孕中期母血PAPPA与PIGF在预测子痫前期发生的作用

Role of Maternal PAPPA and PIGF Levels at Second Trimester in the Prediction of Preeclampsia

目的：通过检测孕中期（15～19周）孕妇血清（妊娠相关血浆蛋白 APAPPA）与（胎盘生长因子PIGF）的水平，评价该指标在预测孕末期子痫前期发生的作用。方法采用前后测量的研究方法，选取2013年6月～2015年7月在渭南市妇幼保健院诊治的204例单胎孕妇，从孕中期一直观察至孕末期（36～40周）。其中孕末期89例诊断为子痫前期，115例为正常孕妇。分别检测其孕中期及孕末期 PAPPA与PIGF水平等指标。结果①子痫前期患者，孕中期 PAPPA与 PIGF水平明显低于同期正常单胎孕妇（2.3μg／ml vs 4.6μg／ml，U＝11.31，P＝0.017；78 pg／ml vs 160 pg／ml，U＝8.26，P＝0.003）；②子痫前期患者，孕末期PAPPA与PIGF明显低于其孕中期水平（1.6μg／ml vs 2.3μg／ml，U＝9.41，P＝0.011；56 pg／ml vs 78 pg／ml，U＝6.77，P＝0.023）；③ROC曲线显示，孕中期PAPPA Cutoff值为2.2μg／ml及PIGF Cutoff值为75 pg／ml时，子痫前期发生预测值特异度为61.7％，敏感度为87.8％，AUC为0.86（95％可信区间0.83～0.91）。结论孕中期（15～19周）检测PAPPA与PIGF水平，可成为预测发生子痫前期的有用指标。

Objective To determine the PAPPA and PIGF levels in maternal serum at second trimester（15 to19 weeks）to e-valuate the role of these in the prediction of preeclampsia at last trimester.Methods Using premeasure postmeasure design, identified 204 singleton pregnancies within 15 to 19 weeks of gestation that followed 89 who had developed preeclampsia during 36 and 40 weeks,gestation at Weinan Municipal Maternal and Child Health Hospital at June 2013 and July 2015,115 with normotensive pregnant.PAPPA and PIGF concentration were determined.Results ①PAPPA and PIGF levels were significantly reduced in the preeclampsia groups compared to the normotensive pregnant group at second trimester （2.3μg/ml vs 4.6μg/ml,U=11.31,P=0.017;78 pg/ml vs 160 pg/ml,U=8.26,P=0.003）.②PAPPA and PIGF levels were sig-nificantly reduced at last trimester compared to second trimester in the preeclampsia groups （1.6μg/ml vs 2.3μg/ml,U=9.41,P=0.011;56 pg/ml vs 78 pg/ml,U=6.77,P=0.023）.③Receiver operating characteristic curve analysis showed that at second trimester（at 15 to 19 weeks）a cutoff value of 2.2μg/ml for PAPPA and a cutoff value of 75pg/ml for PIGF were able to predict preeclampsia with specificity,sensitivity and area under the curve （AUC）61.7%,87.8%,AUC 0.86（95%CI,0.83~0.91）respectively.Conclusion Measuring PAPPA and PIGF in the second trimester（at 15 to 19 weeks）may be useful in the prediction of preeclampsia.