摘要
目的了解早孕期产前筛查标志物(PAPP-A、Freeβ-hCG和NT)及母血清D-二聚体(D-D)水平预测母体后期发生子痫前期(PE)的诊断价值。方法采用回顾性病例对照研究方法,随机抽取2014年11月至2019年4月杭州市妇产科医院产科住院分娩的267例孕妇资料,其中,47例正常孕妇、126例妊娠期高血压(GH)、53例PE和41例重度子痫前期(SPE),采用受试者工作特征曲线(ROC)来评价早孕期血清D-D水平对PE等妊娠期高血压疾病(HDP)的诊断价值。结果GH、PE和SPE组的D-D水平分别为(266.85±40.77)ng/ml.(293.61±49.74)ng/ml和(326.46±43.16)ng/ml,均高于对照组(219.37±42.04)ng/ml,差异有统计学意义(F=49.798,P<0.001)。GH、PE和SPE组PAPP-A.Freeβ-hCG和NT水平均低于对照组,差异无统计学意义(P>0.05)。D-D对GH、PE、SPE的AUC分别为0.781、0.859、0.961,当D-D的cut off值分别为235.18 ng/ml.287.21 ng/ml、280.17ng/mI时,对应的灵敏度和特异度分别为0.746、0.585、0.829和0.681、1.000、0.957。结论早孕期孕妇血清D-D水平与GH、PE具有相关性和诊断价值,且有随着高血压病情进展,孕妇血清D-D水平有逐渐增高的趋势。不同HDP类型的灵敏度和特异度差异较大,以SPE的灵敏度和特异度最佳。相反,早孕期产前筛查标志物(PAPP-A、Freeβ-hCG和NT)对HDP无诊断价值。
Obiective To investigate the diagnostic value of prenatal screening markers(PAPP-A,Freeβ-HCG and NT)and maternal serum D--dimer(D-D)levels in predicting the development of matermal preclampsia(PE)in late pregnancy.Methods A retrospective case control study method was applied to randomly select the date of 267 pregnant women who gave birth in Hangzhou Obstetrics and Gynecology Hospital from November 2014 to April 2019,including 47 normal pregnant women,126 gestational hypertension(GH),53 PE,and 41 severe preeclampsia(SPE).Receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of serum D-D level in early pregnancy for PE and other hypertensive disorder complic ating pregnancy(HDP).Results The levels ofD-D in GH,PE and SPE groups were(266.85±40.77)ng/ml,.(293.61±49.74)ng/ml and(326.46±43.16)ng/ml,respectively,which were all higher than those of control group(219.37±42.04)ng/ml,and the difference was stitically significant(F=49.798,P<0.001).The levels of PAPP-A,Freeβ-HCG and NT in GH,PE and SPE groups were all lower than those in control group,and the differences were not staistically significant(P>0.05).The AUC value of D-dimer were 0.781 for GH,0.859 for PE,0.961 for SPE.When the cut off value ofD-D was 235.18 ng/ml,287.21ng/ml and 280.17 ng/ml,the corresponding sensitivity and specificity were 0.746 and 0.585,0.829 and 0.681,1.000 and 0.957,respectively.Conclusion Maternal serum D-D level in first trimester has correlation and diagnostic value for GH and PE,and with the progression of hypertension,maternal serum D-D level has a tendency of increasing gradually.The sensitivity and specificity of different HDP types are different,and SPE is the best.On the contrary,prenatal screening markers(PAPP-A,Freeβ-hCG and NT)in first trimester have no diagnostic value for HDP.
出处
《浙江临床医学》
2021年第5期720-722,共3页
Zhejiang Clinical Medical Journal
基金
杭州市余杭区科技局科研项目(医疗卫生-2018008)
杭州市医药卫生科技计划项目(2017052)
浙江省医药卫生科技计划项目(2018ZD036)
浙江省医药卫生科技计划项目(2021KY258)。
