孕早期血清PAPP-A水平检测对子痫前期及胎儿宫内受限的临床意义  

Clinical significance of serum PAPP-A level in early pregnancy for preeclampsia and fetal intrauterine growth restriction

作　　者：罗晓华 陈玲玲 王桂杰 申作娟 庞立 梁金兰 张艳 LUO Xiaohua;CHEN Lingling;WANG Guijie;SHEN Zuojuan;PANG Li;LIANG Jinlan;ZHANG Yan(Department of Obstetrics,Dezhou Maternal and Child Health Hospital,Dezhou,Shandong 253000,China)

机构地区：[1]德州市妇幼保健院产科,山东德州253000

出　　处：《中国优生与遗传杂志》2021年第3期409-412,共4页Chinese Journal of Birth Health & Heredity

基　　金：德州市妇幼保健院科研计划项目(DFYKY-201719)。

摘　　要：目的探讨孕早期血清妊娠相关血浆蛋白A(PAPP-A)水平变化,分析其对子痫前期(preeclampsia,PE)、胎儿宫内生长受限(fetal intrauterine growth restriction,FGR)的临床意义。方法采用回顾性列队研究,纳入2017年11月1日-2018年11月1日于德州市妇幼保健院及上海第一妇婴保健院住院分娩的孕妇804例为研究对象,采用酶联免疫吸附(ELISA)法检测孕10~12周血清PAPP-A(pregnancy-associated plasma protein A)水平,以血清PAPP-A水平均值为依据将所有研究对象分为PAPP-A低表达组、PAPP-A高表达组。收集并比较受试者年龄、分娩孕周、妊娠前BMI、婴儿出生体质量、新生儿性别等一般资料;比较两组PE、FGR发病率;采用多因素Logistic回归分析PE、FGR影响因素。结果与PAPP-A(MOM)高表达组比较,PAPP-A中位数倍数(MOM)低表达组羊水过少孕妇比例显著升高(P<0.05);PAPP-A高表达组孕妇PE发病率显著低于PAPP-A低表达组孕妇(17.35%vs. 30.22%)(P<0.05),PAPP-A高表达组孕妇FGR发病患者发病率显著低于PAPP-A低表达组(18.84%vs.39.55%)(P<0.05);血清PAPP-A(MOM)水平低表达、羊水过少均是PE、FGR发生的独立危险因素(P<0.05)。结论孕早期孕妇血清PAPP-A水平异常低表达可能与PE、FGR发生发展有关,可为临床寻找有效生物学指标早期预防PE、FGR提供一定参考。Objective To investigate the change of serum pregnancy-associated plasma protein A(PAPP-A) in early pregnancy and its clinical significance in preeclampsia(PE) and fetal intrauterine growth restriction(FGR). Methods A retrospective cohort study was conducted on 804 pregnant women who delivered in Dezhou Maternal and Child Health Hospital and Shanghai First Maternal and Infant Hospital from November 1, 2017 to November 1, 2018. The level of serum PAPP-A at 10–12 weeks of gestation was detected by ELISA, according to the mean value of serum PAPP-A level, all subjects were divided into low PAPP-A group and high PAPP-A group. General data of subjects’ age, delivery weeks, pre pregnancy BMI, birth weight and gender of infants were collected and compared, incidence rates of PE and FGR in two groups were compared, and multivariate Logistic regression was used to analyze the influencing factors of PE and FGR. Results Compared with that in the PAPP-A(MOM) high expression group, the proportion of pregnant women with oligohydramnios in the PAPP-A(MOM)low expression group was significantly higher(P<0.05);the incidence rate of PE in PAPP-A high expression group was significantly lower than that in PAPP-A low expression group(17.35% vs. 30.22%)(P<0.05). The incidence rate of FGR in PAPP-A high expression group was significantly lower than that in PAPP-A low expression group(18.84% vs. 39.55%)(P<0.05). Low expression of serum PAPP-A(MOM) and oligohydramnios were independent risk factors of PE and FGR(P<0.05). Conclusion The abnormal low expression of serum PAPP-A in early pregnancy may be related to the occurrence and development of PE and FGR, which can provide some reference for clinical finding effective biological indicators to prevent PE and FGR.

关 键 词：子痫前期 胎儿宫内生长受限 妊娠相关血浆蛋白A 临床意义 

分 类 号：R714.244[医药卫生—妇产科学]