孕早期PlGF联合PAPP-A、MAP、UtPI预测子痫前期的临床应用研究

Clinical application of PlGF combined with PAPP-A,MAP and UtPI in predicting preeclampsia in early pregnancy

目的探讨孕早期胎盘生长因子(PlGF)联合妊娠相关蛋白A(PAPP-A)、平均动脉压(MAP)、子宫动脉搏动指数(UtPI)对子痫前期的预测效果,对筛查阳性率、发病率和筛查效率进行分析,为安徽省子痫前期筛查的临床应用提供一定的数据基础。方法2019年~2021年,组织安徽省6家单位开展多中心课题研究,收集11~13^(+6)孕周范围内符合入组条件的孕妇及其临床信息,应用时间分辨荧光免疫分析方法检测PlGF和PAPP-A指标,采用子痫前期风险评估软件,联合母体因素、PlGF、PAPP-A、MAP和UtPI进行多指标联合风险计算,并追踪孕妇的妊娠发展和妊娠结局情况,通过数据统计分析该种筛查模式的临床应用效果。结果共收集到9400例孕妇样本,其中妊娠相关高血压疾病有243例,包括子痫前期128例,慢性高血压伴发子痫前期6例,妊娠期高血压101例,妊娠合并慢性高血压8例,子痫前期发病率约为1.43%。剔除慢性高血压伴发子痫前期、妊娠期高血压和妊娠合并慢性高血压病例,剩余9285例孕妇纳入本次研究。将子痫前期128例作为研究组,其余9157例作为对照组,结果显示研究组PAPP-A、PlGF水平均低于对照组(P<0.05),MAP、UtPI均高于对照组(P<0.05);将收集到完整四联指标(PlGF+PAPP-A+MAP+UtPI)的6139例样本单独进行统计分析,当截断值为1/137时,假阳性率为15%,在PE<32周,PE<34周,PE<37周时的筛查阳性率分别为1.16%,3.31%和15.08%,检出率分别可达到90%,80%和63.64%。结论孕早期PlGF联合PAPP-A、MAP、UtPI检测对早发型子痫前期的预测具有较高的价值。

Objective To explore the predictive effect of early pregnancy placental growth factor(PlGF)combined with pregnancy associated protein A(PAPP-A),mean arterial pressure(MAP)and uterine artery pulsatility index(UtPI)on preeclampsia,and to analyze the positive rate,incidence rate and efficiency of screening,so as to provide some data basis for the clinical application of preeclampsia screening in Anhui Province.Methods From 2019 to 2021,six hospitals in Anhui Province were organized to carry out a multi center research project to collect the clinical information of pregnant women who met the enrollment criteria within 11~13^(+6) gestational weeks.PlGF and PAPP-A were detected by time-resolved fluoroimmunoassay.The eclampsia risk assessment software was used to calculate the combined risk of multiple indicators in combination with maternal factors,PlGF,PAPP-A,MAP and UtPI,and to track the pregnancy development and pregnancy outcome of pregnant women.The clinical application effect of this screening model was analyzed by data statistics.Results A total of 9400 pregnant cases were collected.There were 243 pregnant women with pregnancy related hypertension,including 128 cases of preeclampsia,6 cases of chronic hypertension with preeclampsia,101 cases of gestational hypertension,and 8 cases of pregnancy with chronic hypertension.The incidence rate of preeclampsia was about 1.43%.The cases of chronic hypertension with preeclampsia,gestational hypertension and pregnancy with chronic hypertension were excluded,and the remaining 9285 pregnant women were included in this study.128 cases of preeclampsia were taken as the study group,and the other 9157 cases were taken as the control group.The results showed that PAPP-A and PlGF in the study group were lower than those in the control group(P<0.05),and MAP and UtPI were higher than those in the control group(P<0.05).A total of 6139 samples with complete quadruple indicators(PlGF+PAPP-A+MAP+UtPI)were collected for separate statistical analysis.When the cut-off value was 1/137,the false positive rate of PlGF+PAPPA+MAP+UtPI quadruple screening scheme was 15%,and the positive rates of PE<32 weeks,PE<34 weeks and PE<37 weeks were 1.16%,3.31%and 15.08%respectively,and the detection rates were 90%,80%and 63.64%respectively.Conclusion PlGF combined with PAPP-A,MAP and UtPI in early pregnancy is of high value in predicting early-onset preeclampsia.