促性腺激素 β亚单位 人 妊娠中期 妊娠末期 

分 类 号：R714.245[医药卫生—妇产科学]