妊娠11～14周孕妇血清PAPP-A与血清CA125、TM联合检测在早期诊断胎盘早剥中的价值

Value of serum PAPP-A and serum CA125,TM in early diagnosis of placental abruption in pregnant women at 11～14 weeks of gestation

目的探讨妊娠11~14周孕妇血清中PAPP-A水平值在胎盘早剥中的预测价值,以及联合检测孕妇血清中CA125、TM水平对早期诊断胎盘早剥的临床价值。方法前瞻性选取2014年1月到2015年8月,孕11~14周时行Ⅰ期唐氏筛查的孕妇,孕周大于20周后有阴道出血、子宫体压痛、腰背痛、不明原因胎儿窘迫及宫缩过频、子宫张力过高等怀疑胎盘早剥的孕妇100例作为研究对象,产后检查是否有胎盘早剥再分为早剥组66例、无早剥组34例;同期选择在该院产检并正常分娩的100例孕妇为对照组,分别登记其PAPP-A值,并行CA125、TM检测,B超检查和产后胎盘检查,比较三组检测结果的差异。应用ROC曲线和约登指数评判各血清学指标在胎盘早剥诊断中的价值,并确定PAPP-A和TM相应的诊断界值。结果妊娠11~14周血清PAPP-A值,胎盘早剥组明显低于无胎盘早剥组和正常对照组（P〈0.05）,胎盘早剥组CA-125、TM水平明显高于无胎盘早剥组和正常对照组,均有统计学意义（P〈0.05）。将PAPP-A、TM作为检验变量得出诊断胎盘早剥的界值,PAPP-A〈2 028 m U/L、TM〉55μg/L时预测价值最高。结论妊娠11~14周低水平的血清PAPP-A值对胎盘早剥有预测作用;高水平的血清CA-125和高TM值对胎盘早剥的早期诊断具有较高的临床应用价值。

Objective To investigate the predictive value of serum PAPP-A level in placenta of pregnant women at 11 ~ 14 weeks of gestation, and evaluate the clinical value of serum CA125 and TM levels in the early diagnosis of placental abruption. Methods A total of 100 pregnant women who had vaginal bleeding, uterine tenderness, back pain, unexplained fetal distress, uterine contraction frequency, high tension suspected of placental abruption after receiving Down＇s syndrome screening at PAPP-A levels in 11 - 14 weeks of gestation between Jan.2014 and Aug.2016 were selected as the research subjects, and then according to the result of labor, divided into the placental abruption group （66 cases）, no placental abruption group （44cases）. At the same time, one hundred cases of normal pregnant women were chosen by random method as a normal group. The three serum parameters detection of PAPP-A CA-125 TM were assayed and compared, combined with ultrasound examination. All pregnant women were followed-up to termination of pregnancy. The final diagnosis of placental abruption was determined by the placenta stripping and placenta pathological examination after natural labor or cesarean section. The relevance between the serological indicators and outcomes was analyzed. The value of the indicators was judged by receiver operating characteristic （ROC）and Youden index, and the PAPP-A, TMrelevant detection boundary values were identified. Results The levels of serum PAPP-A at 10 - 14gestation weeks in placental abruption group was significantly lower than the normal and suspicious but no placental abruption group; CA125 and TM in placental abruption group were significantly higher than these in other two group （P〈0.05）. There was no statistical difference the levels of serum PAPP-A and CA125, TM between in no placental abruption group and normal group（ P〉0. 05）. PAPP-A, TM date were used as testing parameter to obtain the boundary values of placental abruption as follows： PAPP-A〈2028mU/L, TM〉55μg/L. The specificity was 91.66, 94.69. The sensitivity of three indexes joint detection for placental abruption was significantly higher than that of one index detection （P〈0.01）. Conclusions The lower levels of serum PAPP-A at 10- 14 gestational weeks have prediction value in the placental abruption, the higher levels of TM and CA125 in pregnant woman have value in early diagnosis placental abruption. The combined date is more effective than any single parameter.