妊娠早期母体PAPPA、PlGF和MAP对多种妊娠并发症的预测价值

Predictive value of maternal first trimester PAPPA,PlGF and MAP for multiple pregnancy complications

目的评价孕早期母体妊娠相关血浆蛋白A(PAPPA)、胎盘生长因子(PlGF)和平均动脉压(MAP)对多种妊娠并发症的预测价值。方法采用前瞻性的病例对照巢氏研究,选取孕早期唐氏筛查的孕妇作为研究对象。测定其母体血液中PAPPA、PlGF含量,测量血压并计算MAP。分析PAPPA、PlGF、MAP与各种妊娠并发症的关系,将具有显著相关性的指标确定为危险因素指标,分析危险因素指标对妊娠并发症的预测价值。结果3516例孕妇参与本研究,2336例为无妊娠并发症单胎孕妇,1143为发生妊娠并发症的单胎孕妇,另外37例为无妊娠并发症双胎孕妇。孕早期PAPPA、PlGF含量、MAP中的一项或几项是子痫前期、小于胎龄儿、妊娠糖尿病、妊娠高血压、地中海贫血的危险因素。这些预测指标在重度子痫前期、轻度子痫前期、妊娠高血压、小于胎龄儿、妊娠糖尿病的受试者工作曲线下面积分别为0.833、0.798、0.756、0.644、0.590,检出率分别为79%、68%、77%、44%、54%。结论孕早期PAPPA、PlGF含量、MAP中的一项或几项使子痫前期、小于胎龄儿、妊娠糖尿病、妊娠高血压的危险增加,危险因素联合对上述妊娠并发症具有一定的预测价值。

Objective To evaluate the predictive value of maternal first trimester pregnancy-associated plasma protein A(PAPPA),placental growth factor(PlGF)and mean arterial pressure(MAP)for multiple pregnancy complications.Methods Pregnant women with Down syndrome screening in the first trimester were selected as subjects in this prospective case-control nest study.PAPPA and PlGF levels in maternal blood were measured,blood pressure was measured and MAP was calculated.The relationship between PAPPA,PlGF,MAP and various pregnancy complications was analyzed.The indexes with significant correlation were identified as risk factors.The predictive values of risk factors for multiple pregnancy complications were analyzed.Results 3516 pregnant women were recruited in this study.2336 were single pregnant women without pregnancy complications.1143 were single pregnant women with pregnancy complications,and 37 were twin pregnant women without pregnancy complications.One or more of PAPPA,PlGF and MAP in the first trimester were risk factors for preeclampsia,small for gestational age,gestational diabetes mellitus,gestational hypertension and thalassemia.The areas under the working curve of these predictors were 0.833,0.798,0.756,0.644 and 0.590 for severe preeclampsia,mild preeclampsia,gestational hypertension,small for gestational age and gestational diabetes,with detection rates of 79%,68%,77%,44%and 54%respectively.Conclusions Maternal PAPPA,PlGF and MAP in the first trimester increase the risk of preeclampsia,small gestational age,gestational diabetes mellitus and gestational hypertension.Combined risk factors have certain predictive values for the above pregnancy complications.