孕妇血清PAPP-A、PP-13、β-HCG水平与妊娠期糖尿病、子痫前期的相关性临床研究

A clinical study on the relationship between serum PAPP-A,pp-13,β-hCG and gestational diabetes and preeclampsia

目的研究孕妇血清妊娠相关血浆蛋白A(PAPP-A)、人绒毛膜促性腺激素(β-HCG)、胎盘蛋白13(PP-13)与妊娠期糖尿病(GDM)、子痫前期(PE)的相关性,探讨其在早期预测中的价值。方法将2019年11月-2020年5月期间在衡水市第二人民医院妇产科孕11-13+6w行早孕唐氏筛查,并于医院分娩的孕妇纳入研究范围,选择其中符合本次试验标准的GDM孕妇120例(GDM组)和PE孕妇120例(PE组)作为研究对象,并选择同期无合并症的正常孕期孕妇120例作为对照组。所有孕妇均于孕11-13+6w采用酶联免疫吸附法检测血清PP-13水平,采用化学发光法检测血清PAPP-A、β-HCG水平;所得数据经校正混杂因素后转化为中位数倍数(MoM)。采用ROC曲线分析血清PAPP-A、PP-13、β-HCG水平分别对GDM、PE的预测价值。结果三组间血清PAPP-A MOM、PP-13 MOM、β-HCG MOM比较具有明显统计学差异(P<0.05),其中GDM组、PE组PAPP-A MOM、PP-13 MOM均低于对照组(P<0.05),GDM组β-HCG MOM低于对照组,PE组β-HCG MOM高于对照组(P<0.05)。GMD组PAPP-A MOM、PP-13 MOM高于对照组,β-HCG MOM低于对照组(P<0.05);PAPP-A MOM、PP-13 MOM、β-HCG MOM预测GDM的ROC曲线下面积分别为0.807(95%CI 0.750-0.865)、0.601(95%CI 0.530-0.673)、0.589(95%CI 0.517-0.661),PAPP-A MOM在GDM诊断中的灵敏度、特异度均高于PP-13 MOM、β-HCG MOM;PAPP-A MOM、PP-13 MOM、β-HCG MOM预测PE的ROC曲线下面积分别为0.855(95%CI 0.804-0.907)、0.825(95%CI 0.772-0.877)、0.838(95%CI 0.7810.895),PAPP-A MOM、PP-13 MOM、β-HCG MOM在GDM诊断中的灵敏度、特异度比较无明显差异,均具有较好的诊断效果。结论孕妇血清PAPP-A、PP-13、β-HCG水平在GDM、PE中异常表达;其中在PE诊断中,PAPP-A、PP-13、β-HCG具有一定的预测价值,具有较高的灵敏度和特异度;在GDM诊断中,仅PAPP-A具有诊断价值,PP-13、β-HCG灵敏度和特异度较低。

Objective:To study the correlation of pregnancy associated plasma protein A(PAPP-A),human chorionic gonadotropin(β-hCG),placental protein 13(pp-13)with gestational diabetes mellitus(GDM)and preeclampsia(PE)in pregnant women,and to explore their value in early prediction.Methods:From November 2019 to May 2020,Tang′s screening of early pregnancy was carried out in the second people′s Hospital of Hengshui in the period of 11-13+6 weeks,and pregnant women delivered in hospital were included in the study.120 GDM pregnant women(GDM group)and 120 PE pregnant women(PE group)were selected as the study objects,and 120 normal pregnant women without complications in the same period were selected as the control group.All pregnant women were tested for serum pp-13 by enzyme-linked immunosorbent assay(ELISA)and serum PAPP-A andβ-hCG by chemiluminescence at 11-13+6 weeks of gestation.ROC curve was used to analyze the predictive value of serum PAPP-A,pp-13 andβ-HCG to GDM and PE respectively.Results:The serum PAPP-A mom,pp-13 mom andβ-hCG mom in GDM group and PE group were lower than those in control group(P<0.05),β-hCG mom in GDM group was lower than that in control group,andβ-hCG mom in PE group was higher than that in control group(P<0.05).PAPP-A mom and pp-13 mom in GMD group were higher than those in control group,andβ-hCG mom was lower than those in control group(P<0.05);The area under ROC curve of PAPP-A mom,pp-13 mom andβ-hCG mom was 0.807(95%CI 0.750-0.865),0.601(95%CI 0.530-0.673)and 0.589(95%CI 0.517-0.661),respectively.The sensitivity and specificity of PAPP-A mom in the diagnosis of GDM were higher than those of pp-13 mom andβ-hCG mom;The area under ROC curve of PAPP-A mom,pp-13 mom andβ-hCG mom was 0.855(95%CI 0.804-0.907),0.825(95%CI 0.772-0.877)and 0.838(95%CI 0.7810.895),respectively.The sensitivity and specificity of PAPP-A mom,pp-13 mom andβ-hCG mom in the diagnosis of GDM had no significant difference,and they all had better diagnosis effect.Conclusion:The serum PAPP-A,pp-13 andβ-hCG levels of pregnant women are abnormally expressed in GDM and PE,among which PAPP-A,pp-13 andβ-hCG have a certain predictive value in PE diagnosis,with high sensitivity and specificity,while only PAPP-A has a diagnostic value in GDM diagnosis,with low sensitivity and specificity in pp-13 andβ-hCG.