Department of Clinical Chemistry, School of Medicine, Faculty of Health Sciences, University of Eastern Finland and Eastern Finland Laboratory Centre, P.O. Box 1700, 70211 Kuopio, Finland.
Eur J Obstet Gynecol Reprod Biol. 2011 Jul;157(1):48-52. doi: 10.1016/j.ejogrb.2011.03.004. Epub 2011 Apr 8.
To investigate links between first trimester Down's syndrome screening markers and adverse pregnancy outcomes; preeclampsia (PE), small for gestational age (SGA), preterm delivery (PD) and placental abruption (PA) in spontaneous, chromosomally normal pregnancies.
Cohort study in a university hospital. Data during pregnancy were routinely collected from a total study population of 2844 pregnant women between 2005 and 2007. Four study groups were pregnancies with PE (N=175), PA (N=17), PD (N=213) and SGA (N=275) plus a reference group with normal outcome (N=2164). The median MOMs of maternal serum concentrations of pregnancy associated plasma protein A (PAPP-A) and free beta human chorionic gonadotropin (fβ-hCG) were compared using two-tailed pooled t-tests, continuous variables were compared using Student's two-way t-tests, and Chi-square tests were used to analyse dichotomous variables. Fisher's exact test was used when there were fewer than five units in any of the classes.
The median MOM of maternal serum PAPP-A was significantly lower in women with PE, PD and SGA (0.79, 0.80 and 0.79 MOM, respectively) than in the reference group (0.99 MOM) (p<0.01). The median MOM of maternal serum fβ-hCG was also significantly lower in the SGA group (0.90 MOM) and in the PE and PD groups (0.86 and 0.92 MOM) than in the reference group (0.99 MOM, p=0.02). There was no detectable difference between the biochemical markers in the PA group and the reference group. No statistical difference was found between NT MOMs in the reference and study groups.
The concentrations of first trimester screening (FTS) serum markers were lower in pregnancies where PE, PD and SGA occurred. In the latter two cases, there was an inverse association between incidence and PAPP-A and fβ-hCG values. However, the development of PA during pregnancy could not be predicted from biochemical marker concentrations. The mechanism behind PA is probably less dependent on the placenta than on the decidua.
研究早孕期唐氏综合征筛查标志物与不良妊娠结局（子痫前期、胎儿生长受限、早产和胎盘早剥）之间的关系，这些结局发生在自发性、染色体正常的妊娠中。
这是一项在大学医院进行的队列研究。在 2005 年至 2007 年间，共收集了 2844 名孕妇的数据。研究人群分为 4 组：子痫前期组（175 例）、胎盘早剥组（17 例）、早产组（213 例）和胎儿生长受限组（275 例），同时设正常结局组（2164 例）作为对照。使用双尾 pooled t 检验比较母体血清妊娠相关血浆蛋白 A（PAPP-A）和游离人绒毛膜促性腺激素β亚基（fβ-hCG）浓度的中位数倍数（MOM），使用学生双样本 t 检验比较连续变量，使用卡方检验分析二分类变量。当任何一个分类中少于 5 个单位时，使用 Fisher 确切检验。
与正常结局组（0.99 MOM）相比，子痫前期组、早产组和胎儿生长受限组的母体血清 PAPP-A 中位数倍数（MOM）分别显著降低（0.79、0.80 和 0.79 MOM，p<0.01）。胎儿生长受限组（0.90 MOM）和子痫前期组及早产组（0.86 和 0.92 MOM）的母体血清 fβ-hCG 中位数倍数（MOM）也显著低于正常结局组（0.99 MOM，p=0.02）。胎盘早剥组与正常结局组之间的生化标志物无显著差异。正常结局组与研究组的颈项透明层（NT）中位数倍数（MOM）无统计学差异。
早孕期筛查（FTS）血清标志物在发生子痫前期、早产和胎儿生长受限的妊娠中浓度降低。在后两种情况下，PAPP-A 和 fβ-hCG 值与发生率呈负相关。然而，胎盘早剥的发生并不能通过生化标志物浓度来预测。胎盘早剥的发生机制可能比蜕膜更依赖于胎盘。
