Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Prenat Diagn. 2010 Mar;30(3):216-23. doi: 10.1002/pd.2440.
To explore if the addition of pregnancy-associated plasma protein-A (PAPP-A) to maternal factors and biophysical markers yields a significant improvement in the detection of hypertensive disorders before the clinical onset of disease.
Prospective screening study for early preeclampsia (PE), late PE and gestational hypertension (GH) in women attending their first hospital visit at 11(+0)-13(+6) weeks of gestation. The performance of screening for PE and GH by combinations of maternal factors, uterine artery with the lowest pulsatility index (L-PI), mean arterial pressure (MAP) and serum PAPP-A was determined.
There were 8061 unaffected controls, 37 of whom developed early PE, 128 with late PE and 140 with GH. Compared to the controls, in early PE and late PE MAP and uterine artery L-PI were increased and PAPP-A was decreased. In GH PAPP-A was not significantly different from controls. In screening for a combination of maternal factors, uterine artery L-PI, MAP and PAPP-A the detection rate of early PE was 83.8%, at a 5% false-positive rate. In the prediction of late PE and GH there was no significant improvement from the addition of PAPP-A to the combination of maternal factors, MAP and uterine artery L-PI.
Measurement of PAPP-A improves the performance of screening for early PE provided by a combination of maternal factors and biophysical tests at 11-13 weeks.
探讨在疾病临床发作前，将妊娠相关血浆蛋白 A（PAPP-A）添加到母体因素和生物物理标志物中是否能显著提高高血压疾病的检测率。
对 11（+0）-13（+6）周首次就诊的孕妇进行早发性子痫前期（PE）、晚发性 PE 和妊娠高血压（GH）的前瞻性筛查研究。通过组合母体因素、子宫动脉最低搏动指数（L-PI）、平均动脉压（MAP）和血清 PAPP-A 来确定 PE 和 GH 的筛查表现。
有 8061 名未受影响的对照组，其中 37 名发展为早发性 PE，128 名发展为晚发性 PE，140 名发展为 GH。与对照组相比，早发性 PE 和晚发性 PE 的 MAP 和子宫动脉 L-PI 升高，PAPP-A 降低。GH 中的 PAPP-A 与对照组无显著差异。在筛查母体因素、子宫动脉 L-PI、MAP 和 PAPP-A 的组合时，早发性 PE 的检出率为 83.8%，假阳性率为 5%。在预测晚发性 PE 和 GH 时，将 PAPP-A 添加到母体因素、MAP 和子宫动脉 L-PI 的组合中并不能显著提高检测效果。
在 11-13 周时，测量 PAPP-A 可提高母体因素和生物物理检测组合筛查早期 PE 的性能。
