血清促甲状腺素联合可溶性络氨酸激酶受体1预测子痫前期临床价值

The clinical value of thyroid stimulating hormone combined with soluble tyrosine kinase receptor 1 for predicting preeclampsia

目的:探讨血清促甲状腺素(TSH)联合可溶性络氨酸激酶受体1(sFlt-1)预测子痫前期价值。方法:回顾性收集2016年6月30日-2019年5月30日本院常规产前检查并分娩的子痫前期高危孕妇210例临床资料,于孕20周检测外周血中TSH和sFlt-1水平,根据是否发生子痫前期分为子痫前期组(30例)和非子痫前期组(180例)。分析子痫前期的影响因素,并使用ROC曲线分析TSH、sFlt-1水平对子痫前期的诊断价值。结果:子痫前期组孕妇年龄、采血时收缩压、TSH水平、sFlt-1水平均高于非子痫前期组,初产妇、存在子痫前期病史、合并妊娠前高血压、孕前肥胖、合并结缔组织病等比例均高于非子痫前期组,新生儿体质量低于非子痫前期组(均P<0.05)。两组采血时舒张压、孕次、自然流产史、合并糖尿病、双胎妊娠、FT3、FT4水平均无差异(P>0.05)。logistic多因素分析,高龄、合并高血压、sFlt-1升高、TSH升高是子痫前期的独立危险因素(P<0.05)。ROC曲线结果显示,sFlt-1、TSH水平对子痫前期均具有诊断效能,而二者联合检测诊断效能高于单独检测(P<0.05),灵敏度为64.8%,特异度为79.4%。结论:TSH和sFlt-1水平升高是子痫前期独立危险因素,二者联合检测对子痫前期具有较好的预测价值。

Objective:To investigate the value of serum thyroid stimulating hormone(TSH)combined with soluble tyrosine kinase receptor 1(sFlt-1)for predicting preeclampsia.Methods:The clinical data of 210 pregnant women with high risk of preeclampsia from June 30,2016 to May 30,2019 were collected retrospectively.The levels of peripheral blood TSH and sFlt-1 of these women were measured during 20 gestational weeks,and these women were divided into study group(30 women with preeclampsia)and control group(180 women without preeclampsia).The influencing factors of preeclampsia were analyzed,and the values of TSH and sFlt-1 levels for diagnosing preeclampsia were observed by ROC curve.Results:The maternal age,systolic blood pressure value when blood samples collected,levels of TSH and sflt-1,and the proportions of primiparas,preeclampsia history,rates of pregestational hypertension and obesity,and connective tissue disease rate of women in the study group were significant higher than those of women in the control group,but the body mass of newborns in the study group was significant lower than that in the control group(all P<0.05).There were no difference in diastolic blood pressure value when blood samples collected,times of pregnancy,rates of history of spontaneous abortion,gestational diabetes mellitus,and twin pregnancy,and levels of FT3 and FT4 of women between the two groups(P>0.05).Logistic multivariate analysis suggested that advanced age,pregnancy induced hypertension,the elevated of TSH and sFlt-1 levels were independent risk factors for preeclampsia(P<0.05).ROC curve results showed that both sflt-1 level and TSH level had some diagnostic efficacy for preeclampsia,while the combined detection of sflt-1 level and TSH level had higher diagnostic efficacy compared to that of sflt-1 level or TSH level only(P<0.05).The sensitivity and the specificity of the combined detection of sflt-1 level and TSH level were 64.8%and 79.4%.Conclusion:The elevated of TSH and sFlt-1 levels are independent risk factors of preeclampsia.TSH level combined with sFlt-1 level has a high value for predicting preeclampsia.