孕中期唐氏筛查血清学指标对妊娠期高血压的预测价值分析

Predictive value analysis of Down′s screening serological indicators in the second trimester for gestational hypertension

目的探讨孕中期唐氏筛查血清学指标对妊娠期高血压疾病(GH)的预测效能。方法以2013年6月至2019年6月期间在北京妇产医院规律产检并最终分娩的64849名孕妇为研究对象,GH组(含GH、子痫前期、子痫诊断患者)与非GH组分别有3808例、61041例。于妊娠14~19周空腹抽取静脉血3 ml,通过体格检查、实验室检测等方法得到体重、血清β-人绒毛膜促性腺激素(β-HCG)、游离雌三醇(uE3)及甲胎蛋白(AFP)的含量等信息。β-HCG、AFP、uE3采用所对应孕周中位数倍数值(MOM值)进行分析,采用多因素logistic回归模型与受试者工作特征曲线(ROC曲线)进行血清学指标的预测效能分析。结果64849名研究对象中,GH组(3808例)、非GH组(61041名)年龄分别为(29.51±2.72)、(29.38±2.68)岁,体重分别为(65.46±12.17)、(58.73±9.13)kg,采血孕周分别为(16.53±0.89)、(16.58±0.90)周。多因素logistic回归模型分析结果显示,随着体重、β-HCG和AFP的浓度增加,GH的发生风险随之增加,OR(95%CI)值分别为1.059(1.056~1.062)、1.329(1.188~1.487)和1.195(1.125~1.269);而随着uE3的浓度下降,GH的发生风险随之增加,OR(95%CI)值为0.527(0.464~0.599)。ROC曲线分析结果显示,年龄、体重、血清AFP、β-HCG、uE3及多因素联合诊断对于GH均有预测效能(P值均<0.05);多指标联合诊断和体重的AUC(95%CI)值分别为0.684(0.675~0.693)、0.673(0.663~0.682),但两者的约登指数、灵敏度和特异度等均较小。结论孕中期唐氏筛查的β-HCG、AFP、uE3对GH的预测效能较低。

Objective To discuss the prediction efficacy of Down′s screening serological indicators in the second trimester of gestational hypertension(GH).Methods 64849 pregnant women who had undergone regular check-ups at the Beijing Obstetrics and Gynecology Hospital from June 2013 to June 2019 and finally gave birth were the subjects of the study.There were 3808 cases of the GH group(including patients with GH,preeclampsia,and eclampsia diagnosed)and 61041 cases of non-GH group respectively.3 ml of fasting venous blood was drawn during 14-19 weeks of pregnancy,and body weight,serumβ-human chorionic gonadotropin(β-HCG),free estriol(uE3)and alpha fetal protein(AFP)were obtained through physical check and laboratory testing.β-HCG,AFP,uE3 were analyzed by using the corresponding median times of gestational age(MOM value),and multivariate logistic regression model and receiver operating characteristic curve(ROC curve)were used to analyze the predictive efficiency of serological indicators.Results Among 64849 research subjects,the GH group(3808 cases)and the non-GH group(61041)were(29.51±2.72),(29.38±2.68)years old,the weights were(65.46±12.17),(58.73±9.13)kg,gestational age of blood collection were(16.53±0.89)and(16.58±0.90)weeks respectively.The analysis of multivariate logistic regression model showed that the risk of GH increased with the increase of body weight,β-HCG and AFP concentration,OR(95%CI)values were 1.059(1.056-1.062),1.329(1.188-1.487)and 1.195(1.125-1.269);so did when the concentration of uE3 decrease,OR(95%CI)value was 0.527(0.464-0.599).ROC curve analysis results show that age,weight,serum AFP,β-HCG,uE3 and multivariate diagnosis all have predictive efficiency for GH(P values<0.05);combined diagnosis of multiple indicators and weight AUC(95%CI)were 0.684(0.675-0.693)and 0.673(0.663-0.682),but the Youden index,sensitivity,and specificity of the two were relatively small.Conclusion Theβ-HCG,AFP and uE3 of Down′s screening in the second trimester of pregnancy were relatively low in predicting GH.