sFlt-1/PlGF、CysC、补体C1q在预测子痫前期严重程度中的临床应用价值

Clinical value of sFlt-1 to PlGF ratio,CysC and complement C1q in predicting the severity of preeclampsia

目的:探讨血清可溶性fms样酪氨酸激酶-1(sFlt-1)/人胎盘生长因子(PlGF)、血清胱抑素C(CysC)、补体C1q联合检测在预测子痫前期严重程度中的临床应用价值。方法:选取自2019年1月至2021年8月在本院产科就诊的孕妇235例,其中正常妊娠孕妇124例、轻度子痫前期患者49例、重度子痫前期患者62例。通过电化学发光法检测所有研究对象血清sFlt-1/PlGF水平,免疫比浊法测定血清CysC、补体C1q水平。比较不同组别受检者的血清sFlt-1/PlGF比值、CysC、补体C1q水平。采用多因素Logistic回归分析,绘制ROC曲线并计算曲线下面积(AUC),以评价各单项及联合指标检测的诊断价值。结果:子痫前期组血清sFlt-1/PlGF及CysC的含量显著高于正常妊娠组(Z=-13.226,-12.761;均P<0.05)。子痫前期组血清补体C1q含量显著低于正常妊娠组(Z=-6.975;P<0.05)。Spearman相关性分析结果表明,CysC、sFlt-1/PlGF比值与子痫前期严重程度呈正相关(ρ=0.835,0.781,均P<0.05);C1q与子痫前期严重程度呈负相关(ρ=-0.396,P<0.01)。预测Logistic回归模型:Y=-1.627+0.018*sFlt-1/PlGF+4.016*CysC-0.031*C1q。sFlt-1/PlGF、CysC、C1q联合检测用于预测子痫前期严重程度的敏感度为0.796,特异度为0.919,AUC为0.907,高于各指标单项检测的AUC(分别为0.849,0.735和0.700)。结论:联合检测血清sFlt-1/PlGF比值、CysC、C1q水平对子痫前期发病及病情严重程度具有重要的诊断预测价值。

Objective:To investigate the clinical value of combined measurement for serum soluble fms-like tyrosine kinase-1 to human placental growth factor ratio(sFlt-1/PlGF),serum cystatin C(CysC)and complement C1q in predicting the severity of preeclampsia.Methods:A total of 235 pregnant women who visited our Obstetrics Department between January 2019 and August 2021 were included,comprising 124 normal pregnant women,49 with mild preeclampsia,and 62 with severe preeclampsia.Of them,serum sFlt-1/PlGF were measured by electrochemiluminescence,and serum CysC and complement C1q levels were determined by immunoturbidimetry.The serum sFlt-1/PlGF ratio,CysC and complement C1q levels were compared among subjects of different groups.Multivariate Logistic regression analysis was used to generate a ROC curve with calculation of the area under the curve(AUC)to evaluate the diagnostic values of these indicators used alone or in combination.Results:The levels of serum sFlt-1/PlGF and CysC were significantly higher in the preeclampsia groups than those in the normal pregnancy group(Z=-13.226,-12.761,all P<0.05).The serum complement C1q level was significantly lower in the preeclampsia groups than that in the normal pregnancy group(Z=-6.975,P<0.05).Spearman correlation analysis showed that the ratio of sFlt-1/PlGF(ρ=0.835)and the CysC level(ρ=0.781)were positively correlated with the severity of preeclampsia(both P<0.05),and that complement C1q level was negatively correlated with the severity of preeclampsia(ρ=-0.396,P<0.01).The Logistic regression Predictive model was formulated as:Y=-1.627+0.018*sFlt-1/PlGF+4.016*CysC-0.031*C1q.Combined detection of sFlt-1/PlGF,CysC,and C1q yielded a sensitivity of 0.796,a specificity of 0.919,with an AUC of 0.907 for predicting the severity of preeclampsia which was greater compared with any AUC of each indicator used alone(0.849,0.735,and 0.700,respectively).Conclusion:Combined detection of serum sFlt-1/PlGF ratio,CysC and C1q levels has an important role in diagnosing and predicting the onset and severity of preeclampsia.