妊娠中期β-hCG、AFP及uE_3对子痫前期及胎儿生长受限的预测价值  

The predictive value of maternal second trimester β-hCG,AFP and uE_3 in preeclampsia and fetal growth restriction

作　　者：刘静芳[1] 赵凯萍 王雪卿[1] 孙丽芳[1] 吕艳伟[3] 

机构地区：[1]北京积水潭医院北京大学第四临床医院妇产科,100035 [2]北京积水潭医院北京大学第四临床医院病案统计科,100035 [3]北京积水潭医院北京大学第四临床医院临床流行病学研究室,100035

出　　处：《中国妇产科临床杂志》2016年第4期347-350,共4页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探究唐氏筛查血清标志物水平与子痫前期（preeclampsia,PE）及胎儿生长受限（fetal growth restriction,FGR）发病的相关性,了解妊娠中期血清绒毛膜促性腺激素β亚单位（freeβ-human chorionic gonadotropin,β-hCG）、甲胎蛋白（alpha fetoprotein,AFP）及游离雌三醇（unconjugated estriol,uE3）三种因子单独及联合对PE及FGR发病的预测价值。方法回顾性分析本院2013年4月至2015年10月妊娠1620周PE（PE组）和FGR（FGR组）及正常妊娠（对照组）血清β-hCG、AFP及uE3临床资料,应用工作者曲线（ROC曲线下面积AUC）及约登指数评判各血清指标预测PE及FGR的价值,并确定相应的预测界值。结果 PE组uE3水平明显高于对照组（P〈0.05）;FGR组β-hCG水平明显高于对照组（P〈0.05）。AFP、uE3及β-hCG三者联合预测PE和FGR的AUC值分别为0.621和0.622;而三种因子分别预测PE的AUC值分别是0.456、0.376和0.547;预测FGR的AUC分别为0.610、0.377和0.495。结论妊娠中期β-hCG、AFP及uE3指标均无较好地预测PE和FGR的价值,但是三种因子联合优于单独的预测价值。Objective To explore the correlation between the levels of Down’s syndrome screening serum markers and the incidence of preeclampsia（PE） and fetal growth restriction（FGR）; To understand the predictive value of individual and combined effects of free β human chorionic gonadotropin（β-hCG）, alpha fetoprotein（AFP）and unconjugated estriol（uE3） in the incidence of preeclampsia and FGR. Methods Based on pregnancy outcomes, the patients who had antenatal care at our hospital from April, 2013 to October, 2015 were retrospectively randomly selected and categorized into control group, preeclampsia group（PE group）or fetal growth restriction group（FGR group）. The serum value of β-hCG, AFP, and uE3 were measured during 1620 gestational weeks. First, the correlation between the serological indicators and the outcomes of PE and FGR was analyzed. Then, the predictive value and prediction boundary of each indicator were identified with the application of receiver operating characteristic（AUC： area under the ROC curve）and Youden index. Results In PE group, the uE3 levels are significantly higher than the ones in control group; In FGR group, β-hCG levels were significantly higher than those of control group（P 〈0.05）. The combined predictive values/AUC area values of AFP, uE3 and β-hCG regarding PE and FGR are 0.621 and 0.622, respectively; The individual predictive values of AFP, uE3 and β-hCG for PE are 0.456, 0.376, and 0.547, respectively; and those predictive values for FGR are 0.610, 0.377, and 0.495, respectively. Conclusions The data did not indicate a significant correlation between the three serum measurements and the incidence of PE and FGR, in terms of individual or combined effects. However, the combined predictive value of the three factors were relatively more effective than any of the individual value.

关 键 词：子痫前期 胎儿生长受限 预测 绒毛膜促性腺激素Β亚单位 甲胎蛋白 游离雌三醇 

分 类 号：R714.5[医药卫生—妇产科学]