外周血sFlt-1、PlGF、25-羟基维生素D、D-二聚体、vWF及P-选择素等指标预测子痫前期的价值

Clinical Value of Soluble Fms-like Tyrosine Kinase-1,Placental Growth Factor,25-hydroxyvitamin D,D-dimer,von Willebrand Factor,P-selectin for the Risk Assessment of Preeclampsia during the First Trimester of Pregnancy

目的:分析可溶性血管内皮生长因子受体-1(s Flt-1)、胎盘生长因子(Pl GF)、25-羟基维生素D(25-OHVD)、D-二聚体、血管性假血友病因子(v WF)及P-选择素在子痫前期患者妊娠早期外周血中的表达,探讨其在子痫前期发生中的预测价值。方法:选择2013年1—12月在南方医科大学附属深圳妇幼保健院产科门诊进行产前检查的1 081例妊娠10~13^(+6)周的单胎孕妇作为研究对象,选取发生子痫前期者为病例组(50例),同期无妊娠并发症以及合并症的正常妊娠妇女352例作为对照组。采用酶联免疫吸附试验(ELISA)检测外周血中s Flt-1、Pl GF、25-OH-VD、D-二聚体、v WF及P-选择素的浓度。通过受试者工作特征(ROC)曲线分析这6个生化指标预测PE发生的敏感度和特异度。结果:1病例组外周血s Flt-1、D-二聚体、v WF及P-选择素平均值均高于对照组,差异有统计学意义(P<0.05);外周血Pl GF及25-OH-VD平均值病例组均低于对照组,差异有统计学意义(P<0.05);2ROC曲线结果显示,s Flt-1、Pl GF、25-OH-VD、D-二聚体、v WF及P-选择素的中位数倍数(Mo M)之和预测子痫前期,具有较高的敏感度(78%)和特异度(100%)。结论:妊娠早期联合检测外周血s Flt-1、Pl GF、25-OH-VD、D-二聚体、v WF及P-选择素多项生物学指标联合能提高子痫前期的预测价值。

Objective：To evaluate the signification of serum soluble fms-like tyrosine kinase-1（s Flt-1）,placental growth factor（Pl GF）,25-hydroxyvitamin D（25-OH-VD）,D-dimer,von Willebrand factor（v WF）,P-selectin for predicting risk of pre-eclampsia（PE） during the first trimester of pregnancy. Methods：In this nested cohort,we recruited 1 081 consecutive women who presented for antenatal care between 10 and 13^（＋6） weeks of gestation from Shenzhen Maternity and Child Healthcare Hospital from January 2013 to December 2013. Of the 1 081 pregnant women studied,50 patients were diagnosed with PE as case group. There are 352 normal pregnant women without complications as control group. Serum s Flt-1,PLGF,25-OH-VD,D-dimer,v WF and P-selectin were detected by ELISA. Using ROC curve to evaluate the value of diagnosis preeclampsia for the six index alone or combination. Results：During 10-13＋6weeks of gestation serum levels of s Flt-1,D-dimer,v WF,P-selectin of gravida with PE were significantly higher than the control group（P 0.05）. The serum Pl GF and 25-OH-VD levels in case group was significantly lower than that in the control group（P〈0.05）. Combining total multiple of median（Mo M） of serum s Flt-1,Pl GF,25-OH-VD,D-dimer,v WF,P-selectin using ROC curve analysis can get a sensitivity of 78% and a specificity of100% for predicting the risk of PE. Conclusions：Combining screening of different biomarkers such as serum s Flt-1,Pl GF,25-OH-VD,D-dimer,v WF and P-selectin could increase the predictive value of PE at the first trimester pregnancy.