Department of Obstetrics and Gynaecology, University College London Hospitals, Institute for Women's Health, London, UK.
Ultrasound Obstet Gynecol. 2010 Jun;35(6):671-9. doi: 10.1002/uog.7559.
To investigate the predictive value of the combination of first-trimester serum placental protein 13 (PP13), uterine artery Doppler pulsatility index (PI) and pulse wave analysis (augmentation index at a heart rate of 75 beats per min (AIx-75)), and to evaluate concurrent and contingent strategies using this combination for assessing the risk of pre-eclampsia in high-risk women.
In this nested case-control study, serum PP13, uterine artery mean PI and AIx-75 were measured at between 11 + 0 and 13 + 6 weeks' gestation in women at increased risk of pre-eclampsia. For each case of pre-eclampsia (n = 42), five matched controls were randomly selected from the study group. Gestation specific multiples of the median (MoMs) were adjusted for body mass index, ethnicity, smoking, age and parity. MoMs were compared between cases and controls using the Wilcoxon rank sum test. Sensitivities and specificities were derived from receiver-operating characteristics curves.
Compared with controls, women who developed pre-eclampsia had lower PP13, higher uterine artery mean PI and higher AIx-75 (P < 0.001). For a 10% false-positive rate, the best detection rate for pre-eclampsia (85.7% (95% CI, 71.5-94.6%)) and pre-eclampsia requiring delivery before 34 weeks (92.9% (95% CI, 66.1-99.8%)) was achieved by concurrent testing with all three markers. The best contingency screening sequences for pre-eclampsia were (AIx-75 --> PP13 --> mean PI) and (PP13 --> AIx-75 --> mean PI), with an 86% detection rate for false-positive rates of 9 and 10%, respectively. These two sequences would require 410 and 414 tests, respectively, compared with 756 tests in concurrent testing.
Combination of first-trimester PP13, uterine artery mean PI and pulse-wave analysis is promising for the prediction of pre-eclampsia in women at increased a-priori risk and may be useful in clinical practice. Contingency screening achieved similar detection rates to concurrent testing, but required almost 50% fewer tests, making it a more cost-effective option.
探讨早孕期血清胎盘蛋白 13（PP13）、子宫动脉多普勒搏动指数（PI）和脉搏波分析（心率为 75 次/分时的增强指数（AIx-75））联合检测对预测子痫前期的价值，并评估该联合检测用于评估高危孕妇子痫前期风险的同时检测和后续检测策略。
在这项巢式病例对照研究中，在患有子痫前期风险增加的妇女中，于 11+0 至 13+6 周妊娠时测量血清 PP13、子宫动脉平均 PI 和 AIx-75。对于每例子痫前期（n=42），均从研究组中随机选择 5 例匹配的对照。为了校正体重指数、种族、吸烟、年龄和产次，对妊娠特异性中位数倍数（MoM）进行了调整。使用 Wilcoxon 秩和检验比较病例和对照组之间的 MoM。通过接收者操作特征曲线得出敏感性和特异性。
与对照组相比，发生子痫前期的妇女的 PP13 较低，子宫动脉平均 PI 较高，AIx-75 较高（P<0.001）。对于 10%的假阳性率，联合检测三种标志物可获得子痫前期的最佳检出率（85.7%（95%CI，71.5-94.6%））和需要在 34 周前分娩的子痫前期的最佳检出率（92.9%（95%CI，66.1-99.8%））。子痫前期的最佳后续筛查序列为（AIx-75-->PP13-->mean PI）和（PP13-->AIx-75-->mean PI），假阳性率分别为 9%和 10%时，检出率分别为 86%。与同时检测相比，这两种序列分别需要进行 410 次和 414 次检测。
早孕期 PP13、子宫动脉平均 PI 和脉搏波分析联合检测有望预测高危孕妇的子痫前期，可能在临床实践中具有应用价值。后续检测达到了与同时检测相似的检出率，但需要的检测次数减少了近 50%，因此是一种更具成本效益的选择。
