子痫前期患者血清妊娠相关血浆蛋白-A和血管内皮生长因子水平与妊娠结局的关系

Relationship between serum pregnancy associated plasma protein-A,vascular endothelial growth factor levels and pregnancy outcome in patients with preeclampsia

目的 探讨子痫前期(PE)患者血清妊娠相关血浆蛋白(PAPP)-A、血管内皮生长因子(VEGF)水平与妊娠结局的关系。方法 选择2020年5月至2021年5月信阳市中心医院收治的118例PE患者为研究对象,所有患者于入院当天至分娩后1 d接受临床观察,评估患者妊娠不良事件发生情况,根据评估结果将发生妊娠不良事件的患者纳入妊娠结局不良组,未发生妊娠不良事件患者纳入妊娠结局良好组。于入院次日,收集患者空腹外周静脉血8 mL,采用酶联免疫吸附试验法检测患者血清PAPP-A、VEGF水平;使用全自动血细胞分析仪检测患者全血白细胞(WBC)计数及血小板(PLT)、血红蛋白(Hb)水平。入院次日清晨,收集患者24 h尿液,采用酶联免疫吸附试验法检测患者24 h尿蛋白水平。设计一般资料调查问卷,收集2组患者临床资料,包括:年龄、分娩方式、入院时孕周、分娩时孕周、孕次、孕前体质量指数(BMI)、疾病类型等。采用logistic回归分析PE患者妊娠结局的影响因素。绘制受试者操作特征(ROC)曲线,分析血清PAPP-A、VEGF水平对PE患者妊娠结局不良的预测效能,以曲线下面积(AUC)表示预测价值。结果 本研究纳入的118例PE患者中,86例(72.88%)患者妊娠结局良好(妊娠结局良好组);32例(27.12%)患者发生妊娠不良事件(妊娠结局不良组),其中孕妇不良事件22例,胎儿不良事件10例。2组患者的年龄、孕前BMI、分娩方式、分娩时孕周、孕次、疾病类型比较差异无统计学意义(P>0.05)。妊娠结局不良组患者全血Hb、PLT及血清PAPP-A、VEFG水平显著低于妊娠结局良好组,24 h尿蛋白水平显著高于妊娠结局良好组(P<0.05);2组患者的全血WBC计数比较差异无统计学意义(P>0.05)。Logistic回归分析结果显示,血清PAPP-A、VEGF与PE患者妊娠结局不良有关(P<0.05),全血Hb、PLT、24 h尿蛋白与PE患者妊娠结局无关(P>0.05)。ROC曲线分析显示,血清PAPP-A、VEGF预测PE患者不良妊娠结局的截断值分别为2 718.780 mU·L^(-1)、29.495 ng·L^(-1);血清PAPP-A联合VEGF预测PE患者不良妊娠结局的敏感度显著高于PAPP-A单独检测(P<0.05);血清PAPP-A与VEGF预测PE患者不良妊娠结局的敏感度比较差异无统计学意义(P>0.05);血清PAPP-A、VEGF、PAPP-A联合VEGF预测PE患者不良妊娠结局的AUC、特异度比较差异无统计学意义(P>0.05)。结论 血清PAPP-A、VEGF水平与PE患者妊娠结局不良有关,血清PAPP-A、VEGF水平可作为预测PE患者不良妊娠结局的生物标志物。

Objective To investigate the relationship between serum pregnancy-associated plasma protein(PAPP)-A,vascular endothelial growth factor(VEGF) and pregnancy outcome in patients with preeclampsia(PE).Methods A total of 118 PE patients admitted to Xinyang Central Hospital from May 2020 to May 2021 were selected as the study objects.All patients received clinical observation from the day of admission to the first day after delivery, and the incidence of adverse pregnancy events was evaluated.According to the evaluation results, the patients with adverse pregnancy events were included in the adverse pregnancy outcome group, and the patients without adverse pregnancy events were included in the good pregnancy outcome group.On the next day after admission, 8 mL of fasting peripheral venous blood was collected, and the serum PAPP-A and VEGF levels were detected by enzyme linked immunosorbent assay.The white blood cell(WBC) count, platelet(PLT) and hemoglobin(Hb) levels of the patients were detected by automatic blood cell analyzer.In the morning of the next day after admission, 24 h urine was collected and the 24 h urine protein level was detected by enzyme linked immunosorbent assay.A general data questionnaire was designed to collect the clinical data of patients in the two groups, including age, mode of delivery, gestational week at admission, gestational week at delivery, the number of pregnancies, pre-pregnancy body mass index(BMI),disease type, etc.The influencing factor of the pregnancy outcome of PE patients was analyzed by logistic regression analysis.Receiver operating characteristic(ROC) curve was drawn to analyze the predictive efficacy of serum PAPP-A and VEGF levels on adverse pregnancy outcomes in PE patients, and the predictive value was represented by the area under curve(AUC).Results Of the 118 PE patients included in this study, 86 patients(72.88%) had a good pregnancy outcome(good pregnancy outcome group);32 patients(27.12%) had adverse pregnancy events(adverse pregnancy outcome group),including 22 cases of adverse events of pregnancy and 10 cases of fetal adverse events.There was no significant difference in terms of age, BMI before pregnancy, delivery mode, gestational week, number of pregnancies and disease type of patients between the two groups(P>0.05).Whole blood Hb, PLT,serum PAPP-A and VEFG levels of patients in the adverse pregnancy outcome group were significantly lower than those in the good pregnancy outcome group, and 24 h urinary protein level was significantly higher than that in the good pregnancy outcome group(P<0.05).There was no significant difference in whole blood WBC of patients between the two groups(P>0.05).Logistic regression analysis showed that the levels of serum PAPP-A and VEGF were related to the adverse pregnancy outcome of PE patients(P<0.05),while the whole blood Hb, PLT and 24 h urine protein were not related to the pregnancy outcome of PE patients(P>0.05).The results of ROC curve showed that the cutoff values of serum PAPP-A and VEGF for predicting adverse pregnancy outcomes in PE patients were 2 718.780 mU·L^(-1)and 29.495 ng·L^(-1),respectively.The sensitivity of serum PAPP-A combined with VEGF to predict adverse pregnancy outcome in PE patients was significantly higher than that of PAPP-A alone(P<0.05);there was no significant difference in the sensitivity between PAPP-A alone and VEGF alone in predicting adverse pregnancy outcome in PE patients(P>0.05);there was no significant difference in AUC and specificity of predicting adverse pregnancy outcome in PE patients among the serum PAPP-A,VEGF alone and PAPP-A combined with VEGF(P>0.05).Conclusion The levels of serum PAPP-A and VEGF are related to the adverse pregnancy outcome of PE patients.The levels of serum PAPP-A and VEGF can be used as biomarkers to predict the adverse pregnancy outcome of PE patients.