血清视黄醇结合蛋白4对非糖尿病孕妇分娩巨大儿的预测价值

摘要

Objective:To investigate the predictive value of serumal retinol-binding protein 4(RBP4) level fro fetal macrosomia of non-diabetic pregnant women .Methods :The serumal levels of RBP4 of 500 non-diabetic pregnant women at 12 week ,20 week and 24 week of pregnancy were measured by immune projection turbidimetric method .Fetal macrosomia was defined as birth weight≥4000 g .The cut-off value ,sensitivity and specificity were calculated with receiver operating characteristic (ROC) curve .Results:Of the 500 non-diabetic pregnant women ,30 cases(6% ) got fetal macrosomia .The ROC curve showed that the predictive cut-off values of RBP4 at 12 week ,20 week and 24 week of pregnancy were 61 .0 mg/L ,50 .5 mg/L and 52 .5 mg/L , respectively ;the predictive sensitivity and specificity at 12 week ,20 week and 24 week of pregnancy were 42 .9% and 94 .5% , 70 .0% and 69 .5% ,76 .9% and 73 .2% ,respectively .The predictive cut-off value of RBP4 no later than 24 week of pregnancy was 51 .5 mg/L ;the predictive sensitivity and specificity were 61 .8% and 69 .5% .There was significant difference(P<0 .05) between the serumal level of RBP4 at 24 week of pregnancy in group fetal macrosomia and that in group nonfetal macrosomia . Conclusions :The predictive sensitivity of RBP4 increases in accordance with the increase of serumal level of RBP 4 .The serumal level of RBP4 of non-diabetic pregnant women at 24 week of pregnancy may have higher sensitivity and specificity in the predic-tion of fetal macrosomia .If the serumal level of RBP4 no later than 24 week of pregnancy is beyond 50 mg/L ,then the risk of fetal macrosomia will be higher .%目的：探讨非糖尿病孕妇血清中视黄醇结合蛋白4（retinol-binding protein 4，RBP4）水平对巨大儿的预测价值。方法：采用免疫投射比浊法检测500例非糖尿病孕妇在不同孕周（孕12、20、24周）的血清RBP4水平，以出生体质量≥4000 g者为巨大儿。采用受试者工作特征（receiver operating characteristic ，ROC）曲线计算RBP4预测巨大儿的界值及敏感度和特异度。结果：500例非糖尿病孕妇中，30例分娩巨大儿，巨大儿的发生率为6％。ROC曲线分析发现，孕12、20、24周血清RBP4预测巨大儿发生的界值分别是61．0、50．5、52．5 mg/L ，孕12、20、24周血清 RBP4预测巨大儿发生的敏感度和特异度分别为42．9％和94．5％、70．0％和69．5％、76．9％和73．2％；孕周≤24周血清RBP4预测巨大儿发生的界值是51．5 mg/L ，敏感度为61．8％，特异度为69．5％。巨大儿组与非巨大儿组孕妇孕24周血清RBP4水平差异有统计学意义（ P＜0．05）。结论：随着血清RBP4水平的增加，其预测巨大儿发生的敏感度增加；孕24周血清RBP4预测巨大儿发生的敏感度及特异度均较高；孕24周前血清RBP4水平＞50．0 mg/L的孕妇分娩巨大儿的风险较高。