孕32~35周孕妇血清hepcidin用于区分胎儿生长受限亚组的临床工具研究

Study on Maternal Serum Hepcidin at 32~35 Weeks’Gestation as the Clinical Tool to Distinguish the Subgroups of Fetal Growth Restriction

目的 分析孕32~35周时孕妇血清hepcidin用于区分胎儿生长受限亚组的临床效能。方法 2021年1月至12月,收集195例孕32^(+0)~35^(+7)周的孕妇血清样本,分为适于胎龄儿(AGA)组、小于胎龄儿(SGA)组和宫内生长受限(IUGR)组,所有孕妇均足月分娩(37~41周),同时在分娩后留取脐带血样本。采用化学发光法检测血清hepcidin水平。结果 共有96例(49.23%)AGA、50例(25.64%)SGA,49例(25.13%)IUGR孕妇入选。IUGR组母体血清hepcidin水平高于AGA组和SGA组(P<0.05),SGA组母体血清hepcidin水平低于AGA组,但无统计学差异(P>0.05)。孕前吸烟者母体血清hepcidin水平亦高于不吸烟者(P<0.05)。在ROC曲线分析中,发现母体血清hepcidin阈值为43.09 ng/ml时是区分IUGR和AGA的最佳选择,其诊断准确率为82.7%,LR^(+)为8,LR^(-)为0.3。结论 孕32~35周时母体血清hepcidin水平升高(>43.09 ng/ml)与IUGR相关。这有可能成为区分不同形式胎儿生长受限的临床工具,值得进一步研究。

Objective To analyze the clinical efficacy of maternal serum hepcidin in differentiating fetal growth restriction subgroups at 32~35 weeks of gestation.Methods From January to December 2021,a total of 195 serum samples of pregnant women at 32^(+0)~35^(+7)weeks of gestation were collected and divided into AGA(appropriate for gestational age)group,SGA(small for gestational age)group and IUGR(intrauterine growth restriction)group.All pregnant women delivered at term(37~41 weeks),and umbilical cord blood samples were taken after delivery.The level of serum hepcidin was detected by chemiluminescence.Results A total of 96(49.23%)AGA,50(25.64%)SGA and 49(25.13%)IUGR pregnant women were selected.The level of maternal serum hepcidin in IUGR group was higher than that in AGA group and SGA group(P<0.05),and the level of maternal serum hepcidin in SGA group was lower than that in AGA group,but there was no significant difference(P>0.05).The maternal serum hepcidin level of pre-pregnancy smokers was also higher than that of non-smokers(P<0.05).In the ROC curve analysis,it was found that the maternal serum hepcidin threshold was 43.09 ng/mL,which was the best choice to distinguish IUGR and AGA.The diagnostic accuracy was 82.7%,LR^(+)was 8 and LR^(-)was 0.3.Conclusion Elevated maternal serum hepcidin levels(>43.09 ng/ml)measured at 32~35 weeks of gestation are associated with IUGR.This may become a clinical tool to distinguish different forms of fetal growth restriction,which is worthy of further study.