孕早期PAPPA水平在预测孕晚期不良妊娠结局中的意义

The predictive value of PAPPA level in the first trimester of pregnancy for the poor pregnancy outcome in the last trimester pregnancy

目的探讨孕早期PAPPA水平在预测孕晚期不良妊娠结局子痫前期,胎儿生长受限,早产,死胎,胎盘早剥中的意义。方法选取2014年1-12月在我院11~13^(+6)周行PAPPA检测并已在我院分娩的孕妇400例,将PAPPA<0.43MOM定为PAPPA降低,共收取PAPPA<0.43MOM的孕妇200例,PAPPA>0.43MOM的孕妇200例,比较两组不良妊娠结局的发生情况,并比较不同妊娠结局PAPPA水平。结果 PAPPA<0.43MOM组子痫前期,胎儿生长受限,死胎的发生率明显升高,早产,胎盘早剥的发生率无明显差异。PAPPA<0.43MOM组子痫前期,胎儿生长受限,死胎的发生风险为PAPPA>0.43MOM组的4.0,6.7,4.8倍(P<0.05);早产,胎盘早剥的发生风险为PAPPA》0.43MOM组的1.2,1.3倍(P>0.05)。子痫前期,胎儿生长受限,死胎的孕早期PAPPA水平明显低于正常妊娠孕妇(P<0.05),早产,胎盘早剥孕妇的PAPPA水平与正常妊娠孕妇无明显差异(P>0.05)。结论孕早期PAPPA水平在预测孕晚期不良妊娠结局子痫前期,胎儿生长受限,死胎有重要意义。

Objective To explore the predictive value of PAPPA level in the first trimester of pregnancy for the poor pregnancy outcome（preeclampsia,fetal growth restriction,stillbirth,pre- term birth,placental abruption） in the last trimester.Methods Patients who had tested PAPPA in the 11-13＋6 weeks of pregnancy and registered for delivery in our hospital between January and December 2014 were taken into the trial.When PAPPA levelless than 0.43 MOM,we called it PAPPA decreased.Contrasting pregnancy outcomes of pregnant women with PAPPA less than 0.43MOM（n = 200） and PAPPA more than 0.43MOM（n =200）.Contrasting PAPPA levels of different poor pregnancy outcomes.Results The occurrence rate of preeclampsia,stillbirth,fetal growth restriction was increased for those pregancy women with PAPPA 〈0.43 MOM.But the occurrence rate of pre- term birth and placental abruption were not significantly increased.Woman with PAPPA 〈0.43 MOM were at increased risk of preeclampsia,fetal growth restriction,stillbirth compared with PAPPA 〉0.43MOM（OR =4.0,6.7 and 4.8 respectively）（P 〈0.05）.The OR of woman with PAPPA 〈0.43 MOM were1.2 and 1.3 of pre-term birth,placental abruption compared with PAPPA 〉0.43MOM（P 〉0.05）.PAPPA level of the pregnancy woman who suffered from preeclampsia,fetal growth restriction and stillbirth were obviously lower than the normal（P 〈 0.05）.PAPPA level of the pregnancy woman who suffered from pre- term birth,placental abruption were not obviously lower than the normal（P 〉 0.05）.Conclusions PAPPA level in the first trimester of pregnancy played an important role in predicting poor pregnancy outcome（preeclampsia,fetal growth restriction,stillbirth）in the last trimester.