血清STOX1可溶性血管内皮细胞生长因子受体1及血栓调节蛋白对早发型重度子痫前期并发胎盘早剥的预测分析

Prediction of placental abruption in patients with severe preeclampsia with early onset by STOX1,sFlt-1 and TM

目的分析血清STOX1、可溶性血管内皮细胞生长因子受体1(sFlt-1)及血栓调节蛋白(TM)对早发型重度子痫前期并发胎盘早剥的预测价值。方法选取2017年2月—2020年9月收治的343例初诊早发型重度子痫前期患者并于同期招募320例健康孕妇,分别记为疾病组和对照组。两组均取外周血采用酶联免疫吸附法(ELISA)检测血清STOX1、sFlt-1及TM水平并比较;采用logistic回归分析探讨疾病组并发胎盘早剥的因素;绘制受试者工作特征(ROC)曲线分析初诊时血清STOX1、sFlt-1、TM水平及联合对疾病组并发胎盘早剥的预测价值。结果疾病组初诊时血清STOX1、sFlt-1及TM水平均高于对照组(t=38.339,68.138,37.571,均P<0.05);疾病组胎盘早剥发生率为19.53%,高于对照组(χ^(2)=55.231,P<0.05);疾病组胎盘早剥发生者血清STOX1、sFlt-1及TM水平均高于未发生者(t=12.457,8.579,14.413,均P<0.05);分娩史、初诊时血清STOX1水平、初诊时血清sFlt-1、初诊时血清TM水平、羊水过少、低妊娠增长体质量、贫血及脐带过短均是疾病组并发胎盘早剥的危险因素(OR=3.022、5.936、6.373、7.352、3.995、3.174、3.370、2.121,P<0.05);血清STOX1、sFlt-1及TM水平联合预测疾病组并发胎盘早剥的灵敏度高于单独预测(P<0.01),曲线下面积(AUC)高于单独预测(P<0.05),特异度与单独预测比较差异均无统计学意义(均P>0.05)。结论早发型重度子痫前期血清STOX1、sFlt-1、TM水平及胎盘早剥发生率较高,且血清STOX1、sFlt-1、TM水平、分娩史、羊水过少、低妊娠增长体质量、贫血及脐带过短等均是并发胎盘早剥的影响因素,血清STOX1、sFlt-1及TM三者联合对早发型重度子痫前期并发胎盘早剥的预测价值理想。

Objective To analyze the predictive value of serum STOX1,soluble vascular endothelial growth factor receptor 1(sFlt-1)and thrombomodulin(TM)in early-onset severe preeclampsia complicated with placental abruption.Methods 343 newly diagnosed patients with early-onset severe preeclampsia from February 2017 to September 2020 were selected,and 320 healthy pregnant women were recruited in the same period,which were recorded as the disease group and the control group respectively.The levels of serum STOX1,sFlt-1 and TM were detected by enzyme-linked immunosorbent assay(ELISA).logistic regression analysis was used to explore the factors of placental abruption in the disease group.The receiver operating characteristic(ROC)curve was drawn to analyze the serum levels of STOX1,sFlt-1 and TM at the initial diagnosis and the predictive value of the combination in the disease group complicated with placental abruption.Results The levels of serum STOX1,sFlt-1 and TM in the disease group were higher than those in the control group(t=38.339,68.138,37.571,all P<0.05).The incidence of placental abruption in the disease group was 19.53%,which was higher than that in the control group(χ~2=55.231,P<0.05).The levels of serum STOX1,sFlt-1 and TM in patients with placental abruption in the disease group were higher than those without placental abruption(t=12.457,8.579,14.413,all P<0.05).The risk factors of placental abruption in the disease group were delivery history,serum STOX1 level at the initial diagnosis,serum sFlt-1 at initial diagnosis,serum TM level at the initial diagnosis,oligohydramnios,low pregnancy weight gain,anemia and short umbilical cord(OR=3.022,5.936,6.373,7.352,3.995,3.174,3.370,2.121,P<0.05).The sensitivity of combined prediction of serum STOX1,sFlt-1 and TM levels in the disease group complicated with placental abruption was higher than that predicted alone(P<0.01),and the area under the curve(AUC)was higher than that predicted alone(P<0.05).There was no significant difference between the specificity and that predicted alone(P>0.05).Conclusion The levels of serum STOX1,sFlt-1 and TM and the incidence rate of placental abruption in early-onset severe preeclampsia are higher,and the levels of serum STOX1,sFlt-1 and TM and delivery history,oligohydramnios,low pregnancy weight gain,anemia and short umbilical cord are the influencing factors of placental abruption.The combination of serum STOX1,sFlt-1 and TM has a ideal predictive value for early-onset severe preeclampsia complicated with placental abruption.