外周血sFIt-1、β-hCG、PAPP-A、AFP的表达与早发型子痫前期的关系

The relationship of the expression of peripheral-blood sFIt-1,β-hCG,PAPP-A,AFP and early onset preeclampsia

目的探讨外周血可溶性血管内皮生长因子受体-1(sFIt-1)、人绒毛膜促性腺激素(β—hCG)、孕早期妊娠相关蛋白A(PAPP-A)、甲胎蛋白(AFP)的表达与早发型子痫前期(PE)的相关性。方法选取2014年10月—2015年10月武汉市第一医院收治的PE患者84例,其中早发型48例,迟发型36例。选择同期正常妊娠妇女80例为对照组。应用ELISA法测定所有研究对象外周血sFIt-1、β—hCG、PAPP—A、AFP水平,应用受试者特异性曲线(ROC)分析sFIt—1、β-hCG、PAPP-A、AFP对早发型子痫前期的诊断价值。结果早发型组PE患者外周血sFIt—1、β—hCG、PAPP—A、AFP水平均高于对照组(t=9.236、10.422、11.986、14.785,P<0.05),早发型组sFIt—1、PAPP—A、AFP水平高于迟发型组(t=9.236、7.458、10.252,P<0.05),而迟发型组外周血sFIt—1、PAPP-A、AFP与对照组比较差异无统计学意义(t=0.785、0.902、0.525,P>0.05)。早发型组重度PE外周血sFIt-1、β-hCG、PAPP-A、AFP水平均高于轻度患者(t=6.271、31.680、3.449、5.045,P<0.05),而迟发型组重度患者外周血sFIt-1、PAPP—A、AFP水平与轻度患者比较差异无统计学意义(t=0.598、0.230、0.437,P>0.05),而β-hCG比较差异有统计学意义(t=6.043,P<0.05)。经ROC分析可知,sFIt-1+β-hCG+PAPP—A+AFP联合诊断早发型PE的灵敏度及特异度高于单一指标检测。结论外周血sFIt-1、β—hCG、PAPP-A、AFP水平与早发型PE发生发展有密切的关系,早发型与晚发型PE可能存在不同的发病机制。通过联合应用多种指标诊断可提高早发型子痫前期患者诊断灵敏度。

Objective To investigate the relationship of the expression of peripheral-blood vascular endothelial growth factor receptor-1（sFIt-1）,human chorionic gonadotropin（β-hCG）,first trimester pregnancy associated plasma protein A（PAPP-A）,alpha-fetoprotein（AFP） and early onset preeclampsia（PE）.Methods 84 cases of PE（48 cases of early onset,late-onset 36 cases） were selected in our hospital from October 2014 to October 2015.Meanwhile,80 cases of normal pregnancy women were selected as the control group.The levels of peripheral-blood sFIt-1,β-hCG,PAPP-A,AFP of all patients were measured by ELISA.The diagnostic value of fi-hCG,PAPP-A,AFP of early-onset preeclampsia were analyzed by application-specific subjects curve（ROC）.Results The levels of peripheral-blood sFIt-1,β-hCG,PAPP-A,AFP in the PE patients of early-onset group were all higher than the control group（t = 9.236,t =10.422,t =11.986,t =14.785,P〈0.05）,while the levels of sFIt-1,PAPP-A,AFP of early-onset were higher than late-onset（t =9.236,t =7.458,I =10.252,P〈0.05）,and there was no significant difference between the levels of peripheral-blood sFIt-1,PAPP-A,AFP of late-onset groupand the control group（t = 0.785,t = 0.902,t = 0.525,P〉0.05）.The levels of peripheral-blood sFIt-1,0-hCG,PAPP-A,AFP of early-onset severe PE were higher than mild group（t =6.271,t = 31.680,t = 3.449,t =5.045,P〈0.05）,and there was no significant difference between the levels of peripheral-blood sFIt-1,PAPP-A,AFP of delayed severe patients and the mild group（t =0.598,t =0.230,t =0.437,P〈0.05）,and β-hCG was statistically significant t =6.043,P〈0.05）.ROC analysis shows that the sensitivity and specificity of sFIt-1 ＋ β-hCG ＋ PAPP-A ＋ AFP joint diagnosis of early-onset PE were higher than single index detection.Conclusion There is a close relationship between peripheral blood sFIt-1,β-hCG,PAPP-A,AFP levels and early-onset PE,and different pathogenesis may exist between early-onset and late-onset PE.It can enhance the diagnostic sensitivity of early- onset preeclampsia with combination of multiple indexes.