胎盘微血管指数和血清TIMP-2水平对子痫前期孕妇胎儿生长受限的预测价值

Value of placental microvascular index and serum TIMP-2 level in predicting fetal growth restriction in preeclampsia pregnant women

目的探讨胎盘微血管指数联合血清基质金属蛋白酶抑制因子2(TIMP-2)水平对子痫前期(PE)孕妇胎儿生长受限(FGR)的预测价值。方法选择PE孕妇139例(观察组),其中发生FGR 41例、未发生FGR 98例,同期另选正常孕妇50例(对照组)。观察组入院次日,对照组体检当日,采用三维超声诊断仪行胎盘微血管检查,记录胎盘微血管指数,包括血管化指数(VI)、血流指数(FI)、血管化-血流指数(VFI);采集空腹外周静脉血,离心留取血清,采用双抗体酶联免疫吸附法检测血清TIMP-2。分析PE孕妇发生FGR的危险因素,采用受试者工作特征(ROC)曲线分析胎盘微血管指数和血清TIMP-2水平对PE孕妇发生FGR的预测价值。结果观察组胎盘微血管指数VI、FI、VFI水平均低于对照组,血清TIMP-2水平高于对照组(P均<0.05)。单因素分析发现,PE孕妇发生FGR者胎盘微血管指数VI、FI、VFI均低于未发生FGR者,而血清TIMP-2水平高于未发生FGR者(P均<0.05)。多因素Logistic回归分析发现,胎盘微血管指数VI、FI、VFI降低和血清TIMP-2水平升高均为PE孕妇发生FGR的独立危险因素(P均<0.05)。ROC曲线分析发现,胎盘微血管指数VI、FI、VFI及血清TIMP-2水平预测PE孕妇发生FGR的曲线下面积(AUC)分别为0.792、0.797、0.821、0.696,四者联合预测PE孕妇发生FGR的AUC为0.949。胎盘微血管指数VI、FI、VFI和血清TIMP-2水平联合预测PE孕妇发生FGR的AUC高于四者单独(P均<0.05)。结论胎盘微血管指数VI、FI、VFI降低和血清TIMP-2水平升高是PE孕妇发生FGR的独立危险因素;胎盘微血管指数VI、FI、VFI和血清TIMP-2水平对PE孕妇发生FGR均有一定预测价值,四者联合预测价值更高。

Objective To investigate the predictive value of placental microvascular index combined with serum ma-trix metalloproteinase inhibitor 2(TIMP-2)levels in fetal growth restriction(FGR)in pregnant women with preeclampsia(PE).Methods A total of 139 PE pregnant women(observation group),including 41 with FGR,98 without FGR,and meanwhile,50 normal pregnant women(control group)were selected.On the day after admission in the observation group and on the day of physical examination in the control group,the placental microvascular examination was performed by three-dimensional ultrasonic diagnostic instrument,and the placental microvascular index,including vascularization index(VI),blood flow index(FI)and vascularization-flow index(VFI),was recorded.Fasting peripheral venous blood was col-lected,serum was retained by centrifugation,and serum TIMP-2 was detected by double antibody enzyme-linked immuno-sorbent assay.The risk factors of FGR in PE pregnant women were analyzed,and the predictive value of placental micro-vascular index and serum TIMP-2 level for FGR in PE pregnant women was analyzed by receiver operating characteristic(ROC)curve.Results The placental microvascular indexes VI,FI and VFI levels in the observation group were lower than those in the control group,and the serum TIMP-2 level was higher than that in the control group(all P<0.05).Uni-variate analysis showed that the placental microvascular indexes VI,FI and VFI of the PE pregnant women with FGR were lower than those in PE pregnant women without FGR,while the serum TIMP-2 level was higher(all P<0.05).Multivari-ate Logistic regression analysis showed that the decreased placental microvascular indexes VI,FI and VFI and the in-creased serum TIMP-2 were independent risk factors for FGR in PE pregnant women(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of placental microvascular indexes VI,FI,VFI and serum TIMP-2 in predict-ing the occurrence of FGR in PE pregnant women was 0.792,0.797,0.821 and 0.696,respectively,and the AUC of the four combined in predicting the occurrence of FGR in PE pregnant women was 0.949.The AUC of the combination of pla-cental microvascular indexes VI,FI,VFI and serum TIMP-2 in predicting FGR in PE pregnant women was higher than that of the four alone(all P<0.05).Conclusions The decreased placental microvascular indexes VI,FI and VFI and the increased serum TIMP-2 level are independent risk factors for FGR in PE pregnant women.The placental microvascu-lar indexes VI,FI,VFI and serum TIMP-2 have certain predictive value for the occurrence of FGR in PE pregnant wom-en,and the predictive value of the four combined is higher.