孕早期血清胎盘生长因子 妊娠相关血浆蛋白A及绒毛膜促性腺激素β亚单位对胎盘缺血性疾病的预测价值  

Predictive value of early pregnancy serum PLGF,PAPP-A,and-hCG for placental ischemic diseases

作　　者：周庆调 余晓红 ZHOU Qing-diao;YU Xiao-hong(Department of Obstetrics and Gynecology,Wenzhou People's Hospital,Wenzhou Maternal and Child Health Hospital,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州市人民医院温州市妇幼保健院,浙江温州325000

出　　处：《中国妇幼保健》2025年第7期1196-1200,共5页Maternal and Child Health Care of China

基　　金：浙江省温州市科技局计划项目(Y20210347)。

摘　　要：目的 探讨孕早期血清胎盘生长因子(PLGF)、妊娠相关血浆蛋白A(PAPP-A)及绒毛膜促性腺激素β亚单位(β-hCG)对胎盘缺血性疾病的预测价值,并分析其在亚型中的预测效能差异。方法 采用匹配病例对照研究设计,纳入98例胎盘缺血性疾病孕妇(病例组)和147例正常孕妇(对照组),采用时间分辨荧光免疫分析法测定孕早期血清PLGF、PAPP-A和β-hCG水平,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC)、灵敏度、特异度及似然比等指标,并进行亚组分析。结果 胎盘缺血性疾病组血清中PLGF、β-hCG、PAPP-A水平显著低于正常对照组,差异有统计学意义(P<0.05)。PLGF、PAPP-A及β-hCG预测胎盘缺血性疾病的AUC分别为0.785、0.762及0.734,灵敏度为66.3%~72.4%,特异度为70.9%~75.7%。3项指标联合预测的AUC达到0.892,灵敏度为85.6%,特异度为81.7%,明显优于单项指标(P<0.05)。在疾病亚型中,3项联合指标对FGR的预测效能最高,其次是子痫前期,胎盘早剥最低,但差异无统计学意义(Breslow-Day检验,P>0.05)。结论 孕早期血清PLGF、PAPP-A及β-hCG联合对胎盘缺血性疾病有较好的预测价值,且效能在不同亚组中总体一致,有望作为一种筛查和早期预警的手段应用于临床,以帮助识别高危孕妇,及时给予预防和干预措施。Objective To investigate the predictive value of early pregnancy serum placental growth factor(PLGF),pregnancy-associated plasma protein A(PAPP-A),andβ-human chorionic gonadotropin(β-hCG)for placental ischemic diseases and to analyze the differences in predictive performance among disease subtypes.Methods A case-control study was conducted on 98 pregnant women with placental ischemic diseases(case group)and 147 normal pregnant women(control group).Serum levels of PLCF,PAPP-A andβ-hCG were measured by time-resolved fluorescence immunoassay in early pregnancy.Receiver operating characteristic(ROC)curves were plotted,and the area under the curve(AUC),sensitivity,specificity,and likelihood ratios were calculated.Subgroup analyses were also performed.Results lower serum PLGF,PAPP-A andβ-hCG levels were observed in the ischemic placental disease group compared to the normal control group(P<0.05).The AUCs of PLGF,PAPP-A,andβ-hCG for predicting placental ischemic diseases were 0.785,0.762 and 0.734,respectively,with sensitivities of 66.3%-72.4%and specificities of 70.9%-75.7%.The AUC of the combined prediction of the three indicators reached 0.892,with a sensitivity of 85.6%and a specificity of 81.7%,which was significantly better than the single indicators(P<0.05).Among the disease subtypes,the combined indicators had the highest predictive efficacy for fetal growth restriction(FGR),followed by preeclampsia,and the lowest for placental abruption,but the differences were not statistically significant(Breslow-Day test,P>0.05).Conclusion The combined use of serum PLCF,PAPP-A,andβ-hCG in early pregnancy has a good predictive value for placental ischemic diseases,and the efficacy is generally consistent across different subgroups.It is expected to be applied in clinical practice as a screening and early warning tool to help identify high-risk pregnant women and provide timely prevention and intervention measures.

关 键 词：胎盘缺血性疾病 胎盘生长因子 妊娠相关血浆蛋白A 预测 疾病亚型 

分 类 号：R271.4[医药卫生—中医妇科学]