中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2015年
2期
101-107
,共7页
先兆子痫%绒毛膜促性腺激素,β亚单位,人%妊娠相关血浆蛋白A%甲胎蛋白类%雌三醇
先兆子癇%絨毛膜促性腺激素,β亞單位,人%妊娠相關血漿蛋白A%甲胎蛋白類%雌三醇
선조자간%융모막촉성선격소,β아단위,인%임신상관혈장단백A%갑태단백류%자삼순
Pre-eclampsia%Chorionic gonadotropin,beta subunit,human%Pregnancy-associated plasma protein-A%Alpha-fetoproteins%Estriol
目的探讨孕早中期孕妇血清中β-hCG、妊娠相关血浆蛋白A（PAPP-A）、甲胎蛋白（AFP）及游离雌三醇（uE3）水平检测在联合预测子痫前期中的价值。方法前瞻性随机选取2012年4月至2013年6月上海交通大学医学院附属国际和平妇幼保健院产科行产前检查并分娩的1805例孕妇，根据随访结果将其分为正常对照组及子痫前期组（包括轻度及重度子痫前期）。孕10～14周时检测孕妇血清中PAPP-A、β-hCG的水平；孕15～20周时检测其血清中AFP、β-hCG及uE3的水平。对血清指标与部分妊娠结局的相关性进行分析，应用受试者工作曲线（ROC曲线）及约登指数评判各血清指标预测子痫前期的价值，并确定相应的预测界值。结果（1）1805例孕妇中未发生妊娠期高血压疾病1739例（正常对照组）,发生子痫前期66例（子痫前期组）,子痫前期发生率为3.66%（66/1805）,其中轻度子痫前期43例、重度子痫前期23例。（2）孕10～14周时正常对照组孕妇血清PAPP-A水平平均为（3972±2311）mU/L，子痫前期组孕妇平均为（2837±1849）mU/L，两组比较，差异有统计学意义（P<0.01）；正常对照组孕妇血清β-hCG水平为55（37~83）U/L，子痫前期组孕妇平均为（57±35）U/L，两组比较，差异无统计学意义（P>0.05）。子痫前期组轻度孕妇血清PAPP-A、β-hCG及AFP水平分别为（3249±1877）mU/L、（61±38）U/L及（35±11）μg/L，重度孕妇分别为（1758±1297）mU/L、（47±23） U/L及（47±22）μg/L，两者PAPP-A水平比较，差异有统计学意义（P<0.05）。（3）孕15～20周时子痫前期组孕妇血清β-hCG、AFP及uE3水平分别为（47909±31396）U/L、（38±15）μg/L及（0.98±0.31）μg/L,正常对照组分别为（39267±25054）U/L、（47±18）μg/L及（1.17±0.39）μg/L,子痫前期组孕妇血清中AFP及uE3水平均明显低于正常对照组，分别比较，差异均有统计学意义（P<0.05）。子痫前期组轻度孕妇血清β-hCG及uE3水平分别与重度孕妇比较，差异均无统计学意义（P>0.05）。（4）孕10～14周时，孕妇血清PAPP-A水平与新生儿出生体质量（r=0.068,P=0.011）及分娩孕周（r=0.057,P=0.048）呈正相关；孕15～20周时，孕妇血清AFP水平与新生儿出生体质量（r=0.149,P=0.000）呈正相关；血清β-hCG水平与新生儿1分钟Apgar评分（r=-0.085,P=0.024）呈负相关；血清uE3水平与分娩孕周（r=0.086,P=0.036）呈正相关。（5）将血清PAPP-A、AFP及uE3水平作为检验变量得出预测子痫前期的界值，分别为PAPP-A 1831 mU/L、AFP 41μg/L及uE31.04μg/L，预测子痫前期的特异度分别为97.82%、98.54%及98.80%。（6）以PAPP-A、AFP及uE3的联合预测因子作为检验变量绘制ROC曲线并计算约登指数，联合预测因子为0.032时约登指数最大（为0.41），其预测子痫前期的价值最大。故以0.032作为PAPP-A、AFP及uE3联合预测因子的预测界值，其预测子痫前期的特异度为98.93%，敏感度为70.59%，相对风险度为2.37。结论无论是PAPP-A、AFP及uE3各单项血清指标还是联合预测因子，对子痫前期发病均有预测价值，但联合预测因子的预测价值要优于任一单项血清指标。
目的探討孕早中期孕婦血清中β-hCG、妊娠相關血漿蛋白A（PAPP-A）、甲胎蛋白（AFP）及遊離雌三醇（uE3）水平檢測在聯閤預測子癇前期中的價值。方法前瞻性隨機選取2012年4月至2013年6月上海交通大學醫學院附屬國際和平婦幼保健院產科行產前檢查併分娩的1805例孕婦，根據隨訪結果將其分為正常對照組及子癇前期組（包括輕度及重度子癇前期）。孕10～14週時檢測孕婦血清中PAPP-A、β-hCG的水平；孕15～20週時檢測其血清中AFP、β-hCG及uE3的水平。對血清指標與部分妊娠結跼的相關性進行分析，應用受試者工作麯線（ROC麯線）及約登指數評判各血清指標預測子癇前期的價值，併確定相應的預測界值。結果（1）1805例孕婦中未髮生妊娠期高血壓疾病1739例（正常對照組）,髮生子癇前期66例（子癇前期組）,子癇前期髮生率為3.66%（66/1805）,其中輕度子癇前期43例、重度子癇前期23例。（2）孕10～14週時正常對照組孕婦血清PAPP-A水平平均為（3972±2311）mU/L，子癇前期組孕婦平均為（2837±1849）mU/L，兩組比較，差異有統計學意義（P<0.01）；正常對照組孕婦血清β-hCG水平為55（37~83）U/L，子癇前期組孕婦平均為（57±35）U/L，兩組比較，差異無統計學意義（P>0.05）。子癇前期組輕度孕婦血清PAPP-A、β-hCG及AFP水平分彆為（3249±1877）mU/L、（61±38）U/L及（35±11）μg/L，重度孕婦分彆為（1758±1297）mU/L、（47±23） U/L及（47±22）μg/L，兩者PAPP-A水平比較，差異有統計學意義（P<0.05）。（3）孕15～20週時子癇前期組孕婦血清β-hCG、AFP及uE3水平分彆為（47909±31396）U/L、（38±15）μg/L及（0.98±0.31）μg/L,正常對照組分彆為（39267±25054）U/L、（47±18）μg/L及（1.17±0.39）μg/L,子癇前期組孕婦血清中AFP及uE3水平均明顯低于正常對照組，分彆比較，差異均有統計學意義（P<0.05）。子癇前期組輕度孕婦血清β-hCG及uE3水平分彆與重度孕婦比較，差異均無統計學意義（P>0.05）。（4）孕10～14週時，孕婦血清PAPP-A水平與新生兒齣生體質量（r=0.068,P=0.011）及分娩孕週（r=0.057,P=0.048）呈正相關；孕15～20週時，孕婦血清AFP水平與新生兒齣生體質量（r=0.149,P=0.000）呈正相關；血清β-hCG水平與新生兒1分鐘Apgar評分（r=-0.085,P=0.024）呈負相關；血清uE3水平與分娩孕週（r=0.086,P=0.036）呈正相關。（5）將血清PAPP-A、AFP及uE3水平作為檢驗變量得齣預測子癇前期的界值，分彆為PAPP-A 1831 mU/L、AFP 41μg/L及uE31.04μg/L，預測子癇前期的特異度分彆為97.82%、98.54%及98.80%。（6）以PAPP-A、AFP及uE3的聯閤預測因子作為檢驗變量繪製ROC麯線併計算約登指數，聯閤預測因子為0.032時約登指數最大（為0.41），其預測子癇前期的價值最大。故以0.032作為PAPP-A、AFP及uE3聯閤預測因子的預測界值，其預測子癇前期的特異度為98.93%，敏感度為70.59%，相對風險度為2.37。結論無論是PAPP-A、AFP及uE3各單項血清指標還是聯閤預測因子，對子癇前期髮病均有預測價值，但聯閤預測因子的預測價值要優于任一單項血清指標。
목적탐토잉조중기잉부혈청중β-hCG、임신상관혈장단백A（PAPP-A）、갑태단백（AFP）급유리자삼순（uE3）수평검측재연합예측자간전기중적개치。방법전첨성수궤선취2012년4월지2013년6월상해교통대학의학원부속국제화평부유보건원산과행산전검사병분면적1805례잉부，근거수방결과장기분위정상대조조급자간전기조（포괄경도급중도자간전기）。잉10～14주시검측잉부혈청중PAPP-A、β-hCG적수평；잉15～20주시검측기혈청중AFP、β-hCG급uE3적수평。대혈청지표여부분임신결국적상관성진행분석，응용수시자공작곡선（ROC곡선）급약등지수평판각혈청지표예측자간전기적개치，병학정상응적예측계치。결과（1）1805례잉부중미발생임신기고혈압질병1739례（정상대조조）,발생자간전기66례（자간전기조）,자간전기발생솔위3.66%（66/1805）,기중경도자간전기43례、중도자간전기23례。（2）잉10～14주시정상대조조잉부혈청PAPP-A수평평균위（3972±2311）mU/L，자간전기조잉부평균위（2837±1849）mU/L，량조비교，차이유통계학의의（P<0.01）；정상대조조잉부혈청β-hCG수평위55（37~83）U/L，자간전기조잉부평균위（57±35）U/L，량조비교，차이무통계학의의（P>0.05）。자간전기조경도잉부혈청PAPP-A、β-hCG급AFP수평분별위（3249±1877）mU/L、（61±38）U/L급（35±11）μg/L，중도잉부분별위（1758±1297）mU/L、（47±23） U/L급（47±22）μg/L，량자PAPP-A수평비교，차이유통계학의의（P<0.05）。（3）잉15～20주시자간전기조잉부혈청β-hCG、AFP급uE3수평분별위（47909±31396）U/L、（38±15）μg/L급（0.98±0.31）μg/L,정상대조조분별위（39267±25054）U/L、（47±18）μg/L급（1.17±0.39）μg/L,자간전기조잉부혈청중AFP급uE3수평균명현저우정상대조조，분별비교，차이균유통계학의의（P<0.05）。자간전기조경도잉부혈청β-hCG급uE3수평분별여중도잉부비교，차이균무통계학의의（P>0.05）。（4）잉10～14주시，잉부혈청PAPP-A수평여신생인출생체질량（r=0.068,P=0.011）급분면잉주（r=0.057,P=0.048）정정상관；잉15～20주시，잉부혈청AFP수평여신생인출생체질량（r=0.149,P=0.000）정정상관；혈청β-hCG수평여신생인1분종Apgar평분（r=-0.085,P=0.024）정부상관；혈청uE3수평여분면잉주（r=0.086,P=0.036）정정상관。（5）장혈청PAPP-A、AFP급uE3수평작위검험변량득출예측자간전기적계치，분별위PAPP-A 1831 mU/L、AFP 41μg/L급uE31.04μg/L，예측자간전기적특이도분별위97.82%、98.54%급98.80%。（6）이PAPP-A、AFP급uE3적연합예측인자작위검험변량회제ROC곡선병계산약등지수，연합예측인자위0.032시약등지수최대（위0.41），기예측자간전기적개치최대。고이0.032작위PAPP-A、AFP급uE3연합예측인자적예측계치，기예측자간전기적특이도위98.93%，민감도위70.59%，상대풍험도위2.37。결론무론시PAPP-A、AFP급uE3각단항혈청지표환시연합예측인자，대자간전기발병균유예측개치，단연합예측인자적예측개치요우우임일단항혈청지표。
Objective To discover the value of combined maternal first and second-trimester serumβ-hCG, pregnancy associated plasma protein A (PAPP-A), alpha-fetoprotein(AFP)and unconjugated estriol (uE3) in the prediction of preeclampsia.Methods A total of 1 805 pregnant women who had antenatal care at International Peace Maternal and Child Health Hospital Affiliated to Shanghai Jiaotong University between April 2012 and June 2013 were selected prospectively by random method. According to the outcome, they were defined as the control group and the preeclampsia group (including mild and severe cases). PAPP-A and β-hCG level were measured at 10-14 gestational weeks. AFP, β-hCG and uE3 were measured at 15-20 gestational weeks. The relevance between the serological indicators and outcomes was analyzed. The value of the indicators was judged by receiver operating characteristic(ROC)and Youden index, and the relevant predictive boundary values were identified.Results (1) Among the 1 805 cases, 1 739 women did not have hypertension(the control group), while 66 women had preeclampsia(the preeclampsia group). The incidence of preeclampsia was 3.66% (66/1 805), including 43 mild cases and 23 severe cases. (2) At 10-14 gestational weeks, the mean value of PAPP-A in the control group was(3 972± 2 311) mU/L, while in the preeclampsia group it was(2 837 ± 1 849)mU/L. The difference between the two groups had statistical significance(P<0.01). The mean value ofβ-hCG of the control group was 55(37~83) U/L, while in the preeclampsia group it was (57 ± 35) U/L. There was no statistical significance (P>0.05). PAPP-A,β-hCG and AFP of mild preeclampsia cases were(3 249 ± 1 877)mU/L,(61 ± 38)U/L and(35 ± 11)μg/L respectively, and in severe cases they were(1 758±1 297)mU/L,(47±23)U/L and(47±22)μg/L, respectively. There was statistically significant difference in PAPP-A(P<0.05). (3) At 15-20 gestational weeks,β-hCG, AFP and uE3 in the preeclampsia group were(47 909±31 396)U/L,(38±15)μg/L and(0.98± 0.31)μg/L respectively, and in the control group they were(39 267 ± 25 054)U/L,(47 ± 18)μg/L and (1.17±0.39)μg/L,respectively. AFP and uE3 of the preeclampsia group were lower than those in the control group and the difference was statistically significant (P<0.05). However, β-hCG and uE3 of the mild preeclampsia cases and the severe cases had no statistical difference (P>0.05). (4)At 10-14 gestational weeks, PAPP-A demonstrated positive relevance to the newborn weight(r=0.068, P=0.011)and gestational weeks at delivery(r=0.057,P=0.048). At 15-20 weeks, positive relevance was found between AFP and the newborn weight (r=0.149,P=0.000), while negative relevance was found between β-hCG and Apgar scores (r=-0.085,P=0.024), and positive relevance was found between uE3 and gestational weeks at delivery(r=0.086,P=0.036).(5) PAPP-A, AFP and uE3 data were used as testing parameters to obtain the boundary values of preeclampsia prediction as follows: PAPP-A 1 831 mU/L, AFP 41 μg/L and uE3 1.04 μg/L. The specificity was 97.82%,98.54% and 98.80%, respectively. (6) ROC was drawn and Youden index was calculated based on the joint predicative factor of PAPP-A, AFP and uE3. Youden index reached its peak (0.41) when the joint predictive factor was 0.032, meaning that the factor had the highest prediction value. The prediction value of the PAPP-A, AFP and uE3 was 0.032, with the specificity and sensitivity of 98.93%and 70.59%, respectively. The odds ratio was 2.37. Conclusion Both the individual parameter (PAPP-A, AFP and uE3) and the combined data have prediction value for preeclampsia, but the latter is more effective than any of the single parameter.
