双侧子宫动脉S/D值联合血清25(OH)D水平检测在子痫前期中的诊断价值

摘要

目的 探讨母亲血清25(OH)D水平和双侧子宫动脉S/D平均值对子痫前期(PE)早期预测的临床价值.方法 纳入收集2016年1月至2018年6月在苏州大学附属第三医院和常州市妇幼保健医院定期产检并住院分娩的重度子痫前期(SPE)患者60例、轻度子痫前期(MPE)40例,选取同期正常分娩的孕妇60例为对照组.3组孕妇均于15～20周测量双侧子宫动脉S/D均值,于24周检测母亲血清25(OH)D水平;同时绘制S/D平均值、血清25(OH)D水平及联合检测的ROC曲线,比较各曲线下面积,同时计算S/D平均值、血清25(OH)D水平和联合检测PE的诊断效能.结果 SPE组的不良妊娠结局发生率明显高于MPE组,MPE组又高于正常组,差异有统计学意义(P < 0.05).SPE组双侧子宫动脉S/D平均值(4.09 ± 0.62),明细高于MPE组S/D平均值(3.26 ± 0.55)和正常组S/D平均值(2.62 ± 0.51),而MPE组S/D平均值又明显高于正常组,差异有统计学意义(P < 0.05);SPE组25(OH)D水平为(32.44 ± 5.84),明显低于MPE组25(OH)D水平(37.15 ± 5.90)和正常组25(OH)D水平(42.57 ± 7.44),而MPE组25(OH)D水平又明显低于正常组,差异均有统计学意义(P < 0.05);子痫前期组双侧子宫动脉S/D值平均值与25(OH)D水平呈负相关(r = -0.66,P < 0.01);S/D平均值、25(OH)D水平单独检测的ROC曲线下面积分别为0.787和0.719,均低于联合检测的ROC曲线下面积0.908,差异有统计学意义(均P < 0.001).结论 双侧子宫动脉S/D平均值和血清25(OH)D水平检测均可用于子痫前期的诊断和监测,且二者联合检测的诊断效能优于单项检测.%Objective To evaluate the clinical value of maternal serum 25(OH)D level and bilateral uterine artery S/D mean in early prediction of pre-eclampsia(PE). Methods Sixty normal pregnancy women(normal group),40 mild preeclampsia women(MPE group)and 60 severe preeclampsia women(SPE group)who were examined in Changzhou First People′s Hospital and Changzhou Maternal and Child Health Care Hospital between January 2016 and June 2018 were included. The mean value of S/D of bilateral uterine artery was measured from 15th to 20th weeks in all the 3 groups,and serum 25(OH)D level of the mother was measured at 24th week. Meanwhile, the ROC curves of S/D mean value,serum 25(OH)D level and combined detection were drawn to compare the area under each curve(AUC),and the diagnostic efficiency of S/D mean value,serum 25(OH)D level and combined detection PE were also calculated. Results The incidence of adverse pregnancy outcome in SPE group was significantly higher than that in MPE group,and that in MPE group was significantly higher than that in normal group(P < 0.05). The mean value of S/D of bilateral uterine artery in SPE group was(4.09 ± 0.62),which was higher than that in MPE group(3.26 + 0.55)and in normal group(2.62 ± 0.51),while the mean value of S/D in MPE group was significantly higher than that in normal group and the difference was statistically significant(P < 0.05). The level of serum 25(OH)D in SPE group was(32.44 ± 5.84),which was significantly lower than that in MPE group(37.15 ± 5.90)and in normal group(42.57 ± 7.44),while the serum 25(OH)D level in MPE group was significantly lower than that in normal group,and the difference was statistically significant(P < 0.05). The mean value of S/D of bilateral uterine artery in the pre-eclampsia group was negatively correlated with 25(OH)D level(r = -0.66,P < 0.01). The area under the ROC curve separately detected by S/D mean value and 25(OH)D level was 0.787 and 0.719 respectively,both of which were lower than that by jointly detection(0.908)and the difference was statistically significant(P < 0.001). Conclusion Both the mean S/D value of bilateral uterine arteries and serum 25(OH)D level can be used for the diagnosis and monitoring of pre-eclampsia,and the diagnostic efficacy of the combined detection is superior to that of single detection.