胎盘生长因子联合子宫动脉、脐带血流动力学指标对妊娠妇女子痫前期发病的预测价值

Prognostic value of placental growth factor combined with hemodynamic indexes of uterine artery and umbilical cord on the incidence of preeclampsia in pregnant women

目的 分析胎盘生长因子(PLGF)联合子宫动脉、脐带血流力学指标对妊娠妇女子痫前期发病的预测价值。方法 对2018年1月至2021年6月期间来盐城市妇幼保健院进行妊娠检查的5 740例单胎妊娠妇女展开回顾性研究,其中包括1 106例孕早期妇女(孕11~13周^(+6))、2 207例孕中期妇女(孕20~24周^(+6))和2 427例孕晚期妇女(孕30~36周^(+6)),随访并依据妇女是否出现子痫前期分为早期子痫前期组(n=28)和早期非子痫前期组(n=1 078)、中期子痫前期组(n=94)和中期非子痫前期组(n=2 113)、晚期子痫前期组(n=165)和晚期非子痫前期组(n=2 262)。比较孕早期子痫前期组和非子痫前期组、孕中期子痫前期组和非子痫前期组、孕晚期子痫前期组和非子痫前期组妇女PLGF、子宫动脉搏动指数(UtPI)、子宫动脉阻力指数(UtRI)、脐动脉搏动指数(UAPI)、脐动脉阻力指数(UARI)水平,分析各指标对妊娠妇女子痫前期发病的预测价值。结果 与早期非子痫前期组相比,早期子痫前期组妇女的血清PLGF水平降低,UtPI、UtRI、UAPI、UARI水平均升高;与中期非子痫前期组相比,中期子痫前期组妇女的血清PLGF水平降低,UtPI、UtRI、UAPI、UARI水平均升高;与晚期非子痫前期组相比,晚期子痫前期组妇女的血清PLGF水平降低,UtPI、UtRI、UAPI、UARI水平均升高,差异均有统计学意义(P<0.05)。以最终临床诊断为“金标准”,5 740例妊娠妇女共确诊287例子痫前期,绘制PLGF、UtPI、UtRI、UAPI、UARI诊断妊娠妇女子痫前期发病的受试者工作特征(ROC)曲线,确定最佳截断值分别为PLGF(89.54 pg/mL)、UtPI(1.34)、UtRI(0.65)、UAPI(0.84)、UARI(0.73)。PLGF、UtPI、UtRI、UAPI、UARI对于妊娠妇女子痫前期发病均有较佳的临床价值,且5者联合应用预测效果更佳,敏感度为91.56%,特异度为94.47%,曲线下面积为89.51,95%CI:0.715~0.899。结论 血清PLGF在子痫前期中呈低表达,UtPI、UtRI、UAPI、UARI在子痫前期中呈高表达。PLGF、UtPI、UtRI、UAPI、UARI对妊娠妇女子痫前期发病均有较佳的预测价值,且各指标联合诊断效果更佳。

Objective To analyze the predictive value of placental growth factor(PLGF) combined with hemodynamic indexes of uterine artery and umbilical cord on the incidence of preeclampsia in pregnant women. Methods A retrospective study was conducted on 5 740 women with single pregnancy who came to Yancheng Maternal and Child Health Hospital for pregnancy examination from January 2018 to June 2021, including 1 106 women in the first trimester(11-13^(+6) weeks), 2 207 women in the second trimester(20-24^(+6) weeks of pregnancy) and 2 427 women in the third trimester(30-36^(+6) weeks of pregnancy) were followed up and divided into the early preeclampsia group(n=28) and early non-preeclampsia group(n=1 078), mid-term preeclampsia group(n=94), mid-term non-preeclampsia group(n=2 113), advanced preeclampsia group(n=165) and advanced non-preeclampsia group(n=2 262) according to whether the women had preeclampsia. The levels of PLGF, uterine artery pulsation index(UtPI), uterine arterial resistance index(UtRI), umbilical artery pulsation index(UAPI), umbilical artery resistance index(UARI) of women in preeclampsia group and early non-preeclampsia group, mid-term preeclampsia group and mid-term non-preeclampsia group, advanced preeclampsia group and advanced non-preeclampsia group were compared, the predictive value of each index on the onset of preeclampsia in pregnant women was analyed. Results Compared with the early non-preeclampsia group, the level of serum PLGF in the early preeclampsia group decreased, and the levels of UtPI, UtRI, UAPI, UARI increased;compared with the mid-stage non-preeclampsia group, the levels of serum PLGF decreased in the mid-stage preeclampsia group, the levels of UtPI, UtRI, UAPI, UARI increased;compared with the advanced non-preeclampsia group, the levels of serum PLGF in the advanced preeclampsia group decreased, the levels UtPI, UtRI, UAPI, UARI increased, the differences were statistically significant(P<0.05). Taking the final clinical diagnosis as the "gold standard", a total of 287 cases of preeclampsia were diagnosed in 5 740 pregnant women. The receiver operating characteristic(ROC) curves of PLGF, UtPI, UtRI, UAPI, UARI for the diagnosis of preeclampsia in pregnant women were drawn, and the best cutoff values were determined as PLGF(89.54 pg/mL), UtPI(1.34), UtRI(0.65), UAPI(0.84), UARI(0.73). PLGF, UtPI, UtRI, UAPI, UARI have better clinical value for the onset of preeclampsia in pregnant women, and the combined application of the five has better predictive effect, the sensitivity was 91.56%, specificity was 94.47%, area under the curve was 89.51, 95%CI: 0.715-0.899. Conclusion Serum PLGF was low expressed in preeclampsia, while UtPI, UtRI, UAPI and UARI were high expressed in preeclampsia. PLGF, UtPI, UtRI, UAPI, and UARI have better predictive value for the onset of preeclampsia in pregnant women, and the combined diagnosis effect of each index is better.