张向东 刘姣 钱碧霞 单群达 靳春雷 郑芬 蓝小芳 雷永良

[摘要] 目的 探讨血清胎盘生长因子（PLGF）、和肽素（CPT）、可溶性Fms样酪氨酸激酶1（sFlt-1）聯合子宫动脉搏动指数（PI）在预测子痫前期（PE）发生的临床应用价值。 方法 选取2016年4月至2018年6月在丽水市妇幼保健院产科分娩且入院诊断为PE的136例孕妇作为子痫前期组，同期选取164例正常分娩孕妇作为对照组。比较两组孕妇四项指标（PLGF、CPT、sFlt-1、PI）水平，通过计算ROC曲线下面积（AUC），以平行试验和序列试验的灵敏度、特异度、准确度、似然比（阴、阳性似然比）及诊断指数为参数，多指标评价联合检测的诊断效率。 结果 子痫前期组PLGF水平明显低于正常妊娠组水平，差异有统计学意义（P<0.01），子痫前期组sFlt-1、CPT、PI水平明显高于对照组，差异有统计学意义（P<0.01）;经ROC曲线分析，四项指标AUC在0.701～0.879;7种模式（PI+PLGF、PI+sFlt-1、PI+CPT、PLGF+sFlt-1+CPT、PI+PLGF+sFlt-1、PI+PLGF+CPT、PI+PLGF+sFlt-1+CPT）组合的平行试验只有PLGF+sFlt-1+CPT的阴性似然比>0.1，7种模式组合的序列试验只有PI+PLGF+sFlt-1+CPT的阳性似然比>10。 结论 四项指标单一预测PE有一定局限性;6种联合模式组合的平行试验可作为PE筛查和排除指标，其中PI+PLGF的组合为最佳指标;7种组合序列试验只有PI+PLGF+sFlt-1+CPT可作为PE预测确诊指标。

[关键词] 子痫前期;和肽素;血清胎盘生长因子;可溶性Fms样酪氨酸激酶1;子宫动脉搏动指数;ROC曲线;似然比

[中图分类号] R714.244          [文献标识码] A          [文章编号] 1673-9701（2021）07-0001-04

The value of serum PLGF， CPT and sFlt-1 combined with PI in predicting the occurrence of preeclampsia in pregnant women

ZHANG Xiangdong   LIU Jiao   QIAN Bixia   SHAN Qunda   JIN Chunlei   ZHENG Fen   LAN Xiaofang   LEI Yongliang

Prenatal Diagnosis Center， Lishui Maternal and Child Health Care Hospital in Zhejiang Province， Lishui   323000， China

[Abstract] Objective To investigate the clinical application value of serum placental growth factor（PLGF）， Copeptin （CPT）， soluble FMs-like tyrosine kinase 1（sFlt-1） combined with pulsatility index（PI） in predicting the occurrence of preeclampsia（PE）. Methods A total of 136 cases of pregnant women diagnosed with PE who gave birth in the obstetrics department of Lishui Maternal and Child Health Care Hospital between April 2016 and June 2018 were enrolled as the preeclampsia group. A total of 164 normal pregnant women were selected as control group at the same time. The four indicators（PLGF， CPT， sFlt-1， PI） between two groups were compared. Multiple indexes were used to evaluate the diagnostic efficiency of combined test by computing the area under the ROC curve（AUC）， with parallel test and sequence test the sensitivity， specificity， accuracy， likelihood ratio（negative， positive likelihood ratio） and diagnostic index for the parameter. Results PLGF level in preeclampsia group was significantly lower than that in normal pregnancy group（P<0.01）. sFlt-1， CPT and PI level in preeclampsia group were significantly higher than those in normal pregnancy（P<0.01）. The AUC of the four indexes was between 0.701 and 0.879 by ROC curve analysis. Only PLGF+sFlt-1+CPT had a negative likelihood ratio >0.1 in parallel test of seven modes（PI+PLGF， PI+sFlt-1， PI+CPT， PLGF+sFlt-1+CPT， PI+PLGF+sFlt-1， PI+PLGF+CPT， PI+PLGF+sFlt-1+CPT）. The positive likelihood ratios of PI+PLGF+sFlt-1+CPT was >10 in sequence test of seven modes. Conclusions The single use of 4 indexes in predicting PE has some limitations. The parallel test of 6 combination modes can be used as PE screening and exclusion indexes， among which the combination of PI+PLGF is the best index. Only PI+PLGF+SFlt-1+CPT in sequence test of seven modes could be used as the prediction and diagnosis index of PE.

[Key words] Preeclampsia; Copeptin; Serum placental growth factor; Soluble FMS-like tyrosine kinase 1; Uterine artery pulsation index; ROC curve; Likelihood ratio

子痫前期（Preeclampsia，PE）是最常见的危害母婴健康的妊娠并发症，在孕妇中的发病率为2%～8%，是我国孕产妇死亡的第二大原因[1]。PE不但严重威胁孕产妇健康，且会增加围产儿发生胎儿宫内窘迫、发育迟缓、早产及新生儿远期患内分泌营养代谢性疾病的风险[2]。随着全面两孩政策的落地实施，更多高龄高危孕产妇分娩，该疾病发生率将有逐步上升的趋势。大多……