妊娠早期血清学指标联合子宫动脉血流动力学指标预测子痫前期

Efficacy of serum markers and hemodynamic index of bilateral uterine arteries to predict preeclampsia in first trimester of pregnancy

目的探讨早孕期妊娠相关血清蛋白A(PAPP-A),游离β-人绒毛膜促性腺激素(Free-β-hCG)及双侧子宫动脉血流动力学指标联合预测子痫前期的价值。方法随机选择2014年1月至2015年1月在西安交通大学第一附属医院及陕西省第四人民医院产科门诊进行正规产前检查的孕9周至孕12周的单胎孕妇960例。分别检测PAPP-A、Freeβ-hCG及子宫动脉血流动力学指标(PI、RI、S/D)。结果①PAPP-A预测子痫前期的灵敏度为75.00%,特异度96.79%;Free-β-hCG灵敏度78.57%,特异度为96.22%;②子宫动脉PI、RI及S/D的灵敏度分别为74.65%、70.27%、77.27%,特异度为别为95.97%、95.83%、97.04%;③PAPP-A、Free-β-hCG及子宫动脉血流联合预测子痫前期灵敏度86.21%,特异度95.67%,约登指数为0.82。结论早孕期血清PAPP-A、Free-β-hCG及子宫动脉血流动力学指标联合应用对孕期发生子痫前期具有更高的预测价值。

Objective To assess the efficacy of pregnancy associated plasma protein-A （PAPP-A）, free β human chorionic gonadotropin （free-β-hCG） and hemodynamic indexes of bilateral uterine arteries to predict preeclampsia in first trimester of pregnancy. Methods From January 2014 to January 2015, 960 outpatients of singleton at gestational weeks of 9 - 12, taking regular prenatal examination in Fourth People＇ s Hospital of Shaanxi or First Affiliated Hospital of Xi＇ an Jiaotong University, were randomly selected. PAPP-A, Free-β-HCG and hemodynamic indexes of bilateral uterine arteries （PI, RI, S/D） were detected for them. Results The sensitivity and specificity of PAPP-A in predicting preeclampsia were 75. 00% and 96. 79%, respectively, and those of free-β-hCG were 78. 57% and 96. 22%, respectively. The sensitivity of PI, RI and S/D in uterine arteries was 74.65% , 70.27% and 77.27% , respectively, while the specificity of them was 95.97% , 95.83% and 97.04%, respectively. Using combination of PAPP-A, free-β-hCG and indexes （ PI, RI, S/D） of bilateral uterine arteries, the specificity and sensitivity of prediction were 86.21% and 95.67%, respectively. Youden index was 0. 82. Conclusion Combining of PAPP-A, free-β-HCG and hemodynamic index of bilateral uterine arteries appear to be more valuable in predicting preeclampsia in first trimester of pregnancy.