摘要
目的 评价孕15~20周孕妇血清中β-HCG、PlGF水平及比值对重度子痫前期的预测价值。方法 选取2014年5月至2015年6月于北京大学深圳医院行产前检查并分娩的1722名产妇组成列队,在15~20周时采集肘静脉血,存储于-80℃冰箱内以备检测。根据随访结果分成重度子痫前期组及正常妊娠组。应用ELISA方法检测两组血清中β-HCG和PlGF水平,结果均转化为正常妊娠组浓度的中位数的倍数（MoM值）,并计算β-HCG/PlGF比值。采用方差分析、Kruskal-Wallis秩和检验和Mann-Whitney U检验比较各指标的组间差异。应用受试者工作曲线（ROC曲线）评价3项指标预测重度子痫前期发生的临床价值。结果 11722名孕妇中发生子痫前期的共52例（3.2%）,其中诊断为重度子痫前期31例,同期采血且孕龄相近的正常妊娠孕妇102例作为对照组。2重度子痫前期组孕妇血清中β-HCG的MoM值[中位数（p25,p75）]较正常妊娠组明显升高,分别为1.27（0.78,1.86）MoM和0.96（0.71,1.17）MoM（P=0.021）;重度子痫前期组孕妇血清中PlGF的MoM值较正常妊娠组明显下降,分别为0.68（0.54,1.01）MoM和1.38（0.89,2.72）MoM（P〈0.01）;重度子痫前期组的β-HCG/PlGF比值明显高于正常妊娠组,分别为1.91（1.27,3.13）和0.70（0.38,0.99）（P〈0.01）,差别均有统计学意义。3预测价值：取β-HCG截断值为1.12MoM时,预测重度子痫前期的敏感度和特异度分别为54%和88%,曲线下面积（AUC）为0.664（95%CI：0.575~0.746;P=0.025）;取PlGF截断值为0.83MoM时,预测重度子痫前期的敏感度和特异度分别71%和82%,AUC为0.818（95%CI：0.740~0.881;P〈0.01）;取β-HCG/PlGF比值截断值为1.13时,预测重度子痫前期的敏感度和特异度分别82.3%和86.3%,AUC为0.914（95%CI：0.851~0.956;P〈0.01）。结论 孕中期早期,对孕妇血清中的β-HCG、PlGF水平进行检测并计算二者比值,对预测重度子痫前期发生有较好的临床价值,其中β-HCG/PlGF�
Objectives To evaluate early second-trimester maternal serum beta-human chorionic gonado- tropin （β-HCG）, placental growth factor（PIGF） and their ratio in the prediction of severe preeelampsia. Method This was a case-control study based on a cohort of 1722 singleton pregnancies who underwent an 15-20 weeks aneuploidy screening at Peking University Shenzhen Hospital between May 2014 and June 2015. According to the outcome, they were defined as severe preeclampsia group and normal pregnancy group. Maternal serum levels of β-HCG and PIGF were measured with enzyme-linked immunosorbent assay（ELISA）. The value of β-HCG, P1GF and their ratio were compared between different outcome groups. Results Toally 31 patients with severe preeclampsia and 102 women with normal pregnancy out comes were included in this study. Serum marker levels were expressed as multiples of the median（MoM）. Compared with normal pregnancies, serum β-HCG levels was significantly increased in the severe pre- eclampticpregnancies[median（p25,p75）, 1. 27（0. 78,1. 86）MoM vs. 0. 96（0. 71,1. 17） MoM, P= 0.021） ] ; P1GF levels was significantly decreased [ （median （ p25, p75）, 0.68 （0.54,1.01 ） MoM vs. 1.38 （0.89,2.72）MoM, P〈0.01-]; the β-HCG/P1GF ratio was signicantly higher [（median（p25,p75） ,1.91 1.27,3. 13） vs. 0.70 （0. 38,0.99）, P 〈 0.01 ） ]. The sensitivity and specificity to predict severe pre- eclampsia were 54% and 88% for β-HCG （cut off value 1.12MoM）, 71% and 82% for P1GF（cut off value 0.83MoM）, 82% and 86% for β-HCG/P1GF ratio（cut off value 1. 13）, with areas under the curves （AUCs） of 0. 664（95%CI： 0. 575-0. 746; P=0. 025）, 0. 818（95%CI： 0. 740-0. 881; P〈0.01） and 0. 914（95 %CI： 0. 851-0. 956 ; P〈0.01） respectively. Conclusions Maternal serum β-HCG, P1GF and their ratio may serve as potential candidates in predicting severe preeclampsia in the early second-trimester, among which, β-HCG/P1GF ratio yeild higher sensitivity and specificity.
出处
《中国产前诊断杂志（电子版）》
2015年第3期19-25,共7页
Chinese Journal of Prenatal Diagnosis(Electronic Version)
基金
深圳市知识创新计划基础研究项目(20130319184850)
