胎盘生长因子水平联合唐氏筛查结果预测子痫前期的价值

Value of concentration of PLGF combined with Down’s screening results in predicting preeclampsia

目的探讨孕早中期胎盘生长因子(placental growth factor,PLGF)联合甲胎蛋白(alpha-fetoprotein,AFP)、β-hCG及游离雌三醇(unconjugated estriol,uE3)水平预测子痫前期(pre-eclampsia,PE)的价值。方法分析2018年5月—2020年3月郑州大学附属郑州中心医院妇产科行常规产检并分娩的367例孕妇,据随访结果分为PE组、对照组,采用ELISA法检测PLGF、AFP、β-hCG、uE3水平。分析各血清指标与部分产科结局相关性,应用受试者工作曲线(ROC曲线)及约登指数评判预测PE的价值,并确定相应界值。结果PE组PLGF、AFP及uE3水平均低于对照组,差异有统计学意义(P<0.05);两组β-hCG水平差异无统计学意义(P>0.05)。PLGF、AFP及uE3水平分别与新生儿出生体重及分娩孕周均呈正相关(P<0.05)。PLGF、AFP及uE3联合因子为检验变量时约登指数最大为0.622,特异度91.23%,敏感度68.92%。结论无论是PLGF、AFP、uE3各单项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。

Objective To discover the value of combined maternal first and second-trimester serum placental growth factor(PLGF),alpha-fetoprotein(AFP),β-hCG and unconjugated estriol(uE3)in the prediction of preeclampsia.Methods A total of 367 pregnant women who had antenatal care and born between May 2018 and March 2020 were selected,they were defined as the control group and the preeclampsia group(PE group).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 The level of PLGF、AFP and uE3 in the PE group was significantly lower than that in the control group.The difference between the two groups had statistical significance(P=0.012).For the level ofβ-hCG,there was no significant difference between two groups(P>0.05).The level of PLGF,AFP and uE3 in pregnant women was positively correlated with the birth weight(P<0.05)and the gestational age(P<0.05).ROC was drawn and Youden index was calculated based on the joint predicative factor of PLGF,AFP and uE3.The maximum value of Jordan index(0.622)is obtained in the joint prediction.Therefore,PLGF,AFP,β-hCG and uE3 were used to predict preeclampsia,with the specificity and sensitivity of 91.23%and 68.92%,respectively.Conclusion Both the individual parameter(PLGF,AFP and uE3)and the combined data have prediction value for preeclampsia,but the latter is more effective than any of the single parameter.