UtA-PI、MAP和PLGF对不同孕期子痫前期诊断意义

Predictive value of uterine artery pulsatility index,mean arterial pressure and serum placental growth factor on preeclampsia at different gestational weeks

目的探讨妊娠期12、22和32周子宫动脉搏动指数、平均动脉压和血清胎盘生长因子对子痫前期(PE)的预测价值。方法选取828例于2014年5月至2016年6月在衢州市人民医院建卡的妊娠期妇女,随访至分娩,按照是否为子痫前期分为正常妊娠组(NC组)、妊娠高血压组(GH组)和子痫前期组(PE组),分析三组患者孕11~13^(+6)周、19~24^(+6)周及30~34^(+6)周子宫动脉搏动指数(UtA-PI),平均动脉压(MAP)和血清胎盘生长因子(PLGF)的表达情况。结果 GH组、PE组孕30~34^(+6)周MAP、UtA-PI及PLGF与孕19~24^(+6)周、孕11~13^(+6)周差异有统计学意义(t=3.403~8.117,均P<0.05)。Logistic回归分析显示,孕11~13^(+6)周时PLGF与PE的发生有关(OR:0.647,95%CI:0.414~0.961,P<0.05);孕19~24^(+6)周时,PLGF、UtA-PI为PE发生的影响因素(OR:1.714,95%CI:1.134~5.104,P<0.05;OR:0.739,95%CI:0.524~0.976,P<0.05);孕30~34^(+6)周时,MAP、UtA-PI及PLGF与PE的发生显著相关(OR:1.618,95%CI:1.036~3.892,P<0.05;OR:1.982,95%CI:1.297~6.555,P<0.05;OR:1.828,95%CI:1.022~5.609,P<0.05)。ROC曲线分析显示,孕11~13^(+6)周时,PLGF对PE具有一定诊断价值(AUC:0.706,95%CI:0.584~0.809,P<0.05);孕19~24^(+6)周时,PLGF及UtA-PI对PE有一定诊断价值(AUC:0.749,95%CI:0.634~0.849,P<0.05;AUC:0.705,95%CI:0.591~0.819,P<0.05);孕30~34^(+6)周时,MAP、PLGF及UtA-PI三者联合(AUC:0.922,95%CI:0.753~0.948,P<0.05)诊断PE具有更高灵敏度和特异度(AUC:0.776,95%CI:0.679~0.861,P<0.05;AUC:0.735,95%CI:0.621~0.833,P<0.05;AUC:0.711,95%CI:0.582~0.802,P<0.05)。结论孕30~34^(+6)周MAP、PLGF及UtA-PI诊断PE明显优于孕19~24^(+6)周、孕11~13^(+6)周,但早期PLGF降低对于早期筛查PE有一定价值,值得参考。

Objective To evaluate the predictive value of uterine artery pulsatility index （UtA PI）, mean arterial pressure （MAP） and serum placental growth factor （PLGF） on preeclampsia （PE） at 12, 22 and 32 weeks of gestation. Methods Totally 828 pregnant women establishing health card in People＇ s Hospital of Quzhou City during May 2014 to June 2016 were divided into normal pregnancy group （NC group）, gestational hypertension group （GH group） and PE group. The cases were followed up till delivery. UtA-PI, MAP and PLGF of three groups at 11- 13 gestational weeks, 19-24 gestational weeks and 30 34 gestational weeks were analyzed. Results There were significant differences in MAP, UtA-PI and PLGF between 30-34 gestational weeks and 19-24 and 11-13 gestational weeks in GH group and PE group （t value ranged 3.403 8.117, all P〈0.05）. Logistic regression analysis showed that PLGF was correlated with PE at gestational weeks of 11-13 （0R=0.647,95%CI： 0.414-0.961, P〈0.05） and that PLGF and UtA-PI were the influencing factors of PE at the time of gestation from 19 to 24 weeks （0R=1.714,95%CI： 1.134-5.104,P〈0.05;OR=0.739,95GC1：0.524 0.976,P〈0.05）. The levels of MAP, UtA-PI and PLGF were correlated with PE during 30 to 84 weeks （OR = 1. 618,95%CI ： 1.036 - 3.892, P〈0.05 ; OR = 1. 982,95 % CI ： 1. 297 - 6.555, P 〈0.05 ; OR = 1. 828, 95%CI：1.022-5.609,P〈0.05）. ROC curve analysis showed that PLGF had certain diagnostic value for PE at 1-1 13 weeks of gestation （AUC=0.706,95%CI =0.584-0.809,P〈0.05）. PLGF and UtA-PI had certain diagnostic value for PE at 19-24 weeks of gestation （AUC=0.749,95% CI：0.634 0.849,P〈0.05;AUC 0.705,95%CI：0.591-0.819,P〈0.05）. Combining MAP, PLGF and UtA-PI in diagnosis of PE during 30 34 weeks of gestation had higher sensitivity and specificity （AUC= 0.776,95 CI：0.679-0.861,P〈0. 05;AUC=0. 735,95%CI：0. 621-0. 833,P〈0. 05;AUC=0.711,95% CI：0.582-0.802,P〈0.05）. Conclusion MAP, PLGF and UtA-PI at 30-34 weeks of gestation are significantly better than at 19-24 and 11-13 weeks of gestation in diagnosis of PE, but early reduction of PLGF is valuable for early screening of PE.