孕11～14周妊娠相关蛋白A联合子宫动脉搏动指数预测早发型子痫前期的研究

摘要

Objective To explore the value of pregnancy-associated protein A (PAPP-A)combined with uterine artery pulsatility index (PI)to predict early-onset preeclampsia at 11 ~14 weeks of gestation.Methods A total of 176 cases of singleton pregnancy pregnant at 11 ~14 weeks,selected as the observation group,were assigned into normal pregnancy and preeclampsia according to pregnancy out-come.Pregnancy-associated protein A and uterine artery pulsation index were compared between normal pregnant women and pregnant women with preeclampsia.At the same time another 144 cases of singleton pregnancy pregnant at 8 ~10 weeks were selected as control group.Specificity and sensitivity of serum PAPP-A combined with uterine artery PI prediction of preeclampsia were evaluated.Results The incidences of preeclampsia were 5.95% and 4.35% respectively in the observation group and control group,showing no signifi-cant difference (P >0.05).The levels of PAPP-A were significantly lower in women with preeclampsia than in normal pregnant women (P <0.05).The uterine artery PI was significantly higher in women with preeclampsia than in normal pregnant women (P <0.05).As for PAPP-A combined with uterine artery PI test,the sensitivities and specificities were 85.34% vs 80.64%,and 81.22% vs 68.18%in observation and control group.Conclusions Serum PAPP-A and uterine artery PI both changed obviously in women pregnant at 8-10 weeks and 11-14 weeks before the onset of preeclampsia,however the combination of serum PAPP-A and uterine artery PI in predic-tion of preeclampsia at 11-14 weeks of gestation is more sensitive and specific,which has higher predictive value.%目的：探讨孕11～14周妊娠相关蛋白 A（PAPP-A）联合子宫动脉搏动指数（PI）预测早发型子痫前期的价值。方法选择单胎妊娠孕妇176例作为观察组，根据妊娠结局分为正常妊娠和子痫前期，对比正常妊娠孕妇和子痫前期孕妇妊娠相关蛋白 A 及子宫动脉搏动指数。另选择同期孕8～10周单胎妊娠孕妇144例作为对照组，分别计算两组孕妇血清 PAPP-A 联合子宫动脉 PI 预测子痫前期时的特异度及敏感度。结果观察组和对照组的子痫前期发生率分别为5．95％和4．35％，差异无统计学意义（P ＞0．05）；观察组和对照组中子痫前期孕妇 PAPP-A 水平均显著低于正常孕妇（P ＜0．05）；观察组和对照组中子痫前期孕妇子宫动脉（PI）均显著高于正常孕妇（P ＜0．05）；PAPP-A 联合子宫动脉 PI 检测时，对观察组孕妇的敏感度为85．34％，特异度为81．22％，对照组孕妇的敏感度为80．64％。特异度为68．18％。结论子痫前期发病前在孕8～10周、孕11～14周时孕妇血清 PAPP-A 及子宫动脉 PI 均有显著变化，但血清 PAPP-A 联合子宫动脉 PI 预测子痫前期在孕11～14周具有更高的敏感度和特异度，具有更高的预测价值。