Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
BJOG. 2010 Oct;117(11):1384-9. doi: 10.1111/j.1471-0528.2010.02690.x.
To investigate the predictive value of maternal serum pregnancy-associated plasma protein A (PAPP-A), free β subunit of human chorionic gonadotrophin (fβ-hCG), placental protein 13 (PP13), placental growth factor (PlGF) and a desintegrin and metalloproteinase 12 (ADAM12), for first-trimester identification of early-onset pre-eclampsia.
Nested case-control study.
Routine first-trimester screening for trisomy 21 in the Netherlands.
Eighty-eight women who developed pre-eclampsia or haemolysis, elevated liver enzymes, low platelets (HELLP) syndrome before 34 weeks of gestation and 480 controls.
PP13, PlGF and ADAM12 were measured in stored first-trimester serum, previously tested for PAPP-A and fβ-hCG. All marker levels were expressed in multiples of the gestation-specific normal median (MoMs). Model predicted detection rates for fixed false-positive rates were obtained for statistically significant markers alone and in combination.
Development of pre-eclampsia or HELLP syndrome.
PP13 and PlGF were reduced in women with pre-eclampsia, with medians 0.68 MoM and 0.73 MoM respectively (P < 0.0001 for both). PAPP-A was reduced (median 0.82 MoM, P < 0.02) whereas ADAM12 and fβ-hCG did not differ between control women and those with pre-eclampsia. In pre-eclampsia complicated by a small-for-gestational-age fetus, all markers except fβ-hCG had lower values, compared with pregnancies involving fetuses of normal weight. The model-predicted pre-eclampsia detection rate for a combination of PP13 and PlGF was 44% and 54%, respectively, for a fixed 5% and 10% false-positive rate.
This study demonstrates that PP13 and PlGF in the first-trimester might be promising markers in risk assessment for early pre-eclampsia/HELLP syndrome but for an adequate screening test additional characteristics are necessary.
研究母体血清妊娠相关血浆蛋白 A（PAPP-A）、人绒毛膜促性腺激素游离β亚基（fβ-hCG）、胎盘蛋白 13（PP13）、胎盘生长因子（PlGF）和去整合素金属蛋白酶 12（ADAM12）对早发型子痫前期的预测价值。
巢式病例对照研究。
荷兰常规唐氏综合征 21 三体筛查的第一孕期筛查。
88 例在 34 周前发生子痫前期或溶血、肝酶升高、血小板减少（HELLP）综合征的孕妇和 480 例对照。
在储存的第一孕期血清中检测 PP13、PlGF 和 ADAM12，之前检测过 PAPP-A 和 fβ-hCG。所有标志物水平均以特定孕龄的正常中位数倍数（MoM）表示。对于有统计学意义的标志物，单独和联合使用，计算固定假阳性率的模型预测检出率。
子痫前期或 HELLP 综合征的发生。
子痫前期患者的 PP13 和 PlGF 降低，中位数分别为 0.68 MoM 和 0.73 MoM（均 P < 0.0001）。PAPP-A 降低（中位数 0.82 MoM，P < 0.02），而 ADAM12 和 fβ-hCG 在对照组和子痫前期患者之间没有差异。在伴有胎儿生长受限的子痫前期患者中，除 fβ-hCG 外，所有标志物的水平均较低，与体重正常的胎儿相比。PP13 和 PlGF 联合的模型预测子痫前期检出率分别为 44%和 54%，固定假阳性率为 5%和 10%。
本研究表明，第一孕期的 PP13 和 PlGF 可能是预测早发型子痫前期/HELLP 综合征风险的有前途的标志物，但对于一个合适的筛查试验，还需要其他特征。
