论文部分内容阅读
目的分析胎盘蛋白13(PP-13)、妊娠相关蛋白A(PAPPA)、孕中期子宫动脉超声搏动指数(PI)检测对不良妊娠结局的预测价值。方法收集天津市中心医院2015年4月-2016年2月收治的812例孕妇的临床资料,所有产妇均于孕11+0~13+6周完成彩色多普勒超声、血清PP-13、PAPPA检查,均随访至分娩或妊娠终止,并按照是否发生不良妊娠结局分为不良组与非不良组,分析PP-13、PAPPA、PI对产妇不良妊娠结局的预测价值。结果 (1)812例孕妇均完成随访,无1例失访。其中妊娠期间引产3例(0.37%),妊娠期间发生高危事件263例(32.39%)。发生妊娠不良结局130例(16.01%)。不良组年龄高于非不良组,其甲减、糖尿病合并妊娠、妊娠期糖尿病、妊娠期高血压、PE、重度PE、胎盘异常、羊水异常、产后出血所占比例均高于非不良组,对比差异有统计学意义(P<0.05);(2)不良组PP-13、PAPPA浓度水平低于非不良组,PI高于非不良组,组间比较差异有统计学意义(P<0.05);(3)不良组PP-13 Mo M、PAPPA Mo M低于非不良组,PI Mo M高于非不良组,组间比较差异有统计学意义(P<0.05);(4)孕中期PP-13+PI预测不良妊娠结局敏感度最高,其次为PP-13+PAPPA+PI;PP-13+PI值ROC线下面积最大时,诊断敏感度为80%,特异度为98%;PP-13+PAPPA+PIROC线下面积最大时,诊断敏感度为75%、特异度为90%。结论孕中期PP-13、PAPPA、PI的变化均与产妇不良妊娠结局发生存在紧密关联,以PP-13联合PI监测对妊娠不良结局预测的敏感度、特异度最高。
Objective To analyze the predictive value of placental protein 13 (PP-13), pregnancy-associated protein A (PAPPA) and mid-trimester uterine artery pulsatile index (PI) in adverse pregnancy outcomes. Methods The clinical data of 812 pregnant women in Tianjin Central Hospital from April 2015 to February 2016 were collected. All the pregnant women completed color Doppler ultrasound, serum PP-13, PAPPA All the patients were followed up until childbirth or termination of pregnancy. According to whether the adverse pregnancy outcomes were divided into bad group and non-poor group, the predictive value of PP-13, PAPPA and PI on adverse pregnancy outcomes was analyzed. Results (1) 812 pregnant women were followed up, none of them were lost. Among them, 3 cases were induced labor during pregnancy (0.37%), and 263 cases (32.39%) were high risk during pregnancy. 130 cases of adverse pregnancy outcomes (16.01%). The incidences of hypothyroidism, diabetes complicated with pregnancy, gestational diabetes mellitus, gestational hypertension, PE, severe PE, placental abnormalities, amniotic fluid anomalies and postpartum hemorrhage were all higher in the poor group than in the non-negative group (P <0.05); (2) The levels of PP-13 and PAPPA in the poor group were lower than those in the non-poor group and PI were higher than those in the non-poor group (P <0.05); (3) The levels of Mo-M and PAPPA Mo M in the poor group were lower than those in the non-poor group and PI Mo M were higher than those in the non-poor group (P <0.05); (4) 13 + PI showed the highest sensitivity of adverse pregnancy outcomes, followed by PP-13 + PAPPA + PI. The diagnostic sensitivity and specificity of PP-13 + PI were the highest at 80% and 98%, respectively. + When PAPPA + PIROC line area is the largest, the diagnostic sensitivity is 75% and the specificity is 90%. Conclusion The changes of PP-13, PAPPA and PI in the second trimester of pregnancy are closely related to the occurrence of adverse pregnancy outcomes. The sensitivity and specificity of PP-13 combined with PI in predicting adverse pregnancy outcomes are the highest.