初产妇孕早期血清PAPP-A水平与不良妊娠结局的关系  

Relationship between serum PAPP-A level in first trimester and adverse pregnancy outcomes in primiparas

作　　者：王雅 廖丹 朱俊平 王晶 WANG Ya;LIAO Dan;ZHU Junping;WANG Jing(Department of Obstetrics and Gynecology,Hainan Modern Women and Children’s Hospital,Haikou,Hainan 571100,China)

机构地区：[1]海南现代妇女儿童医院妇产科,海南海口571100

出　　处：《中国优生与遗传杂志》2023年第3期586-591,共6页Chinese Journal of Birth Health & Heredity

基　　金：海南省卫生计生行业科研项目(19A200181)。

摘　　要：目的分析初产妇孕早期血清妊娠相关血浆蛋白-A(PAPP-A)水平与不良妊娠结局的相关性。方法共纳入2019年1月至2021年7月期间在海南现代妇女儿童医院产科进行活产的11619例单胎初产妊娠妇女,通过酶联免疫吸附试验法检测孕早期(妊娠12~14周)血清PAPP-A水平,记录不良妊娠结局的发生情况。结果所有孕妇孕早期血清PAPP-A水平为2.0(1.56,2.63)mIU/mL,PAPP-AMoM的中位值为0.99(0.77,1.29)。将PAPP-AMoM<0.99的初产妇纳入低PAPP-A水平亚组(n=7358),PAPP-A MoM≥0.99纳入高PAPP-A水平亚组(n=4261)。低PAPP-A水平亚组妊娠不良结局(早产、先兆子痫、低出生体质量)的发生率显著高于高PAPP-A水平亚组(P<0.001)。在调整各种混杂因素,包括年龄、检测孕周和孕前BMI后,经多变量Logistic回归分析,PAPP-A MoM是先兆子痫(OR=0.453,95%CI=0.086~0.855,P<0.001)、低出生体质量儿(OR=0.241,95%CI=0.072~0.503,P<0.001)、早产(OR=0.765,95%CI=0.469~0.899,P<0.001)的独立危险因素。经受试者操作特征曲线分析,孕早期PAPP-AMoM预测初产妇发生早产(0.803)、PE(0.791)、低出生体质量儿(0.767)的曲线下面积均显著优于甲胎蛋白MoM、游离β-人绒毛膜促性腺激素MoM、游离雌三醇MoM(P<0.05)。结论孕早期测量血清PAPP-A MoM水平可以作为预测妊娠不良结局(如PE、低出生体质量儿、早产)的有价值的生物标志物。Objective To analyze the correlation between pregnancy-associated plasma protein-A(PAPP-A)level and adverse pregnancy outcomes in primiparas during the first trimester.Methods A total of 11619 singleton first-time pregnant women who had live births in the Obstetrics Department of Hainan Modern Women and Children’s Hospital from January 2019to July 2021 were enrolled.Serum PAPP-A levels in the first trimester(12-14 weeks of gestation)were detected by enzyme-linked immunosorbent assay,and the incidence of adverse pregnancy outcomes was recorded.Results The serum PAPP-A level of all pregnant women in the first trimester was 2.0(1.56,2.63)mIU/mL,and the median PAPP-A MoM value was 0.99(0.77,1.29).Primiparas with PAPP-A MoM<0.99 were included in the low PAPP-A subgroup(n=7358),and PAPP-A MoM≥0.99 was included in the high PAPP-A subgroup(n=4261).The incidence of adverse pregnancy outcomes(preterm birth,preeclampsia,low birth weight)was significantly higher in low PAPP-A subgroup than in high PAPP-A subgroup(P<0.001).After adjusting for various confounding factors,including age,gestational age,and pre-pregnancy BMI,multivariate Logistic regression analysis showed that PAPP-A MoM was an independent risk factor for preeclampsia(OR=0.453,95%CI=0.086-0.855,P<0.001)and low birth weight infant(OR=0.241,95%CI=0.072-0.503,P<0.001)and preterm birth(OR=0.765,95%CI=0.469-0.899,P<0.001).After receiver operating characteristic curve analysis,the area under the curve of early pregnancy PAPP-A MoM in predicting preterm birth(0.803),PE(0.791)and low birth weight(0.767)were significantly better than those of alpha-fetoprotein MoM,freeβ-human choriogonadotropin MoM and unconjugated estriol MoM(P<0.05).Conclusion Measurement of serum PAPP-A MoM level in the first trimester can be used as a valuable biomarker for predicting adverse pregnancy outcomes such as PE,low birth weight,and preterm birth.

关 键 词：初产妇 孕早期 妊娠相关血浆蛋白-A 早产 妊娠结局 

分 类 号：R714.2[医药卫生—妇产科学]