摘要
目的回顾性分析早孕期母血清PAPP-A与自然流产、妊娠期高血压及妊娠期糖尿病等妊娠并发症的相关性。方法收集早孕期唐氏综合征筛查病例7397例,将孕期胎儿结构正常、未发生妊娠并发症及出生后新生儿正常病例2443例作为正常对照组,比较其与妊娠并发症组母血清PAPP-A水平差异。结果早孕期唐氏筛查样本共7397例,5113例随访成功,其中孕期及产后随访正常病例2443例(47.8%),孕期自然流产或终止妊娠病例106例(2.1%),先兆流产病例98例(1.9%),妊娠期高血压综合征74例(1.4%),妊娠期糖尿病148例(2.9%),妊娠期糖耐量异常237例(4.6%)。统计分析发现,低PAPP-A水平与自然流产、妊娠期高血压综合征、妊娠期糖尿病存在显著相关性(P<0.0001),而与先兆流产无显著相关(P=0.25);ROC曲线分析未发现能够诊断妊娠期并发症的PAPP-A切割值,但提示低PAPP-A对于自然流产(AUC=0.6545,P<0.0001)、妊娠期高血压综合征(AUC=0.6410,P<0.0001)、妊娠期糖尿病(AUC=0.6458,P<0.0001)可作为较好的筛查指标。当PAPP-A数值低于第5(0.46MOM)或第10(0.58MOM)百分位时,早孕期自然流产、妊娠期糖尿病、妊娠期糖耐量异常的发生率明显升高(P<0.01)。结论早孕期母血清PAPP-A值与妊娠期并发症如自然流产、妊娠期高血压综合征及妊娠期糖尿病具有显著的统计学相关性,其在产科临床的应用有待进一步证实。
Objective This is a retrospective study,the Purpose of this study is to investigate the relationship between low level of PAPP-A at first trimester and pregnant outcome(miscarriage,pregnancy-induced hypertension syndrome and gestational diabetes mellitus).Methods From 2008 to 2009,there were 7397 pregnancies who received Down syndrome screening at first trimester in clinic in Guangzhou Women and Children Hospital.Those cases without any pregnant complications were taken as normal controls,PAPP-A levels were compared between those cases with pregnant complications and controls so that we could investigate the relationship between low level of PAPP-A and pegnant outcome,and assess the feasibility in applying the PAPP-A into early screening of pregnant complications.Results There were 7 397 cases enrolled in this study,only 5 113 cases were followed up successfully,the follow-up rate is 69.1%.From the results of followed up data,2 443 cases(47.8%)were defined with no complications,which were then taken as normal controls in this research.For cases with pregnant complications,there were 106 cases(2.1%)of miscarriage,98 cases with threatened abortion(1.9%),PIH were found in 74 cases(1.4%),GDM in 148 cases(2.9%),and IGT in 237 cases(4.6%).By statistic analysis,we found there was close correlation between low level PAPP-A and miscarriage,PIH and GDM(P<0.001),and no correlation with threatened abortion(P=0.25),Receiver operator characteristic(ROC)curve analysis did not reveal any obvious single PAPP-A MoM cutoff value for any outcome variable analyzed.So arbitrary cutoff values were chosen for analysis of relative risk at PAPP-A values of 5th and 10th percentile.The results showed us significant difference of PAPP-A in pregnancies with miscarriage,GDM and IGT,but no positive result was found in PIH groups.Conclusion Low level of maternal serum PAPP-A at first trimester has close correlation with pregnant complications,this marker could be used not only as a predictor of chromosome anomalies but also of adverse pregnancy outcome.
出处
《中国产前诊断杂志（电子版）》
2011年第2期16-20,共5页
Chinese Journal of Prenatal Diagnosis(Electronic Version)
