血清PAPP-A、PP13和sFlt-1/PlGF比值檢測對子癇前期高危孕婦患病的預測價值

［摘 要］目的 分析血清妊娠相關α血漿蛋白（PAPP-A）、胎盤蛋白13（PP13）和可溶性胎盤血管內皮生長因子受體-1（sFlt-1）/胎盤生長因子（PlGF）比值檢測對子癇前期（PE）高危因素孕婦PE發生的預測價值。方法 選取2021年3月至2023年3月合肥市第二人民醫院收治的187例具有PE高危因素的孕婦，根據妊娠20周后是否發生PE分為患病組（28例）和未患病組（159例）。收集所有孕婦一般資料，并采用酶聯免疫吸附試驗檢測所有孕婦血清PAPP-A、PP13、sFlt-1、PlGF水平，采用Pearson相關分析各指標的關系，繪制受試者工作特征（ROC）曲線評估各項指標對PE發生的預測價值。結果 妊娠16周及分娩前患病組血清PAPP-A水平均低于未患病組，血清PP13水平均高于未患病組，sFlt-1/PlGF比值均高于未患病組，差異有統計學意義（t值介于4.198～8.173之間，P＜0.05）；患病組孕婦經干預治療后血清PAPP-A水平升高，血清PP13水平降低，sFlt-1/PlGF比值降低，差異有統計學意義（t值介于2.024～3.671之間，P＜0.05）；血清PAPP-A水平與PP13、sFlt-1/PlGF比值均呈負相關性（r值分別為-0.836、-0.775，P＜0.05），血清PP13水平與sFlt-1/PlGF比值呈正相關性（r=0.670，P＜0.05）；ROC分析結果顯示，血清PAPP-A、PP13、sFlt-1/PlGF預測PE發生的曲線下面積（AUC）分別為0.810、0.805、0.798，均有一定的預測價值（P＜0.05）。結論 血清PAPP-A、PP13和sFlt-1/PlGF比值對PE高危因素孕婦發生PE有較高的預測價值。

［關鍵詞］子癇前期；妊娠相關α血漿蛋白；胎盤蛋白13；可溶性胎盤血管內皮生長因子受體-1；胎盤生長因子

Doi：10.3969/j.issn.1673-5293.2024.09.001

［中圖分類號］R179""" ［文獻標識碼］A"""［文章編號］1673-5293（2024）09-0001-06

Predictive value of serum PAPP-A，PP13 and sFlt-1/PlGF ratio for the occurrence of

preeclampsia in high-risk pregnant women

［Abstract］ Objective To analyze the predictive value of serum pregnancy-associated plasma protein-A （PAPP-A），placental protein 13 （PP13） and the soluble fms-like tyrosine kinase-1 （sFlt-1）/placental growth factor （PlGF） ratio tests for the occurrence of preeclampsia （PE） in pregnant women with high-risk factors for PE. Methods A total of 187 pregnant women with high-risk factors for PE who were admitted to Hefei Second Peoples Hospital from March 2021 to March 2023 were selected.They were divided into a diseased group （28 cases） and a non-diseased group （159 cases） based on whether PE occurred after 20 weeks of gestation.General information was collected from all pregnant women，and serum levels of PAPP-A，PP13，sFlt-1 and PlGF were measured using enzyme-linked immunosorbent assay （ELISA）.Pearson correlation analysis was used to examine the relationships among the indicators，and receiver operating characteristic （ROC） curves were plotted to assess the predictive value of each indicator for the occurrence of PE. Results The serum PAPP-A levels in the diseased group were lower than those in the non-diseased group at 16 weeks of gestation and before delivery，while serum PP13 levels and the sFlt-1/PlGF ratio were higher in the diseased group，with statistically significant differences （t=4.198-8.173，P＜0.05）.After intervention treatment，the diseased group showed increased serum PAPP-A levels，decreased serum PP13 levels，and a reduced sFlt-1/PlGF ratio，with statistically significant differences （t=2.024-3.671，P＜0.05）.The levels of serum PAPP-A were negatively correlated with PP13 and sFlt-1/PlGF ratio （r=-0.836 and -0.775，respectively，P＜0.05），and serum PP13 levels were positively correlated with sFlt-1/PIGF ratio （r=0.670，P＜0.05）.ROC analysis results showed that area under the curve （AUC） for predicting PE occurrence was 0.810 for serum PAPP-A，0.805 for PP13，and 0.798 for the sFlt-1/PlGF ratio，all of which had certain predictive value （P＜0.05）. Conclusion Serum PAPP-A，PP13 and sFlt-1/PlGF ratio have high predictive value for the occurrence of PE in pregnant women with high-risk factors.

［Key words］ preeclampsia;pregnancy-associated plasma protein-A;placental protein 13;soluble fms-like tyrosine kinase-1;placental growth factor

子癇前期（preeclampsia，PE）是妊娠期間一種常見的高危疾病，表現為血壓升高、蛋白尿和水腫等癥狀，嚴重時會危及母嬰生命。PE不僅是孕產婦發生不良妊娠結局的重要原因，同時也是出現不良新生兒結局的重要原因。目前PE的病因和具體發病機制尚不清楚，多認為是一種多因素（多胎妊娠、PE家族史、初產婦、輔助生殖等）、多機制（炎癥免疫過度激活、血管內皮細胞受損等）的疾病。……