Poon L C Y, Maiz N, Valencia C, Plasencia W, Nicolaides K H
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Ultrasound Obstet Gynecol. 2009 Jan;33(1):23-33. doi: 10.1002/uog.6280.
To examine the relationship between low maternal serum pregnancy-associated plasma protein-A (PAPP-A) and uterine artery pulsatility index (UtA-PI) at 11+0 to 13+6 weeks with subsequent development of pre-eclampsia (PE).
UtA-PI and serum PAPP-A were measured in women attending for routine care at 11+0 to 13+6 weeks of gestation. In the population, 156 (1.9%) women developed PE, including 32 (0.4%) in whom delivery was before 34 weeks (early PE) and 124 (1.5%) with delivery at 34 weeks or more (late PE); 7895 (98.1%) women had no PE. Regression analysis was used to examine which of the factors amongst maternal characteristics, log PAPP-A multiples of the median (MoM) and log UtA-PI MoM contributed to the prediction of PE.
The median PAPP-A MoM was 1.002 (interquartile range (IQR), 0.685-1.411) in the unaffected group, 0.555 (IQR, 0.463-0.922) in early PE and 0.911 (IQR, 0.580-1.247) in late PE. Serum PAPP-A was below the 5th centile in 21.9% of early PE and 6.5% of late PE cases. The PAPP-A-related patient-specific risk for PE was strongly influenced by maternal characteristics. There was a significant association between log UtA-PI MoM and log PAPP-A MoM (P=0.001), and the detection rate of screening for PE by maternal variables and UtA-PI was not improved by inclusion of PAPP-A. Regression analysis was used to establish tables that allow modification of the maternal history and PAPP-A-related patient-specific risk for PE by the measurement of UtA-PI.
Low PAPP-A is a marker for subsequent development of PE. The PAPP-A-related patient-specific risk for PE can be modified by the measurement of UtA-PI.
研究孕11⁺⁰至13⁺⁶周时孕妇血清妊娠相关血浆蛋白-A（PAPP-A）水平降低与子宫动脉搏动指数（UtA-PI）之间的关系，以及子痫前期（PE）的后续发展情况。
对妊娠11⁺⁰至13⁺⁶周接受常规检查的孕妇测量UtA-PI和血清PAPP-A。在该人群中，156名（1.9%）孕妇发生了PE，其中32名（0.4%）在34周前分娩（早发型PE），124名（1.5%）在34周及以后分娩（晚发型PE）；7895名（98.1%）孕妇未发生PE。采用回归分析来研究孕产妇特征、PAPP-A中位数倍数（MoM）的对数和UtA-PI MoM的对数这些因素中哪些有助于预测PE。
未受影响组的PAPP-A MoM中位数为1.002（四分位间距（IQR），0.685 - 1.411），早发型PE组为0.555（IQR，0.463 - 0.922），晚发型PE组为0.911（IQR，0.580 - 1.247）。21.9%的早发型PE病例和6.5%的晚发型PE病例血清PAPP-A低于第5百分位数。与PAPP-A相关的PE患者特异性风险受孕产妇特征的强烈影响。UtA-PI MoM的对数与PAPP-A MoM的对数之间存在显著关联（P = 0.001），纳入PAPP-A并未提高通过孕产妇变量和UtA-PI筛查PE的检出率。采用回归分析建立表格，通过测量UtA-PI来修正孕产妇病史和与PAPP-A相关的PE患者特异性风险。
低PAPP-A是PE后续发展的一个标志物。通过测量UtA-PI可以修正与PAPP-A相关的PE患者特异性风险。
