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目的探讨妊娠早期细胞角蛋白19片段抗原(CYFRA21-1)、甲胎蛋白(AFP)检测在对子痫前期(PE)预测中的价值。方法选取2015年1月-2016年10月在十堰市妇幼保健院定期产检并诊断为妊娠期高血压疾病的83例孕妇为研究对象,根据随访结果将孕妇分为A、B、C组,A组为子痫前期孕妇(40例),B组为妊娠期高血压疾病孕妇(43例),C组为正常妊娠孕妇(50例)。分别于孕12~14周检测血清CYFRA21-1、AFP水平。应用受试者工作曲线评价CYFRA21-1、AFP指标预测PE发生的临床价值。结果 C组血清CYFRA21-1水平明显低于A组和B组(均P<0.01),B组血清CYFRA21-1水平明显低于A组(P<0.05);C组血清AFP水平明显低于A组和B组(均P<0.01);(2)孕妇血清CYFRA21-1水平与新生儿体质量及分娩孕周呈负相关(r=-0.301,P=0.000;r=-0.244,P=0.005);孕妇血清AFP水平与分娩孕周呈负相关(r=-0.613,P=0.000);(3)血清CYFRA21-1(MOM值)AUC为0.680(P<0.01),当MOM截断值为1.245时,灵敏度为42.5%,特异性91.4%;血清AFP(MOM值)的ROC曲线下面积(AUC)为0.725(95%CI:0.634~0.815),MOM截断值为1.035时,灵敏度为85.0%,特异性49.5%;联合检测AUC为0.783,MOM截断值为1.270时,灵敏度为87.5%,特异性为55.9%。结论孕早期检测血清CYFRA21-1、AFP水平在健康孕妇、妊娠期高血压及子痫前期孕妇中有逐渐增高趋势,单独指标或联合检测CYFRA21-1、AFP指标对PE均有预测价值,但联合检测要优于单一指标预测PE发病的价值,值得临床进一步研究。
Objective To investigate the value of CYFRA21-1 and AFP in the prediction of preeclampsia (PE) in early pregnancy. Methods From January 2015 to October 2016, 83 pregnant women with regular pregnancy test and diagnosis of gestational hypertension in Shiyan MCH hospital were selected as study subjects. According to the follow-up results, pregnant women were divided into A, B and C groups, A The group was pregnant women with preeclampsia (40 cases), the group B was pregnant women with gestational hypertension (43 cases), and the group C was normal pregnant women (50 cases). Serum levels of CYFRA21-1 and AFP were detected at 12-14 weeks of gestation. The clinical curve of CYFRA21-1 and AFP was used to predict the clinical value of PE. Results The serum level of CYFRA21-1 in group C was significantly lower than that in group A and B (all P <0.01). The level of serum CYFRA21-1 in group B was significantly lower than that in group A (P <0.05). The serum AFP level in group C was significantly lower than that in group A (P <0.01). (2) The level of serum CYFRA21-1 in pregnant women was negatively correlated with body weight and gestational age of newborns (r = -0.301, P = 0.000; r = -0.244, P = 0.005 ). The serum AFP level of pregnant women was negatively correlated with gestational age of delivery (r = -0.613, P = 0.000). (3) The serum AFP of CYFRA21-1 (MOM value) was 0.680 (P <0.01) , The sensitivity was 42.5% and the specificity was 91.4%. The AUC of AFP (MOM value) was 0.725 (95% CI: 0.634-0.815) and the sensitivity was 85.0% when MOM cutoff was 1.035, Specificity of 49.5%; combined detection of AUC was 0.783, MOM cutoff of 1.270, the sensitivity was 87.5%, the specificity was 55.9%. Conclusions The levels of serum CYFRA21-1 and AFP in pregnant women in the first trimester tend to increase in healthy pregnant women, gestational hypertension and pregnant women with preeclampsia. The individual indexes or the combined detection of CYFRA21-1 and AFP indicators have predictive value for PE, Detection is better than a single index to predict the value of PE, it is worth further clinical study.