From Fetal Medicine Unit, Division of Clinical Developmental Sciences and Protein Reference Unit and Division of Basic Medical Sciences, St. George's University of London, United Kingdom.
Obstet Gynecol. 2010 Jun;115(6):1233-1238. doi: 10.1097/AOG.0b013e3181dd5137.
To estimate the ability of maternal serum markers and uterine artery Doppler in predicting preeclampsia.
In this nested case-control study, maternal serum concentrations of cystatin C, beta2-microglobulin, serum amyloid A, C-reactive protein (CRP), and neopterin were measured, and resistance index of uterine artery blood flow was assessed in 45 women in whom preeclampsia subsequently developed and in 125 women with normal pregnancy outcome. Univariable regression analysis was performed to estimate correlations between serum markers and resistance index for the development of preeclampsia. Significant variables were identified using multiple logistic regressions.
Maternal serum markers were measured at a median gestational age of 14.7 weeks (interquartile range 3.1) in control group members and 16.3 weeks (interquartile range 4.8) in the case group members, and uterine resistance index was measured at the second-trimester scan. Univariable logistic regression showed that women with subsequent preeclampsia had increased levels of cystatin C, beta2-microglobulin, neopterin, CRP, and resistance index. Cystatin C, CRP, and resistance index remained independently associated with preeclampsia when multiple logistic regression was applied. Receiver-operating characteristic curve analysis showed that a combination of markers had a better area under the curve (AUC; 0.825) than when used in isolation (cystatin C, AUC 0.725; CRP, AUC 0.634; resistance index, AUC 0.728). Sensitivity of uterine artery resistance index, cystatin C, and CRP combined for predicting preeclampsia was 69.2% for a screen-positive rate of 15%.
Maternal serum cystatin C, CRP, and uterine artery mean resistance index are independent predictors of preeclampsia. There is improved prediction of preeclampsia when serum markers are combined with Doppler indices.
评估母体血清标志物和子宫动脉多普勒在预测子痫前期中的作用。
在这项巢式病例对照研究中，测量了 45 例随后发生子痫前期的孕妇和 125 例正常妊娠结局孕妇的母血清胱抑素 C、β2-微球蛋白、血清淀粉样蛋白 A、C 反应蛋白（CRP）和新蝶呤浓度，并评估了子宫动脉血流阻力指数。采用单变量回归分析估计血清标志物与发生子痫前期的阻力指数之间的相关性。采用多元逻辑回归识别有意义的变量。
对照组成员的中位妊娠周数为 14.7 周（四分位间距 3.1），病例组成员为 16.3 周（四分位间距 4.8），进行了子宫阻力指数的测量。单变量逻辑回归显示，随后发生子痫前期的孕妇胱抑素 C、β2-微球蛋白、新蝶呤、CRP 和阻力指数水平升高。当应用多元逻辑回归时，胱抑素 C、CRP 和阻力指数与子痫前期仍独立相关。受试者工作特征曲线分析显示，标志物联合应用的曲线下面积（AUC；0.825）优于单独应用（胱抑素 C，AUC 为 0.725；CRP，AUC 为 0.634；阻力指数，AUC 为 0.728）。子宫动脉阻力指数、胱抑素 C 和 CRP 联合预测子痫前期的敏感度为 69.2%，筛查阳性率为 15%。
母体血清胱抑素 C、CRP 和子宫动脉平均阻力指数是子痫前期的独立预测因子。当血清标志物与多普勒指数联合应用时，子痫前期的预测得到改善。
