Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
Placenta. 2012 Sep;33(9):735-40. doi: 10.1016/j.placenta.2012.05.012. Epub 2012 Jun 28.
To describe normative levels of PP13 in first trimester of pregnancy and determine the accuracy of PP13 in predicting preeclampsia and small for gestational age (SGA) infants.
We measured PP13 in archived first trimester serum samples from an unselected maternal cohort of 2989 women. Associations of PP13 levels and diagnostic accuracy in predicting adverse pregnancy outcomes were assessed using multivariate logistic regression models. Due to inadequate number of cases we then conducted a systematic review and subsequent meta-analysis of predictive accuracy. Structured searches including all languages were completed in electronic databases and supplemented by cross-checking reference lists of relevant publications. Characteristics, data extraction and quality assessment of studies was conducted by independent assessors.
Overall, 2678 women were included in the in-house study with 71 (2.7%) preeclampsia cases, 5 (0.2%) early-onset preeclampsia (≤34 weeks) cases; and 191 (7.1%) and 41 (1.5%) infants SGA<10th and <3rd centile. Median (IQR) normative level of PP13 in unaffected pregnancies was 53.5 (37.7-71.8) pg/ml. The area under the receiver operating characteristic curve (AUC) for multivariate models was 0.72 (95%CI 0.66-0.78) for preeclampsia; 0.82 (95%CI 0.63-0.99) for early-onset preeclampsia; 0.73 (95%CI 0.69-0.77) for SGA<10th centile; and 0.83 (95%CI 0.78-0.88) for SGA<3rd centile. Eight studies were included in the systematic review, normative levels of PP13 were assessed in four studies but these were variable; and meta-analysis was performed on seven studies. Sensitivity rates of PP13 based on 5% fixed false positive rates were 24%, 45% and 26% for preeclampsia, for early-onset preeclampsia and SGA, respectively. There was no evidence of between-study heterogeneity.
First trimester PP13, in combination with maternal characteristics and other serum biomarkers was inadequate for screening purposes and predicting women at risk.
描述妊娠早期 PP13 的正常水平，并确定 PP13 预测子痫前期和小于胎龄儿（SGA）的准确性。
我们测量了 2989 名未选择的孕妇队列的存档妊娠早期血清样本中的 PP13。使用多变量逻辑回归模型评估 PP13 水平与预测不良妊娠结局的准确性之间的关联。由于病例数不足，我们随后进行了系统评价和后续的荟萃分析，以评估预测准确性。包括所有语言的结构化搜索在电子数据库中完成，并通过交叉核对相关出版物的参考文献进行补充。研究的特征、数据提取和质量评估由独立评估员进行。
共有 2678 名妇女被纳入内部研究，其中 71 例（2.7%）患有子痫前期，5 例（0.2%）患有早发型子痫前期（≤34 周）；191 例（7.1%）和 41 例（1.5%）婴儿 SGA<10 百分位和<3 百分位。未受影响妊娠的 PP13 中位数（IQR）正常水平为 53.5（37.7-71.8）pg/ml。多变量模型的受试者工作特征曲线（AUC）下面积为子痫前期 0.72（95%CI 0.66-0.78）；早发型子痫前期 0.82（95%CI 0.63-0.99）；SGA<10 百分位 0.73（95%CI 0.69-0.77）；SGA<3 百分位 0.83（95%CI 0.78-0.88）。系统评价纳入了 8 项研究，其中 4 项研究评估了 PP13 的正常水平，但这些水平各不相同；对 7 项研究进行了荟萃分析。基于 5%固定假阳性率的 PP13 敏感性率分别为子痫前期 24%、早发型子痫前期 45%和 SGA<3 百分位 26%。研究之间没有证据表明存在异质性。
妊娠早期的 PP13，结合母体特征和其他血清生物标志物，不适合用于筛查目的和预测高危妇女。
