可溶性血管内皮生长因子受体-1/胎盘生长因子与子宫动脉搏动指数联合预测子痫前期的临床价值研究

Predicative Value of sFlt-1/PLGF Ratio and Uterine Artery PI for Preeclampsia

目的探讨血清中可溶性血管内皮生长因子受体-1(sFlt-1)/胎盘生长因子(PLGF)与子宫动脉搏动指数联合预测子痫前期的价值。方法选取2014年1月—2016年1月在郑州大学第二附属医院产科门诊规范产前检查的382例孕妇为研究对象。根据合并子痫前期情况分为3组:对照组348例、轻度子痫前期组23例、重度子痫前期组11例。收集各组孕妇的一般临床资料,采用电化学发光免疫分析法检测sFlt-1和PLGF水平并计算两者比值,采用三维超声测定子宫动脉搏动指数,采用受试者工作特征(ROC)曲线评估sFlt-1/PLGF与子宫动脉搏动指数对子痫前期的预测价值。结果 3组孕妇年龄、采血时孕周、妊娠次数及体质指数(BMI)比较,差异无统计学意义(P>0.05);3组孕妇sFlt-1/PLGF、子宫动脉搏动指数比较,差异有统计学意义(P<0.05);对照组与轻度子痫前期组、对照组与重度子痫前期组、轻度子痫前期组与重度子痫前期组比较,sFlt-1/PLGF、子宫动脉搏动指数差异均有统计学意义(P<0.05)。sFlt-1/PLGF预测子痫前期发生的ROC曲线下面积为0.864[95%CI(0.082,0.926)],当截断点选择为9.995时,灵敏度和特异度分别为79.4%和89.9%;子宫动脉搏动指数预测子痫前期发生的ROC曲线下面积为0.795[95%CI(0.700,0.890)],当截断点选择为0.715时,灵敏度和特异度分别为82.4%和73.3%。两指标并联灵敏度为97.06%,特异度为65.80%;串联灵敏度为64.71%,特异度为97.41%。结论 sFlt-1/PLGF联合子宫动脉搏动指数对子痫前期的发生具有重要的预测价值。

Objective To study the predictive value of soluble fms-like tyrosine kinase-1(sFlt-1)/placenta growth factor(PLGF)ratio combined with uterine artery pulsatility index(PI)for preeclampsia.Methods The enrolled participants were 382 pregnant women who underwent the conventional prenatal testing in Obstetric Clinic,The Second Affiliated Hospital of Zhengzhou University from January 2014 to January 2016,including 348 with normal pregnancy outcome(control group),23 with mild preeclampsia(mild preeclampsia group)and 11 with severe preeclampsia(severe preeclampsia group).Clinical data of them were collected.The sFlt-1 and PLGF were measured by electro-chemiluminescence immunoassay,and the ratio of the two was calculated.Uterine artery PI was measured by three-dimensional ultrasonography.ROC curve analysis was performed to investigate the value of sFlt-1/PLGF ratio combined with uterine artery PI in the prediction of preeclampsia.Results The distribution of age,distribution of gestational weeks during sampling the peripheral venous blood for testing,gravidity,and distribution of BMI did not differ significantly between the groups(P>0.05).Both the sFlt-1/PLGF ratio and uterine artery PI varied significantly between the three groups(P<0.05),specifically,both the sFlt-1/PLGF ratio and uterine artery PI were lower in the control group compared with the preeclampsia groups(P<0.05),and they were lower in the mild preeclampsia group compared with the severe preeclampsia group(P<0.05).The sensitivity and specificity of preeclampsia incidence predicted by sFlt-1/PLGF ratio were 79.4%and 89.9%,respectively,when the critical value was 9.995,its AUC was 0.864〔95%CI(0.082,0.926)〕.The sensitivity and specificity of preeclampsia incidence predicated by uterine artery PI value were 82.4%and 73.3%,respectively,when the critical value was 0.715,its AUC was 0.795〔95%CI(0.700,0.890)〕.When these two markers were used in parallel combination,the sensitivity reached 97.06%,while specificity dropped to 65.80%.When used in serial combination,the sensitivity decreased to 64.71%,whereas the specificity increased to 97.41%.Conclusion sFlt-1/PLGF ratio combined with uterine artery PI has important diagnostic value for preeclampsia.