中孕早期PAPP-A、INH-A、β-hCG及子宫动脉搏动指数对子痫前期的预测  

PAPP-A, INH-A, β-hCG and uterine artery pulsatility index for the prediction of preeclampsia at the early second trimester

作　　者：李跃萍 闫庆峰 胡春霞[2] 金松[2] 符火[2] 李武莉 LI Yueping1, YAN Qingfeng1, HU Chunxia2, JIN song2, FU Huo2, LI Wuli2(1Department of Basic Medicine and Life Science, 2The First Affiliated Hospital of Hainan Medical College, Haikou 571199, Chin)

机构地区：[1]海南医学院基础医学与生命科学学院,海南海口571199 [2]海南医学院第一附属医院,海南海口571199

出　　处：《分子影像学杂志》2018年第2期219-223,共5页Journal of Molecular Imaging

基　　金：海南省自然科学基金资助项目(814354)

摘　　要：目的探索中孕早期孕妇血清中的PAPP-A、β-hCG、INH-A及子宫动脉搏动指数(PI)与子痫前期的相关性,及其联合预测子痫前期的可行性。方法采用前瞻性巢式病例对照研究,选取于本院产科门诊就诊的单胎孕妇(孕周为11～12^(+6))416例作系统研究,采血测定孕β-HCG、INH-A、PAPP-A,检测PI值。随访后,确诊为子痫前期的孕妇纳入子痫前期组,其余为对照组。结果 416例孕妇在随访观察中,有23例发生子痫前期,纳入病例组;对照组393例,孕期血压正常。子痫前期的发病率5.52%。PAPP-A、β-hCG、INH-A、PI及入组年龄在子痫前期组与对照组间差异有统计学意义(P<0.05)。Logistic回归分析显示,年龄及PI值对疾病预测不产生显著性影响(P>0.05)。在子痫前期发病的相关因素中,PAPP-A和INH-A与子痫前期的发生呈负相关,而β-HCG与子痫前期的发生呈正相关。上述单变量的预测效力PAPP-A>β-hCG>INH-A,而PAPP-A、INH-A、β-hCG变量的联合预测效力明显优于上述变量单独预测,联合预测的曲线下面积可达0.867。结论在中孕早期,PAPP-A、INHA、β-hCG对子痫前期有一定预测价值,PAPP-A、INH-A、β-hCG联合预测子痫前期有相对较高的敏感度和特异性,其预测价值高于单独预测。Objective To evaluate the predictive value of PAPP-A, INH-A, β-hCG and uterine artery pulsatility（PI） for preeclampsia at the early stage of second trimester.Methods The prospective nested case-control study was carried out. Serum samples of 416 pregnant women were obtained at 11-12-＋6 weeks of the gestation. PAPP-A, INH-A and β-hCG concentrations were measured by chemiluminescence method or enzyme-linked immunosorbent assay（ELISA）, while uterine artery pulsatility index（PI） was measured by Doppler velocimetry at the same time.Results 23 pregnant women who were found to have developed preeclampsia were used as the preeclampsia group（PE group）, and the other 393 cases whose blood pressure remained normal were chosen as the control group. The incidence of PE was 5.52%. The MOM values of PAPP-A, β-hCG, INHA and PI in PE group were significantly different from the control group（P〈0.05）.The logistic regression showed that age and PI have no significant effect on the prediction of PE. Among the relative factors, PAPP-A and INH-A are two factors that are negatively correlated with the occurrence of PE, while β-HCG is a positive factor. Comparing these predictive factors individually, the ranking in terms of predictive ability is following： PAPP-Aβ-hCGINH-A. The predictive ability for PE was significantly improved when PAPP-A, INH-A and β-hCG were combinedly used, and the area under the ROC curve can reach to 0.867. Conclusion Combining the screening of different biomarkers, such as serum PAPP-A, INH-A and β-hCG, could increase the predictive value of PE at the early stage of second-trimester.

关 键 词：子痫前期 联合预测 中孕早期 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.244[医药卫生—诊断学]