易晓云

[摘要] 目的 探討孕早期母亲血清妊娠相关血浆蛋白A（PAPP-A）、平均动脉压（MAP）、子宫动脉搏动指数（UtA-PI）联合筛查对预测子痫前期的应用价值。 方法 选取2018年10月至2020年6月自孕早期（孕11～13+6周）建档开始定期在我院产检的单胎妊娠孕妇，测定孕早期血清PAPP-A水平、MAP，采用彩色多普勒超声测定UtA-PI，随访妊娠结局，将发生子痫前期的10例孕妇作为观察组（其中早发型子痫前期组与晚发型子痫前期组各5例），另选取同期未发生子痫前期的正常孕妇189名作为对照组。对三组孕妇的PAPP-A、MAP、UtA-PI中位数倍数（MoM值）行单因素分析，并分析PAPP-A、MAP、UtA-PI在预测子痫前期中的应用价值。 结果 观察组PAPP-A MoM值水平低于对照组，观察组MAP、MoM值水平均高于对照组，且差异均具有统计学意义（P<0.05）;三组间UtA-PI水平比较，差异无统计学意义（P>0.05）;PAPP-A、MAP为子痫前期独立预测因子（P<0.05）;与PAPP-A、MAP、UtA-PI各指标单独检测相比较，联合检测在预测子痫前期的敏感度、特异度及ROC曲线下面积均最高。结论 孕早期PAPP-A、MAP、UtA-PI联合筛查在子痫前期预测中具有重要意义，可及时评估子痫前期发生风险，为临床诊断及干预提供依据。

[关键词] 子痫前期;妊娠相关血浆蛋白A;平均动脉压;子宫动脉搏动指数

[中图分类号] R714.244          [文献标识码] A          [文章编号] 1673-9701（2021）32-0022-04

[Abstract] Objective To investigate the value of combined screening of pregnancy-associated plasma protein A （PAPP-A）， mean arterial pressure （MAP） and uterine artery pulsatility index in early pregnancy （UtA-PI） for predicting preeclampsia. Methods Pregnant women with singleton pregnancies who received regular prenatal examinations in our hospital from October 2018 to June 2020 （11～13+6 weeks of gestation） were selected. Serum PAPP-A level and MAP were measured in early pregnancy. UtA-PI was measured by color Doppler ultrasound. Pregnancy outcomes were followed up. Ten pregnant women with preeclampsia were selected as the observation group （including 5 cases of early-onset preeclampsia and 5 cases of late-onset preeclampsia）， and another 189 normal pregnant women without preeclampsia in the same period were selected as the normal control group. Univariate analysis was performed on the multiple of median （MoM value） of PAPP-A， MAP， and UtA-PI in the three groups. The application value of PAPP-A， MAP， and UtA-PI in predicting preeclampsia was analyzed. Results The MoM of PAPP-A in the observation group was lower than that in the control group， and the MoM of MAP in the observation group was higher than that in the control group， and the differences were statistically significant（P<0.05）. There was no significant difference in the levels of UtA-PI among the three groups（P>0.05）. PAPP-A and MAP were independent predictors of preeclampsia（P<0.05）.The sensitivity， specificity and area under the ROC curve of the combined detection of PAPP-A， MAP， and UtA-PI in predicting preeclampsia were higher than those of various indicators alone. Conclusion The combined screening of PAPP-A， MAP， and UtA-PI in early pregnancy is of great significance in the prediction of preeclampsia. It can timely evaluate the risk of preeclampsia and provide the basis for clinical diagnosis and intervention.

[Key words] Preeclampsia; Pregnancy-associated plasma protein A; Mean arterial pressure; Uterine artery pulsatility index

子痫前期是指妊娠20周以后出现的血压升高及蛋白尿，伴有恶心、呕吐、头痛等不适症状，可导致妊娠期严重的母婴并发症，也是导致孕产妇死亡的重要因素[1]。因此，如在孕早期便能监测子痫前期的发生，对改善孕产妇不良结局将有显著意义。目前，预测子痫前……