目的:探究孕早期血清妊娠相关血浆蛋白A(PAPP-A)、胎盘生长因子(PlGF)在预测评估子痫前期(PE)价值.方法:回顾性分析2018年10月-2021年11月于本院孕早期建档并就诊至分娩的PE孕妇80例临床资料纳入PE组,根据病情严重程度将80例PE组孕妇分为重度组(n=35)和非重度组(n=45);同期产前检查至分娩的健康孕妇84例临床资料纳入对照组.比较各组孕早期(孕11～13周)时血清PAPP-A、PlGF)尿蛋白(24h尿蛋白定量)及孕晚期血压(收缩压、舒张压)水平,经Pearson相关系数分析PE孕妇孕早期时PAPP-A、PlGF与孕早期尿蛋白(24h尿蛋白定量)水平、孕晚期血压(收缩压、舒张压)的相关性.经受试者工作特征(ROC)曲线分析PE孕妇孕早期血清PAPP-A、P1GF 水平对 PE 预测效能.结果:孕早期 PE 组血清 PAPP-A(25.91±2.64 ng/ml)、PlGF(18.07±2.93μg/L)均低于对照组(28.15±3.42 ng/ml、21.77±4.35μg/L),24h尿蛋白定量、收缩压、舒张压均高于对照组,PE病情越严重其血清PAPP-A、PLGF水平越低(均P＜0.05);相关性分析显示,PE孕妇血清PAPP-A、PlGF水平与24h尿蛋白定量水平、收缩压、舒张压均呈负相关;ROC曲线分析,孕早期PAPP-A水平预测PE的敏感度为74.3％、特异性为66.7％、曲线下面积(AUC)为0.676,PlGF水平预测PE敏感度60.0％、特异性68.9％、AUC为0.671(P＜0.05).结论:PE孕妇孕早期PAPP-A、PlGF水平低于健康孕妇,且随PE病情加重PAPP-A、PlGF水平降低;孕早期PAPP-A、PlGF水平预测PE有一定临床价值.
Clinical value of the levels of serum pregnancy-associated plasma protein A and placental growth factor of pregnant women during the first trimester of pregnancy for evaluating their preeclampsia
Objective:To explore the application value of the levels of serum pregnancy-associated plasma protein A(PAPP-A)and placental growth factor(PlGF)of pregnant women during the first trimester of pregnancy for evalua-ting their preeclampsia(PE).Methods:The clinical data of 80 pregnant women with PE in study group who were reg-istered in hospital during the first trimester of pregnancy and treated until delivery from October 2018 to November 2021 were analyzed retrospectively.The women in the study group were divided 35 women with severe PE in group A and 45 women with mild PE in group B.The clinical data of 84 healthy pregnant women who had pregnancy examina-tion and were followed up until delivery in control group during the same period were also analyzed retrospectively.The levels of serum PAPP-A and PlGF and the urine protein value(24h urine protein)during the first trimester of pregnan-cy(11-13 gestational weeks),and the values of blood pressure(systolic blood pressure and diastolic blood pressure)during the third trimester of pregnancy of the women were compared among these groups.Pearson correlation coeffi-cient was used to analyze the correlation between the levels of serum PAPP-A and P1GF of the women during the first trimester of pregnancy and their urine protein value(24h urine protein)during the first trimester of pregnancy and the values of blood pressure(systolic blood pressure and diastolic blood pressure)during the third trimester of pregnancy.The predictive efficacy of the serum PAPP-A and PlGF levels during the first trimester of pregnancy of the women for their PE was analyzed by receiver operating characteristic(ROC)curve.Results:The levels of serum PAPP-A(25.91±2.64 ng/ml)and PlGF(18.07±2.93µg/L)of the women in the study group were significantly lower than those(28.15±3.42 ng/ml and 21.77±4.35μg/L)of the women in the control group.The 24h urine protein quantification level and the values of the systolic blood pressure and diastolic blood pressure of the women in the study group were significantly higher than those of the women in the control group.The levels of serum PAPP-A and PLGF of the women in group A were significantly lower than those of the women in group B(all P＜0.05).Correlation analysis showed that the serum PAPP-A and PlGF levels of the women with PE were negatively correlated with their 24-hour urinary protein quantitative level and systolic blood pressure and diastolic blood pressure values.ROC curve analysis showed that the sensitivity,the specificity and the area under the curve(AUC)of the PAPP-A level of the pregnant women during the first trimester of pregnancy for predicting their PE occurrence were 74.3％,66.7％and 0.676,re-spectively.The sensitivity,the specificity and the AUC of the PlGF level of the pregnant women during the first tri-mester of pregnancy for predicting their PE occurrence were 60.0％,68.9％and 0.671,respectively(P＜0.05).Con-clusion:The levels of PAPP-A and PlGF of the pregnant women with PE during the first trimester of pregnancy are lower than those of the healthy pregnant women,and which of the women decrease with their PE severity.The levels of PAPP-A and PlGF of the pregnant women during the first trimester of pregnancy have certain predictive values for their PE occurrence.
PreeclampsiaThe first trimester of pregnancyPregnancy-associated plasma protein APlacental growth factorPredictive value
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