血清PLGF、PAPP-A、AFP水平对胎盘早剥的预测价值

Predictive values of serum PLGF,PAPP-A and AFP in placental abruption

目的探讨血清胎盘生长因子(PLGF)、妊娠相关蛋白A(PAPP-A)、甲胎蛋白(AFP)水平在胎盘早剥的预测价值。方法选择2018年1月至2020年1月于南京医科大学附属无锡妇幼保健院诊治的200例胎盘早剥患者为研究对象,设为胎盘早剥组,并选择同期体检的健康孕妇190例作为对照组,分析血清PLGF、PAPP-A、AFP水平变化情况及其对胎盘早剥的预测价值。结果胎盘早剥组血清PLGF、PAPP-A水平显著低于对照组(t值分别为23.976、12.552,P<0.05),AFP水平显著高于对照组(t=22.340,P<0.05)。不同胎盘早剥程度患者血清PLGF、PAPP-A、AFP水平比较差异有统计学意义(F值分别为107.453、130.144、77.699,P<0.05),进一步每两组间比较结果显示胎盘早剥Ⅰ度患者血清PLGF、PAPP-A显著高于胎盘早剥Ⅱ度、Ⅲ度患者(t值分别为11.325、7.426、9.453、6.327,P<0.05),胎盘早剥Ⅰ度血清AFP显著低于胎盘早剥Ⅱ度、Ⅲ度患者(t值分别为8.609、6.214,P<0.05)。胎盘早剥Ⅱ度血清PLGF、PAPP-A显著高于胎盘早剥Ⅲ度患者(t值分别为9.436、6.346,P<0.05),胎盘早剥Ⅱ度血清AFP显著低于胎盘早剥Ⅲ度患者(t=5.309,P<0.05)。ROC结果显示血清PLGF预测胎盘早剥的AUC为0.955,灵敏度为83.26%,特异度为85.29%,截断值为104.96pg/mL;血清PAPP-A预测胎盘早剥的AUC为0.809,灵敏度83.26%,特异度为88.36%,截断值为3.71U/L;血清AFP预测胎盘早剥的AUC为0.928,灵敏度为83.85%,特异度为86.59%,截断值为243.64μg/L,三者联合检测较单独检测灵敏度、特异度更高(Z值2.435~3.908,P<0.05)。结论血清PLGF、PAPP-A、AFP在胎盘早剥患者中表达异常,对于病情预测具有重要临床意义。

Objective To explore the predictive values of serum placental growth factor(PLGF),pregnancy-associated plasma protein A(PAPP-A),alpha fetoprotein(AFP) levels in placental abruption.Methods A total of 200 patients with placental abruption who received treatment in Wuxi Maternal and Child Health Hospital, Nanjing Medical University from January 2018 to January 2020 were selected as the study subjects and the placental abruption group, and 190 healthy pregnant women who underwent physical examination during the same period were selected as the control group.The changes in serum levels of PLGF,PAPP-A and AFP and their predictive values in placental abruption were analyzed.Results The levels of serum PLGF and PAPP-A in the placental abruption group were significantly lower than those in the control group(t=23.976 and 12.552,respectively, P<0.05),and the level of AFP in the placental abruption group was significantly higher than that in the control group(t=22.340,P<0.05).There were statistically significant differences in serum PLGF,PAPP-A and AFP levels in patients with different degrees of placental abruption(F=107.453,130.144 and 77.699,respectively, P<0.05).Further comparison between the two groups showed that the serum PLGF and PAPP-A levels of placental abruption grade Ⅰ patients were significantly higher than those of placental abruption grade Ⅱ and grade Ⅲ patients(t=11.325,7.426,9.453 and 6.327,respectively, P<0.05).Serum AFP level of placental abruption grade Ⅰ was significantly lower than that of placental abruption grade Ⅱ and grade Ⅲ(t=8.609 and 6.214,respectively, P<0.05).Serum PLGF and PAPP-A levels of placental abruption grade Ⅱ were significantly higher than those of placental abruption grade Ⅲ(t=9.436 and 6.346,respectively, P<0.05),and serum AFP level of placental abruption grade Ⅱ was significantly lower than that of placental abruption grade Ⅲ(t=5.309,P<0.05).ROC results showed that the AUC of serum PLGF for predicting placental abruption was 0.955,the sensitivity was 83.26%,the specificity was 85.29%,and the cutoff value was 104.96 pg/mL.The AUC of serum PAPP-A for predicting placental abruption was 0.809,the sensitivity was 83.26%,the specificity was 88.36%,and the cutoff value was 3.71 U/L.The AUC of serum AFP for predicting placental abruption was 0.928,the sensitivity was 83.85%,the specificity was 86.59%,and the cutoff value was 243.64μg/L.The combined detection of three indicators had higher sensitivity and specificity than the single detection(Z=2.435-3.908,P<0.05).Conclusion The abnormal expression of serum PLGF,PAPP-A and AFP in patients with placental abruption has important clinical significance for prediction of placental abruption.