Department of Obstetrics and Gynecology, Washington University School of Medicine, 4911 Barnes-Jewish Hospital Plaza, St. Louis, MO 63110, USA.
Prenat Diagn. 2010 Apr;30(4):309-13. doi: 10.1002/pd.2452.
To determine the association of, and predictive ability of, pregnancy-associated plasma protein A (PAPP-A), free beta-human chorionic gonadotrophin (beta-hCG), and nuchal translucency (NT) with preterm birth (PTB).
A 5-year retrospective cohort study of women who underwent first-trimester combined screening was performed. Maternal medical, antepartum, and pregnancy outcome data were obtained. PAPP-A and beta-hCG were converted to multiples of the median (MoM), and primary exposure was defined as < or =10th percentile MoM for PAPP-A. Secondary exposures were defined as > or = 90th percentile MoM for beta-hCG and NT values of > or = 20 and 25 mm. The primary outcome was PTB before 35 weeks and the secondary outcome was PTB before 32 weeks. Univariate, bivariate, multivariate, and receiver-operator analyses were used.
Of the 2231 patients meeting inclusion criteria with complete outcome data available, 222 had a PAPP-A level < or =10th percentile MoM. Abnormally low PAPP-A was associated with an increased risk for PTB < 35 weeks [adjusted odds ratio (aOR) 2.0, 1.0-3.8] and < 32 weeks (aOR 2.7, 1.1-6.4), even after adjusting for prior PTB, tobacco exposure, chronic hypertension, and body mass index. PAPP-A < or =10th percentile was not sufficiently predictive of PTB < 35 weeks (area under curve = 0.63, 95% CI 0.53-0.72). Neither abnormally high beta-hCG nor increased NT was associated with an increased risk for PTB.
PAPP-A < or =10th percentile is associated with an increased risk for PTB, but is not sufficiently predictive to be used clinically.
确定妊娠相关血浆蛋白 A（PAPP-A）、游离β-人绒毛膜促性腺激素（β-hCG）和颈项透明层（NT）与早产（PTB）的关联及其预测能力。
对进行了首次 trimester 联合筛查的女性进行了一项为期 5 年的回顾性队列研究。获取了产妇的医疗、产前和妊娠结局数据。将 PAPP-A 和β-hCG 转换为中位数倍数（MoM），主要暴露定义为 PAPP-A <或=第 10 百分位数 MoM。次要暴露定义为β-hCG >或=第 90 百分位数 MoM 和 NT 值>或=20 和 25 mm。主要结局为 35 周前的 PTB，次要结局为 32 周前的 PTB。使用单变量、双变量、多变量和接收器操作者分析。
在符合纳入标准且有完整结局数据的 2231 名患者中，有 222 名患者的 PAPP-A 水平<或=第 10 百分位数 MoM。异常低值 PAPP-A 与 35 周前 PTB 增加的风险相关[调整后的优势比（aOR）2.0，1.0-3.8]和 32 周前 PTB（aOR 2.7，1.1-6.4），即使在调整了既往 PTB、烟草暴露、慢性高血压和体重指数后也是如此。PAPP-A <或=第 10 百分位数不能充分预测 35 周前的 PTB（曲线下面积=0.63，95%CI 0.53-0.72）。异常高的β-hCG或增加的 NT 均与 PTB 增加的风险无关。
PAPP-A <或=第 10 百分位数与 PTB 增加的风险相关，但不能充分预测，因此不能用于临床。
