子宫动脉舒张早期切迹联合妊娠相关血浆蛋白A对子痫前期的预测价值

Predictive value of early diastolic notch of uterine artery combined with pregnancy associated plasma protein-A in preeclampsia

目的研究子宫动脉舒张早期切迹联合妊娠相关血浆蛋白A(PAPP-A)对子痫前期的预测价值。方法回顾性选取2020年6月至2023年6月入邯郸市第一医院的86例子痫前期孕妇为观察对象,设为研究组;同时选取同期入院86名健康孕妇,设为对照组。两组均于妊娠11~13+6周对PAPP-A水平与右、左侧子宫动脉舒张早期切迹指数予以测定。比较两组孕妇的右切迹指数、左切迹指数及PAPP-A水平,同时计算并比较右切迹指数、左切迹指数、PAPP-A单独及联合诊断子痫前期的受试者操作特征(ROC)曲线下面积(AUC),并比较右切迹指数联合PAPP-A与左切迹指数联合PAPP-A的AUC。结果研究组孕妇右、左切迹指数与PAPP-A水平分别为0.71±0.21、0.65±0.27、(3504.84±1598.38)mU/L,均明显低于对照组[0.84±0.18、0.82±0.29、(5019.47±2498.96)mU/L],差异均有统计学意义(P<0.05)。子痫前期预测中右切迹指数的临界值为0.79,敏感度为64.38%,特异度为60.08%,AUC为0.658,95%CI为0.585~0.731;子痫前期预测中左切迹指数的临界值为0.71,敏感度为61.57%,特异度为71.76%,AUC为0.684,95%CI为0.612~0.757;子痫前期预测中PAPP-A的临界值为4003.5 mU/L,敏感度为68.47%,特异度为56.89%,AUC为0.673,95%CI为0.604~0.742;子痫前期预测中联合预测的敏感度为71.18%,特异度为75.47%,AUC为0.772,95%CI为0.711~0.834;右、左切迹指数与PAPP-A联合预测子痫前期的AUC大于单一指标预测,差异有统计学意义(P<0.05)。子痫前期预测中右切迹指数联合PAPP-A的敏感度为54.76%,特异度为80.27%,AUC为0.739,95%CI为0.674~0.804;左切迹指数联合PAPP-A的敏感度为80.79%,特异度为62.79%,AUC为0.757,95%CI为0.695~0.818;左切迹指数联合PAPP-A预测子痫前期AUC大于右切迹指数联合PAPP-A,差异有统计学意义(P<0.05)。结论单一子宫动脉舒张早期右、左切迹指数或者PAPP-A在预测子痫前期中均有良好效果,而子宫动脉舒张早期右、左切迹指数与PAPP-A联合检测的预测价值更高,同时左切迹指数联合PAPP-A预测子痫前期价值要高于右切迹指数联合PAPP-A。

Objective To study the predictive value of early diastolic notch of uterine artery combined with pregnancy associated plasma protein-A(PAPP-A)in preeclampsia.Methods Eighty-six preeclampsia pregnant women admitted to Handan First Hospital from June 2020 to June 2023 were selected retrospectively as the observation group,and 86 healthy pregnant women admitted at the same time were selected as the control group.PAPP-A level and early diastolic notch index of right and left uterine arteries were measured in both groups at 11-13+6 weeks of pregnancy.The right notch index,left notch index and PAPP-A level of pregnant women in the two groups were compared.Meanwhile,the area under receiver operating characteristic curve(AUC)of right notch index,left notch index,PAPP-A alone and jointly diagnosed preeclampsia was calculated and compared,and AUC between right notch index combined with PAPP-A and left notch index combined with PAPP-A was calculated and compared.Results The right and left notch index and PAPP-A level of pregnant women in the study group were 0.71±0.21,0.65±0.27,(3504.84±1598.38)mU/L,which were significantly lower than those in the control group[0.84±0.18,0.82±0.29,(5019.47±2498.96)mU/L],the differences were statistically significant(P<0.05).The critical value of right notch index in preeclampsia prediction was 0.79,the sensitivity was 64.38%,the specificity was 60.08%,AUC was 0.658,95%CI was 0.585-0.731.The critical value of left notch index in preeclampsia prediction was 0.71,sensitivity was 61.57%,specificity was 71.76%,AUC was 0.684,and 95%CI was 0.612-0.757.The critical value of PAPP-A in preeclampsia prediction was 4003.5 mU/L,the sensitivity was 68.47%,the specificity was 56.89%,AUC was 0.673,and 95%CI was 0.604-0.742.The sensitivity of joint prediction in preeclampsia prediction was 71.18%,the specificity was 75.47%,AUC was 0.772,and 95%CI was 0.711-0.834.The joint prediction of right and left notch index and PAPP-A for AUC of preeclampsia was greater than that of single index,and the difference was statistically significant(P<0.05).The sensitivity of right notch index combined with PAPP-A in preeclampsia prediction was 54.76%,specificity was 80.27%,AUC was 0.739,and 95%CI was 0.674-0.804.The sensitivity of left notch index combined with PAPP-A was 80.79%,specificity was 62.79%,AUC was 0.757,and 95%CI was 0.695-0.818.The AUC of left notch index combined with PAPP-A in predicting preeclampsia was greater than that of right notch index combined with PAPP-A,and the difference was statistically significant(P<0.05).Conclusion Single uterine artery early diastolic right and left notch indices or PAPP-A have good predictive effects in predicting preeclampsia,while the combined detection of right and left notch indices and PAPP-A in early uterine artery diastolic has higher predictive value.At the same time,the combination of left notch indices and PAPP-A predicts the value of preeclampsia higher than that of right notch indices combined with PAPP-A.