早孕期非整倍体筛查标志物与妊娠期并发症的相关性

Correlation between first-trimester aneuploidy screening markers and pregnancy complications

目的了解早孕期非整倍体筛查标志物(PAPP-A、freeβ-h CG和NT)与妊娠期并发症的相关性。方法采用回顾性病例对照方法,分析2015年1月—2021年6月,在杭州市西湖区各采血点接受早孕期血清学产前筛查检测,妊娠晚期在杭州市妇产科医院住院分娩的孕妇,将研究对象分为妊娠合并高血压病组(GH,n=97)、子痫前期组(PE,n=43)、妊娠期糖尿病组(GDM,n=167)、妊娠期肝内胆汁淤积症组(ICP,n=76)和对照组(n=192),检测5组孕妇血清标本PAPP-A和freeβ-HCG及胎儿NT水平,并比较其MoM值分布情况。采用受试者工作特征(ROC)曲线确定最佳临界(cut-off)值、曲线下面积(AUC),以及PAPP-A MoM预测妊娠期并发症的效能进行评价。结果PE组的PAPP-A水平低于对照组(Z=3.163,P<0.05),PE组的18三体风险值高于对照组,组间差异有统计学意义(Z=3.150,P=0.001)。PAPP-A对PE的AUC为0.654(95%CI:0.560~0.748,P=0.002),当PAPP-A的cut-off值=1.055 MoM时,对应的灵敏度和特异度分别为0.791和0.469,而PAPP-A对GH、GDM和ICP均无诊断价值,其AUC分别为0.535、0.526和0.550,均P>0.05。结论早孕期母血清低水平PAPP-A是预测晚期孕妇发生PE的标志物,但不能预测GH、GDM和ICP;早孕期母血清freeβ-h CG和胎儿NT对GH、PE、GDM和ICP均没有预测价值。

Objective To investigate the correlation between aneuploidy screening markers(PAPP-A,freeβ-HCG and NT)and pregnancy complications during first-trimester.Methods Retrospective case-control method was used to analyze the pregnant women who received serological prenatal screening in first-trimester at various blood collection sites in Xihu District of Hangzhou from January 2015 to June 2021 and delivered in Hangzhou Maternity Hospital during the third trimester of pregnancy.The subjects were divided into hypertensive pregnancy group(GH,n=97),preeclampsia group(PE,n=43),gestational diabetes mellitus group(GDM,n=167),intrahepatic cholestasis of pregnancy group(ICP,n=76)and control group(n=192).The levels of PAPP-A and freeβ-HCG in serum and fetal NT in 5 groups were detected,and the distribution of MoM value was compared.Receiver operating characteristic(ROC)curves were used to determine the optimal cut-off value,area under curve(AUC),and PAPP-A MoM’s efficacy in predicting pregnancy complications were evaluated.Results The level of PAPP-A in PE group was lower than that in control group(Z=3.163,P<0.05).The risk values of trisomy 18 in PE group were higher than those in control group,and there was statistical significance on the differences among groups(Z=3.150,P=0.001).The AUC of PAPP-A to PE was 0.654(95%CI:0.560-0.748,P=0.002).When the cut-off value of PAPP-A was 1.055 MoM,the corresponding sensitivity and specificity were 0.791 and 0.469,respectively.PAPP-A had no diagnostic value for GH,GDM and ICP,and its AUC was 0.535,0.526 and 0.550,respectively(P>0.05).Conclusion The low level of PAPP-A in first-trimester is a marker to predict PE in late pregnancy,but not GH,GDM and ICP.Maternal serum freeβ-HCG and fetal NT in first-trimester had no predictive value for GH,PE,GDM and ICP.