ROC曲线分析妊娠相关血浆蛋白A、游离雌三醇、β-人绒毛膜促性腺激素对子痫前期的诊断价值

杨斌; 张建武

doi:10.13898/j.cnki.issn.1000-2200.2018.06.027

ROC曲线分析妊娠相关血浆蛋白A、游离雌三醇、β-人绒毛膜促性腺激素对子痫前期的诊断价值

杨斌,
张建武

Predictive value of PAPP-A,fE3 and β-hCG analyzed by ROC curve on preeclampsia

摘要

摘要: 目的：探讨妊娠相关血浆蛋白A（PAPP-A）、游离雌三醇（fE3）、β-人绒毛膜促性腺激素（β-hCG）对子痫前期的预测价值。方法：将117例妊娠期高血压孕妇分为子痫前期组49例和妊娠期高血压组68例，另选择90名健康孕妇作为对照组，分别于孕15~20周和孕24~28周抽取各组孕妇肘静脉血3 mL，采用酶联免疫吸附试验检测血清PAPP-A、fE3、β-hCG水平，比较孕15~20周和孕24~28周时各组血清PAPP-A、fE3、β-hCG水平，根据血清PAPP-A、fE3、β-hCG水平绘制受试者工作特征曲线（ROC），评价PAPP-A、fE3、β-hCG对子痫前期的预测价值。结果：3组孕产妇年龄、产次、孕前体质量指数比较差异无统计学意义（P>0.05），子痫前期组孕周、新生儿出生体质量、新生儿1 min Apgar评分均低于妊娠期高血压组和对照组（P<0.05）。孕15~20周时对照组、妊娠期高血压组、子痫前期组孕妇血清PAPP-A、fE3、β-hCG水平比较差异均无统计学意义（P>0.05）；孕24~28周时子痫前期组血清PAPP-A、fE3水平低于妊娠期高血压组和对照组，β-hCG水平高于妊娠期高血压组和对照组（P<0.05）。相关性分析显示，孕24~28周时血清PAPP-A水平与孕周、新生儿出生体质量均呈正相关关系（P<0.05和P<0.01），血清fE3水平与孕周呈正相关关系（P<0.01），血清β-hCG与新生儿1 min Apgar评分呈负相关关系（P<0.05）。血清PAPP-A、fE3、β-hCG水平及三项串联联合检测对子痫前期均有预测价值（P<0.01），三项指标联合的ROC曲线下面积最高（0.857），其预测价值优于任何一种单项指标。结论：子痫前期孕妇孕中期血清PAPP-A、fE3水平降低，β-hCG水平升高，联合检测孕24~28周时血清PAPP-A、fE3、β-hCG水平能够为预测子痫前期提供依据。

Abstract: Objective:To explore the predictive value of pregnancy-associated plasma protein A(PAPP-A),free estriol(fE3) and β-human choionic gonadotophin(β-hCG) on preeclampsia.Methods:A total of 117 pregnant women with pregnancy-induced hypertension were divided into the preeclampsia group(49 cases) and pregnancy induced hypertension group(68 cases),and 90 healthy pregnant women were set as the control group.The serum levels of PAPP-A,fE3 and β-hCG in three groups during 15 to 20 weeks and 24 to 28 weeks of pregnancy were detected by enzyme linked immunosorbent assay,and the serum levels of PAPP-A,fE3 and β-hCG between three groups were compared.The receiver operating curve(ROC) was drawn according to the serum levels of PAPP-A,fE3 and β-hCG,and the predictive value of PAPP-A,fE3 and β-hCG on preeclampsia was evaluated.Results:The differences of the age,parity and body mass index between three groups were not statistically significant(P>0.05),and the gestational weeks,neonatal birth weight and 1 minute Apgar scores in preeclampsia group were significantly lower than those in pregnancy induced hypertension group and control group(P<0.05).During the 15 to 20 weeks of pregnancy,the differences of the serum levels of PAPP-A,fE3 and β-hCG between three groups were not statistically significant(P>0.05).During the 24 to 28 weeks of pregnancy,the serum levels of PAPP-A and fE3 in preeclampsia group were lower than those in pregnancy induced hypertension group and control group,and the serum level of β-hCG in preeclampsia group was higher than that in pregnancy induced hypertension group and control group(P<0.05).During the 24 to 28 weeks of pregnancy,the correlation analysis showed that serum level of PAPP-A was positively correlated with gestational age and neonatal birth weight(P<0.05 and P<0.01),the serum level of fE3 was positively correlated with gestational age(P<0.01),and the serum level of β-hCG was negatively correlated with neonatal 1 minute Apgar score(P<0.01).The prediction value of the combination of serum PAPP-A,fE3 and β-hCG was better than that of single index(P<0.05).The serum levels of PAPP-A,fE3,β-hCG,and combination detection had predictive value on preeclampsia(P<0.05).The area under the ROC curve of three indexes combination was the highest(0.857).Conclusions:In middle pregnancy of preeclampsia pregnant women,the serum levels of PAPP-A and fE3 decrease,and the level of β-hCG increases.During the 24 to 28 weeks of pregnancy,the combination detection of serum PAPP-A,fE3 and β-hCG can provide a basis for predicting preeclampsia.

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