妊娠早期联合指标对子痫前期的预测
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摘要
目的在妊娠早期收集孕产妇病例资料、体格检查和血清生化指标,并进行联合分析,提出预测和筛查子痫前期的方法。方法将孕早期在我院建档具有完整规律产检资料的孕产妇纳入该项回顾性队列研究分中,收集孕产妇病例资料、人口数据学资料、体格检查和血清生化指标数据,根据妊娠结局分为轻度子痫前期、重度子痫前期与正常对照组,对比2组的各项指标,logistic回归分析计算出妊娠期高血压疾病发病的危险因素和预测公式。结果 2013年1月-2015年12月,在符合纳入研究标准的925例病例中,118人发生子痫前期(Preeclampsia,PET),其中73人发生轻度子痫前期(Mild preeclampsia,mPET),45人发生重度子痫前期(Severe preeclampsia,sPET),正常组807例。发现高龄、低教育水平、合并糖尿病或免疫病史、子痫前期病史、平均动脉压、肥胖、孕妇血清妊娠相关血浆蛋白-A (Pregnancy-associate plasma protein-A)水平和抑制素A (inhibinA,InhA)水平是子痫前期的危险因素。并通过logistic回归分析计算出子痫前期的预测公式,ROC曲线显示联合病例资料和生化指标预测mPET的曲线下面积0.874 (灵敏度83.8%,特异度77.0%),预测s PET的曲线下面积0.889 (灵敏度84.7%,特异度80.0%)。结论通过将孕早期收集孕产妇病例资料、人口数据学资料、体格检查和血清生化指标数据,对子痫前期的预测和筛查具有较高的应用价值。
Objective To observe the value of combined indicators in the prediction of preeclampsia(PE) in the first trimester of pregnancy. Methods A retrospectively cohort analysis was performed on 925 pregnant women who had undergone early clinical examination and delivery. The patients were divided into PE group(118 cases) and control group(807 cases) according to whether PE occurred. The general data,β-hCG and pregnancy-associated plasma protein A(PAPP-A) were comparatively analyzed. The receiver operating characteristic(ROC) curves were used to compare the diagnostic value and diagnostic efficacy of those indicators for predicting adverse pregnancy outcomes. Results High risks for PE including: elder maternal age, over-weight, poor education level, MAP, previous preeclampsia history, family history of chronic hypertension(Materanl family), previous medical history(diabetes mellitus, autoimmune diseases like SLE and APS),PAPP-A and Inh A. ROC curves showed that the area under the curve for mPET and sPET is 0.874(sensitivity 83.8%, specificity 77.0%) and 0.889(sensitivity 84.7%, specificity 80.0%).Conclusion Early prediction of PE complicating pregnancy incorporating maternal characteristics and biomedical markers considered of positive value.
Objective To observe the value of combined indicators in the prediction of preeclampsia(PE) in the first trimester of pregnancy. Methods A retrospectively cohort analysis was performed on 925 pregnant women who had undergone early clinical examination and delivery. The patients were divided into PE group(118 cases) and control group(807 cases) according to whether PE occurred. The general data,β-hCG and pregnancy-associated plasma protein A(PAPP-A) were comparatively analyzed. The receiver operating characteristic(ROC) curves were used to compare the diagnostic value and diagnostic efficacy of those indicators for predicting adverse pregnancy outcomes. Results High risks for PE including: elder maternal age, over-weight, poor education level, MAP, previous preeclampsia history, family history of chronic hypertension(Materanl family), previous medical history(diabetes mellitus, autoimmune diseases like SLE and APS),PAPP-A and Inh A. ROC curves showed that the area under the curve for mPET and sPET is 0.874(sensitivity 83.8%, specificity 77.0%) and 0.889(sensitivity 84.7%, specificity 80.0%).Conclusion Early prediction of PE complicating pregnancy incorporating maternal characteristics and biomedical markers considered of positive value.
引文
[1]李媛媛,张海鲲,李忠良,等.不良妊娠结局现状及其影响因素分析[J].中国妇幼健康研究,2014,25(4):577-580.
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[6]Bellamy L,Casa JP,Hingorani AD,et al.Pre-eclampsia and risk of cardiovascular disease and cancer in later life:systematic review and meta-analysis[J].BMJ,2007,335(7626):974.
[7]Feig DS,Shah BR,Lipscombe LL,et al.Preelampsia as a risk factor for diabetes:a population-based cohort study[J].PloS Med,2013,10(4):e1001425.
[8]Kalousova M,Muravska A,Zima T.Pregnancy-associated plasma protein A(PAPP-A)and preeclampsia[J].Adv Clin Chem.2014.63(1):169-209.
[9]Ranta JK,Raatikainen K,Romppanen J,et al.Decreased PAPP-A is associated with preeclampsia,premature delivery and small for gestational age infants but not with placental abruption[J].Eur J Obstet Gynecol Reprod Biol,2011,157(1):48-52.
[10]Nanda S,Yu CK,Giurcaneanu L,et al.Maternal serum adiponecin at 11-13 weeks of gestation in preeclampsia[J].Fetal Diagn Ther,2011,29(3):208-215.
[11]Florio P,Cobellis L,Luisi S,et al.Changes in inhibins and activin secretion in healthy and pathological pregnancies[J].Mol Cell Endocrinol,2001,180(1/2):123-130.
[12]Bobrow CS,Holmes RP,Muttukrishna S,et al.Maternal serum activin A,inhibin A,and follistatin in pregnancies with appropriately grown and small-for-gestational-age fetuses classified by umbilical artery Doppler ultrasound[J].Am J Obstet Gynecol,2001,186(2):283-287.
[2]聂良华,沈其君.产前筛查试验中MOM方法的原理及其应用[J].中国医院统计,2006,13(4):302.
[3]Redman CW,Sargent IL.Latest advances in understanding preeclampsia[J].Science,2005,308(5728):1592-1594.
[4]林其德.对子痫前期的新妊娠[J].中华妇产科杂志,2009,44(2):81-83.
[5]Souza JP,Gulmezoglu AM,Vogel J,et al.Moving beyond essential interventions for reduction of maternal mortality(the WHO Multicountry Survey on Maternal and Newborn Health:a cross-sectional study[J].Lancet,2013,381(9879):1747-1755.
[6]Bellamy L,Casa JP,Hingorani AD,et al.Pre-eclampsia and risk of cardiovascular disease and cancer in later life:systematic review and meta-analysis[J].BMJ,2007,335(7626):974.
[7]Feig DS,Shah BR,Lipscombe LL,et al.Preelampsia as a risk factor for diabetes:a population-based cohort study[J].PloS Med,2013,10(4):e1001425.
[8]Kalousova M,Muravska A,Zima T.Pregnancy-associated plasma protein A(PAPP-A)and preeclampsia[J].Adv Clin Chem.2014.63(1):169-209.
[9]Ranta JK,Raatikainen K,Romppanen J,et al.Decreased PAPP-A is associated with preeclampsia,premature delivery and small for gestational age infants but not with placental abruption[J].Eur J Obstet Gynecol Reprod Biol,2011,157(1):48-52.
[10]Nanda S,Yu CK,Giurcaneanu L,et al.Maternal serum adiponecin at 11-13 weeks of gestation in preeclampsia[J].Fetal Diagn Ther,2011,29(3):208-215.
[11]Florio P,Cobellis L,Luisi S,et al.Changes in inhibins and activin secretion in healthy and pathological pregnancies[J].Mol Cell Endocrinol,2001,180(1/2):123-130.
[12]Bobrow CS,Holmes RP,Muttukrishna S,et al.Maternal serum activin A,inhibin A,and follistatin in pregnancies with appropriately grown and small-for-gestational-age fetuses classified by umbilical artery Doppler ultrasound[J].Am J Obstet Gynecol,2001,186(2):283-287.