探讨孕11周~14周血妊娠相关蛋白A、癌胚抗原125、甲胎蛋白联合血栓调节素对胎盘早剥的预测价值  

Predictive value of serum PAPP-A,CA125 and AFP combined with thrombomodulin for placental abruption at 11-14 gestational weeks

作　　者：张静[1] 刘永保[1] 张楠 张艳秀[1] ZHANG Jing;LIU Yongbao;ZHANG Nan;ZHANG Yanxiu(The First People′s Hospital of Lianyungang City,Lianyungang 222000,Jiangsu,China)

机构地区：[1]连云港市第一人民医院,江苏连云港222000

出　　处：《中国性科学》2020年第5期46-49,共4页Chinese Journal of Human Sexuality

摘　　要：目的探讨孕11周~14周孕妇血妊娠相关蛋白A(PAPP-A)、癌胚抗原125(CA125)、甲胎蛋白(AFP)联合血栓调节素(TM)对胎盘早剥的预测价值。方法选取2017年6月至2018年6月连云港市第一人民医院接收的128例孕11周~14周孕妇作为研究对象,检查所有孕妇静脉血中PAPP-A、CA125、AFP、TM水平。根据分娩后胎盘情况及病理检查结果将孕妇分为胎盘早剥组和正常组,比较两组孕妇血清中PAPP-A、CA125、AFP和血浆中TM水平,利用受试者工作曲线(ROC曲线)评价PAPP-A、CA125、AFP、TM单独及联合预测胎盘早剥的诊断价值。结果胎盘早剥组孕妇血清PAPP-A水平低于正常组,CA125、AFP、TM水平高于正常组,差异均具有统计学意义(P<0.05);胎盘早剥Ⅲ度孕妇血清PAPP-A水平低于胎盘早剥Ⅱ度和Ⅰ度,但差异无统计学意义(P>0.05);胎盘早剥Ⅲ度孕妇血清CA125、AFP和血浆TM水平高于胎盘早剥II度和I度,差异具有统计学意义(P<0.05);ROC结果显示,PAPP-A、CA125、AFP、TM单独及联合预测胎盘早剥的曲线下面积(AUC)分别为0.759、0.689、0.754、0.680、0.837,截断值分别为3341.71mU/L、30.75kU/L、265.56μg/L、57.51μg/L,联合预测的AUC值高于单项预测,差异具有统计学意义(P<0.05);PAPP-A≤3341.71mU/L、CA125≥30.75kU/L、AFP≥265.56μg/L、TM≥57.51μg/L是引起孕妇出现胎盘早剥的危险因素(P<0.05)。结论孕11周~14周孕妇血清中PAPP-A降低、CA125、AFP、TM升高是胎盘早剥的危险因素,PAPP-A≤3341.71mU/L、CA125≥30.75kU/L、AFP≥265.56μg/L、TM≥57.51μg/L时提示可能发生胎盘早剥,4者联合诊断能够提高预测胎盘早剥的准确率。Objective To investigate the predictive value of serum pregnancy-associated plasma protein-A(PAPP-A),carcino-embryonic antigen 125(CA125)and alpha fetoprotein(AFP)combined with thrombomodulin(TM)for placental abruption at 11-14 gestational weeks.Methods A total of 128 pregnant women at 11-14 gestational weeks who were admitted to the hospital from June 2017 to June 2018 were enrolled.The levels of PAPP-A,CA125,AFP and TM in venous blood were measured.According to placental condition and pathological examination results after delivery,they were divided into placental abruption group and normal group.The levels of serum PAPP-A,CA125 and AFP,and plasma TM were compared between the two groups.The receiver operating characteristic curve(ROC curve)was performed to evaluate the diagnostic value of PAPP-A,CA125,AFP,TM alone and their combination for predicting placental abruption.Results The level of serum PAPP-A in placenta abruption group was lower than that in normal group,with statistically significant difference(P<0.05),while levels of CA125,AFP and TM were higher than those in normal group,with statistically significant difference(P<0.05).Serum PAPP-A levels in placental abruptionⅢdegree pregnant women were higher than those in placental abruptionⅡandⅠdegrees,but the difference was not statistically significant(P>0.05).Serum CA125,AFP and plasma TM levels were higher in placental abruptionⅢdegree pregnant women than those in placental abruption II degree and I degree women,with statistically significant differences(P<0.05).ROC results showed that the area under the curve(AUC)of PAPP-A,CA125,AFP,TM alone and their combination for prediction of placental abruption were 0.759,0.689,0.754,0.680 and 0.837,respectively and the cut-off values were 3341.71 mU/L,30.75 kU/L,265.56μg/L and 57.51μg/L,respectively.AUC value of the four combination prediction was significantly higher than that of single prediction(P<0.05).PAPP-A not greater than 3341.71 mU/L,CA125 not less than 30.75 kU/L,AFP not less than 265.56μg/L

关 键 词：孕11周~14周 妊娠相关蛋白A 癌胚抗原 甲胎蛋白 血栓调节素 胎盘早剥 

分 类 号：R714[医药卫生—妇产科学]