妊娠合并甲状腺功能减退患者血清PAPP-A、RBP-4水平及其对妊娠结局的预测价值  

Serum PAPP-A and RBP-4 levels in patients with pregnancy complicating hypothyroidism and their predictive values for pregnancy outcomes

作　　者：李莎 刘能英 陈莉[1] 段奉菊 曾丽[1] LI Sha;LIU Nengying;Chen Li;DUAN Fengju;ZENG Li(Department of Obstetrics,Yibin Municipal Second People′s Hospital,Yibin,Sichuan 644000,China;Department of Clinical Laboratory,Yibin Municipal Second People′s Hospital,Yibin,Sichuan 644000,China)

机构地区：[1]四川省宜宾市第二人民医院产科,四川宜宾644000 [2]四川省宜宾市第二人民医院检验科,四川宜宾644000

出　　处：《检验医学与临床》2024年第19期2866-2870,共5页Laboratory Medicine and Clinic

基　　金：四川省宜宾市卫生健康委员会科研课题(2020YW028)。

摘　　要：目的探讨血清妊娠相关血浆蛋白A(PAPP-A)和视黄醇结合蛋白4(RBP-4)水平对甲状腺功能减退(简称甲减)患者妊娠结局的预测价值。方法回顾性选取2021年6月至2023年6月在该院产检的149例妊娠合并甲减患者作为观察组,另选取同期在该院产检的50例产检正常的健康孕妇作为对照组。对观察组患者进行随访,根据患者妊娠结局划分为结局良好组和结局不良组;采用酶联免疫吸附试验检测各组甲状腺激素指标和血清PAPP-A、RBP-4水平;采用Pearson相关分析妊娠合并甲减患者血清PAPP-A与RBP-4水平间的相关性;采用多因素Logistic回归分析妊娠合并甲减患者妊娠结局不良的影响因素;采用受试者工作特征(ROC)曲线分析PAPP-A、RBP-4血清水平对妊娠合并甲减患者妊娠结局不良的预测价值。结果与对照组比较,观察组患者PAPP-A、游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)水平明显降低(P<0.05),RBP-4和促甲状腺素(TSH)水平明显升高(P<0.05)。根据观察组患者妊娠结局分为结局良好组96例,结局不良组53例。与结局良好组比较,结局不良组患者TSH、RBP-4水平明显升高(P<0.05),FT4、PAPP-A水平明显降低(P<0.05)。妊娠合并甲减患者血清PAPP-A水平与RBP-4水平呈负相关(r=-0.380,P<0.001)。多因素Logistic回归分析表明,血清FT4、PAPP-A水平升高是妊娠合并甲减患者妊娠结局不良的保护因素(P<0.05),血清TSH、RBP-4水平升高是妊娠合并甲减患者妊娠结局不良的危险因素(P<0.05)。ROC曲线分析结果显示,血清PAPP-A、RBP-4水平预测妊娠合并甲减患者妊娠结局不良的曲线下面积(AUC)分别为0.857(95%CI:0.799~0.914)、0.876(95%CI:0.823~0.929),低于2项联合预测的AUC[0.958(95%CI:0.930~0.986)],差异均有统计学意义(Z=3.136,P=0.002;Z=2.696,P=0.007)。结论妊娠合并甲减患者的血清PAPP-A、RBP-4水平与妊娠结局密切相关,2项联合对妊娠合并甲减患者的妊娠结局具有一定的Objective To explore the predictive value of serum pregnancy associated plasma protein A(PAPP-A)and retinol binding protein 4(RBP-4)levels for pregnancy outcomes in the patients with hypothyroidism.Methods A total of 149 patients with pregnancy complicating hypothyroidism undergoing prenatal checkups in this hospital from June 2021 to June 2023 were retrospectively selected as the observation group.Other 50 healthy pregnant women with normal prenatal examinations were selected as the control group.The observation group conducted the follow up and was divided into the good outcome group and adverse outcome group according to the pregnancy outcomes;the enzyme linked immunosorbent assay was used to detect the thyroid hormone indicators and serum PAPP-A and RBP-4 levels in the subjects of three groups;the Pearson correlation was used to analyze the correlation between serum PAPP-A level and RBP-4 level in pregnant women with hypothyroidism;the multivariate Logistic regression was used to analyze the influencing factors of adverse pregnancy outcomes in the patients with pregnancy complicating hypothyroidism;the receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum PAPP-A and RBP-4 levels for adverse pregnancy outcomes in pregnant women with hypothyroidism.Results Compared with the control group,the levels of PAPP-A,free triiodothyronine(FT3)and free thyroxine(FT4)in the observation group were significantly reduced(P<0.05),while the levels of RBP-4 and thyroid stimulating hormone(TSH)were significantly increased(P<0.05).According to the pregnancy outcomes of the observation group,there were 96 cases in the good outcome group and 53 cases in the poor outcome group.Compared with the good outcome group,the TSH and RBP-4 levels in the poor outcome group were significantly increased(P<0.05),while the FT4 and PAPP-A levels were significantly decreased(P<0.05).There was a negative correlation between serum PAPP-A level and RBP-4 level in the patients with pregnancy complicating hypothyr

关 键 词：妊娠合并甲状腺功能减退 妊娠结局 妊娠相关血浆蛋白A 视黄醇结合蛋白4 甲状腺功能 

分 类 号：R446.11[医药卫生—诊断学] R714.25[医药卫生—临床医学]