妊娠早中期孕妇血清中甲胎蛋白、游离雌三醇、抑制素A及子宫动脉搏动指数预测子痫前期的价值

The value of the levels of alpha-fetoprotein,free estriol,inhibin A and uterine arterial pulse index in predicting preeclampsia of pregnant women in the first and second trimesters of pregnancy

目的:探讨妊娠早中期孕妇血清中甲胎蛋白(AFP)、游离雌三醇(uE3)、抑制素A(InhA)及子宫动脉搏动指数(PI)单独和联合预测子痫前期的价值。方法:选择产检的单胎初孕产妇1000例,其中随访至产后3个月的有945例。将945例孕妇中诊断为子痫前期的孕妇作为病例组,在未发生子痫前期的孕妇中按1∶4的比例为病例组匹配对照组。检测并记录妊娠早中期孕妇血清中的AFP、uE3、InhA和PI。结果:945例孕妇子痫前期的发病率为3.5%(33/945)。病例组和对照组孕妇AFP差异无统计学意义(P>0.05),病例组孕妇InhA和PI高于对照组孕妇,uE3低于对照组孕妇,差异均有统计学意义(P<0.05~P<0.01)。InhA、uE3和PI预测子痫前期的灵敏度分别为48.4%、72.7%和57.6%,InhA、uE3和PI预测子痫前期的特异度分别为78.0%、69.7%和84.8%;联合指标预测子痫前期的灵敏度和特异度分别为75.8%和76.5%;ROC曲线下面积为0.825,大于InhA、uE3和PI值3个单项指标的ROC曲线下面积(P<0.01)。结论:妊娠早中期孕妇血清中的uE3、InhA和PI联合预测和诊断子痫前期的价值相对单个指标较好。

Objective:To analyze the value of the individual and combined the levels of alpha-fetoprotein(AFP),free estriol(uE3),inhibin A(InhA)and uterine arterial pulse index(PI)in predicting preeclampsia of pregnant women in the first and second trimesters of pregnancy.Methods:A total of 1000 singleton primiparas were selected,945 pregnant women diagnosed by preeclampsia were set as the case group,and the case group was matched to the control group in a ratio of 1∶4 among pregnant women without preeclampsia.The serim levels of AFP,uE3 and InhA,and PI were detected and recorded.Results:The incidence rate of preeclampsia in 945 pregnant women was 3.5%(33/945).There was no statistical significance in the AFP level between two group(P>0.05).The value of InhA and PI in case group were higher than those in control group,and the uE3 value in case group was lower than that in control group(P<0.05 to P<0.01).The sensitivities of InhA,uE3 and PI in predicting preeclampsia of pregnant women were 48.4%,72.7%and 57.6%,respectively.The specificities of InhA,uE3 and PI in predicting preeclampsia of pregnant women were 78.0%,69.7%and 84.8%,respectively.The sensitivity and specificity of the combined index for predicting preeclampsia were 75.8%and 76.5%,respectively.The area under the ROC curve of the combined data in predicting preeclampsia was 0.825,which was significantly higher than that of InhA,uE3 and PI,respectively(P<0.05).Conclusions:The combined value of uE3,InhA and PI in predicting preeclampsia is better than that of single parameter in the first and second trimesters of pregnancy.