妊娠早中期孕母血清中PAPP-A、β-hCG、AFP、uE_(3)联合预测子痫前期的临床价值评估  

Diagnostic value of PAPP-A,β-hCG,AFP and uE_(3) in serum of maternal first and second-trimester for predicting preeclampsia

作　　者：詹晓华 冯泰山 吕靖[1] ZHAN Xiaohua;FENG Taishan;LYU Jing(Karamay Central Hospital of Xinjiang,Karamay,Xinjiang 834000,China)

机构地区：[1]克拉玛依市中心医院产科,新疆克拉玛依834000

出　　处：《中国优生与遗传杂志》2024年第12期2626-2631,共6页Chinese Journal of Birth Health & Heredity

基　　金：克拉玛依市中心医院科技项目(YK2021-12)。

摘　　要：目的探讨妊娠早中期孕母血清学筛查指标妊娠相关蛋白A(PAPP-A)、β-人绒毛膜促性腺激素(β-hCG)、甲胎蛋白(AFP)及游离雌三醇(uE_(3))检测结果在妊娠高血压患者、子痫前期患者、重度子痫前期患者及健康对照组间的分布差异,并探讨其预测子痫前期的临床应用价值。方法选取2019年5月至2023年10月在克拉玛依市中心医院产检并分娩的妊娠高血压患者107例,子痫前期患者107例,重度子痫前期患者48例为研究对象,同期分娩的1979例血压正常孕妇作为健康对照组。检测4组孕妇的血清学指标(PAPP-A、β-hCG、AFP、uE_(3))的表达水平,进行统计分析。结果子痫前期组和重度子痫前期组新生儿体质量及血清PAPP-A、β-hCG、AFP、uE_(3)水平均低于健康对照组(P<0.05);重度子痫前期组血清PAPP-A水平相对于子痫前期组和妊娠高血压组均较低;重度子痫前期组血清uE_(3)水平明显低于妊娠高血压组(P<0.01);绘制受试者操作特征(ROC)曲线得出uE_(3)灵敏度最高,而AFP特异度更强;联合诊断的AUC为0.850,灵敏度为87.1%,特异度为67.31%。结论妊娠早中期孕母血清中PAPP-A、β-hCG、AFP、uE_(3)水平检测对子痫前期有一定的预测价值,各指标呈现互补之势,联合诊断效果更佳。Objective To investigate the distribution differences of maternal first and second-trimester serum pregnancy-associated protein A(PAPP-A),β-human chorionic gonadotropin(β-hCG),alpha-fetoprotein(AFP)and unconjugated estriol(uE_(3))among pregnancy induced hypertension patients,preeclampsia patients,severe preeclampsia patients and healthy controls.The clinical application value of this method in predicting preeclampsia was also discussed.Methods 107 pregnant women with pregnancy induced hypertension,107 pregnant women with preeclampsia,48 pregnant women with severe preeclampsia were selected in study group from May 2019 to October 2023,and 50 healthy pregnant women were selected in control group during the same period.The expression levels of serological indexes(PAPP-A,β-hCG,AFP,uE_(3))in four groups of pregnant women were detected and statistically analyzed.Results The neonatal weight and serum levels of PAPP-A,β-hCG,AFP and uE_(3) in the preeclampsia group and severe preeclampsia group were lower than those in the healthy control group(P<0.05).The serum levels of PAPP-A in the severe preeclampsia group was lower than that in the preeclampsia group.The serum levels of PAPP-A and uE_(3) in the severe preeclampsia group were significantly lower than those in the pregnancy induced hypertension group(P<0.05).The ROC curve indicates that uE3 has the highest sensitivity,AFP has stronger specificity.The AUC of combined diagnosis is 0.850,sensitivity is 87.1%,and specificity is 67.31%.Conclusion The detection of PAPP-A,β-hCG,AFP and uE_(3) levels in the serum of maternal first and second-trimester has a certain value in predicting preeclampsia,and each index presents a complementary trend,and the combined diagnosis is better.

关 键 词：妊娠相关蛋白A(PAPP-A) β-人绒毛膜促性腺激素(β-hCG) 甲胎蛋白(AFP) 游离雌三醇(uE_(3)) 子痫前期 

分 类 号：R71[医药卫生—妇产科学]