sFlt-1、sST2和MSP-α联合检测预测子痫前期的价值研究

Analysis of predictive value of combined detection of MSP-α,sST2 and sFlt-1 for preeclampsia

目的巨噬细胞刺激蛋白-α(MSP-α)、可溶性基质素2(sST2)和可溶性血管内皮生长因子受体-1(sFlt-1)联合检测对子痫前期的预测价值。方法采用前瞻性研究,选择2017年10月至2019年10月在上海市嘉定区妇幼保健院定期产检和分娩的孕产妇,根据是否并发子痫前期分为子痫前期组(70例)和对照组(87例),采用ELISA法检测孕产妇血清中MSP-α、sST2和sFlt-1的浓度,分析其与子痫前期的相关性,采用ROC曲线分析3项指标单独和联合检测对该病的预测价值。结果子痫前期组在早孕期和中孕期的sFlt-1、MSP-α水平均高于对照组(t值分别为5.877、5.674、2.427、3.390),中孕期的sST2水平亦高于对照组(t=2.852),差异均有统计学意义(P<0.05)。Logistic回归分析结果提示早、中孕期的sFlt-1及中孕期sST2是子痫前期发病的危险因素,sFlt-1在早孕期和中孕期增高,子痫前期发病的危险增大,OR及其95%CI分别为:1.434(1.186~1.733)、1.724(1.403~2.117),P<0.05;中孕期sST2增高,子痫前期发病的危险性增大,OR及其95%CI为1.163(1.001~1.303),P<0.05。sFlt-1、sST2和MSP-α三者单独检测的敏感性和特异性均低于联合检测,联合检测的敏感性为81.4%,特异性为94.3%,曲线下面积达91.1%(P<0.05)。结论早、中孕期sFlt-1、sST2和MSP-α血清学分子联合检测对子痫前期的发病具有一定的预测价值。

Objective To explore predictive value of combined detection of macrophage stimulating protein alpha(MSP-α),immune molecule soluble stromal 2(sST2)and soluble vascular endothelial growth factor receptor-1(sFlt-1)for preeclampsia.Methods In this prospective study,157 pregnant women who received regular prenatal examination and delivered in Shanghai Jiading District Maternity and Child Health Hospital from October 2017 to October 2019 were selected as study subjects.According to presence or absence of preeclampsia,they were divided into preeclampsia group(n=70)and control group(n=87).The serum levels of MSP-α,sST2 and sFlt-1 were detected with ELISA in 11~15 gestational weeks and 24~27 gestation weeks respectively.The correlation between the three serum biomarkers and preeclampsia was analyzed with logistic regression method and the predictive value of single and combined detection of the three serum biomarkers for preeclampsia was analyzed with ROC.Results The serum levels of sFlt-1 and MSP-αof the pregnant women in the preeclampsia group in the first and the second trimesters of pregnancy and sST2 in the second trimester of pregnancy were higher than those in the control group(t=5.877,5.674,2.427,3.390 and 2.852,respectively,all P<0.05),while in serum level of sST2 in the early pregnancy there was no statistical difference between the two groups(P>0.05).Logistic regression analysis showed the serum levels of sFlt-1 in early and middle pregnancy and sST2 in middle pregnany were correlated with preeclampsia,suggesting that sFlt-1,MSP-αand sST2 were all risk factors of occurrence of preecmplasia,when serum levels of sFlt-1 and MSP-αin the first and the second trimesters of pregnancy and sST2 in the second trimester of pregnancy were elevated,the risk of occurrence of preecmplasia increased[ORs(95%CI)=1.434(1.186~1.733),1.724(1.403~2.117)and 1.163(1.001~1.303)respectively,all P<0.05].The area of ROC of the combined detection of the three serum biomarkers for predicting preeclampsia was 91.1%,the sensitivity was 81.4%and the specificity was 94.3%,which were much higher than those of the single biomarker detection(all P<0.05).Conclusion The combined detection of serum levels of sFlt-1,sST2 and MSP-αin the first and the second trimesters of pregnancy is of certain predictive value for occrrence of preeclampsia.