联合检测妊娠早中期孕妇血清PAPP-A、PLGF及子宫动脉血流参数预测子痫前期的临床意义  

Clinical Significance of Combined Detection of Serum PAPP-A,PLGF and Uterine Artery Blood Flow Parameters in Pregnant Women in Early and Mid-pregnancy in Prediction of Preeclampsia

作　　者：陈佳 郭静 韩悦 曲冬颖 CHEN Jia;GUO Jing;HAN Yue;QU Dong-ying(Department of Obstetrics,Northern Theater General Hospital of PLA,Shenyang 110020,China)

机构地区：[1]中国人民解放军北部战区总医院产科,沈阳110020

出　　处：《解放军医药杂志》2021年第2期60-64,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：辽宁省自然科学基金指导计划(20190551042)。

摘　　要：目的探讨联合检测妊娠早中期孕妇血清妊娠相关血浆蛋白A(PAPP-A)、胎盘生长因子(PLGF)及子宫动脉血流参数预测子痫前期的临床意义。方法选取2017年4月—2019年4月于本院行产前检查的孕16周内孕妇180例为研究对象,行PAPP-A、PLGF及超声子宫动脉血流参数[搏动指数(PI)、血流阻力指数(RI)、收缩期峰值流速/舒张末期血流速度比值(S/D)]检查,根据是否发生子痫前期分为子痫组72例和正常组108例,将子痫组按照病情严重程度分为轻度子痫组54例和重度子痫组18例,比较子痫组和正常组、轻度子痫组和重度子痫组的PAPP-A、PLGF、PI、RI、S/D,分析PAPP-A、PLGF、PI、RI、S/D单独和联合检测对子痫前期的预测价值及与子痫前期严重程度的相关性。结果子痫组PI、RI、S/D高于正常组,血清PAPP-A、PLGF水平低于正常组(P<0.01);重度子痫组PI、RI、S/D高于轻度子痫组,PAPP-A、PLGF水平低于轻度子痫组(P<0.05)。联合检测的灵敏度、特异性、阳性预测值、阴性预测值高于PAPP-A、PLGF、PI、RI、S/D的单独诊断(P<0.05)。PI、RI、S/D与子痫前期孕妇的病情严重程度呈正相关(r=0.471、0.462、0.432;P<0.01,P<0.05),PAPP-A、PLGF与子痫前期孕妇的病情严重程度呈负相关(r=-0.587、-0.597,P<0.01)。结论子痫前期孕妇在妊娠早中期即可出现PAPP-A及PLGF水平降低、子宫动脉血流参数升高,妊娠早中期联合检测PAPP-A、PLGF水平及子宫动脉血流参数对子痫前期的预测价值较高。Objective To explore the clinical significance of the combined detection of serum pregnancy-associated plasma protein A(PAPP-A),placental growth factor(PLGF)and uterine artery blood flow parameters in the early and mid-pregnancy.Methods A total of 180 pregnant women within 16 weeks of gestation who underwent prenatal examination in our hospital from April 2017 to April 2019 were selected as the research subjects.Uterine artery blood flow parameters including pulsatility index(PI),resistance index(RI),systolic peak velocity/end diastolic blood flow velocity ratio(S/D)were examined by PAPP-A,PLGF and B ultrasound.According to the occurrence of preeclampsia,they were divided into eclampsia group(n=72)and normal group(n=108).The eclampsia group was divided into mild eclampsia group(n=54)and severe eclampsia group(n=18)according to the severity of eclampsia.PAPP-A,PLGF,PI,RI,S/D between eclampsia group and normal group,between mild eclampsia group and severe eclampsia group were compared.In addition,the predictive value of PAPP-A,PLGF,PI,RI,S/D in single and combined detection of preclampsia as well as their correlation with severity of preclampsia was analyzed.Results The levels of PI,RI and S/D were higher,while the levels of serum PAPP-A and PlGF were lower in eclampsia group than in control group(P<0.05)The levels of PI,RI and S/D in severe eclampsia group were higher than those in mild eclampsia group,while PAPP-A and PlGF levels were lower in severe eclampsia group than in mild eclampsia group(P<0.05).The sensitivity,specificity,positive predictive value and negative predictive value of combined detection were higher than those of PAPP-A,PLGF,PI,RI,S/D alone(r=0.471,0.462,0.432,P<0.01,P<0.05).PAPP-A and PlGF were negatively correlated with the severity of the disease(r=-0.587,-0.597,P<0.01).Conclusion In patients with preeclampsia in early and mid-pregnancy,PAPP-A and PLGF levels may be decreased and uterine artery blood flow parameters may be increased.Therefore,the combined detection of PAPP-A,PLGF levels and

关 键 词：子痫前期 妊娠相关血浆蛋白A 胎盘生长因子 子宫动脉 搏动血流 预测 超声检查 产前 

分 类 号：R714.245[医药卫生—妇产科学]