一项在斯堪的纳维亚人群中对妊娠11至13周时妊娠高血压疾病筛查的前瞻性研究。
A prospective study of screening for hypertensive disorders of pregnancy at 11-13 weeks in a Scandinavian population.
作者信息
Skråstad Ragnhild B, Hov Gunhild G, Blaas Harm-Gerd K, Romundstad Pål R, Salvesen Kjell Å
机构信息
Department of Laboratory Medicine Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
出版信息
Acta Obstet Gynecol Scand. 2014 Dec;93(12):1238-47. doi: 10.1111/aogs.12479. Epub 2014 Sep 17.
OBJECTIVE
To investigate the prediction of preeclampsia and gestational hypertension using maternal characteristics, mean arterial pressure (MAP), uterine artery pulsatility index (UtAPI), pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PlGF) at gestational weeks 11-13 in a Scandinavian population with a medium to high prior risk for developing hypertensive disorders of pregnancy.
DESIGN
Prospective screening study.
SETTING
National Center for Fetal Medicine, Trondheim, Norway.
POPULATION
579 women who were nulliparous or had a previous history of preeclampsia or gestational hypertension.
METHODS
Women were examined between 11(+0) and 13(+6) weeks, with interviews for maternal characteristics and measurements of MAP, UtAPI, PAPP-A and PlGF. The tests were evaluated separately and in combined models with receiver operating characteristics (ROC) curves.
MAIN OUTCOME MEASURES
Prediction of preeclampsia, severe preeclampsia and gestational hypertension.
RESULTS
The best model for severe preeclampsia (MAP+UtAPI+PlGF+PAPP-A) achieved an area under the ROC curve of 0.866 [95% confidence interval (95% CI) 0.756-0.976]. The best models for preeclampsia (MAP+UtAPI+age) achieved 0.738 (0.634-0.841), gestational hypertension (MAP) 0.820 (0.727-0.913) and hypertensive disorders in pregnancy overall (MAP+PlGF+age) 0.783 (0.709-0.856). Using the best model we could identify 61.5% (95% CI 31.6-86.1) of severe preeclampsia, 38.5% (95% CI 20.2-59.4) of preeclampsia and 42.9% (95% CI 21.8-66) of gestational hypertension at a fixed 10% false-positive rate.
CONCLUSIONS
Maternal characteristics, MAP, UtAPI, PAPP-A and PlGF showed limited value as screening tests. Further research on biochemical and biophysical tests and algorithms combining these parameters is needed before first trimester screening for hypertensive disorders of pregnancy is included in antenatal care in Scandinavia.
目的
在挪威特隆赫姆国家胎儿医学中心进行的一项前瞻性筛查研究中，调查在妊娠11 - 13周时，利用母亲特征、平均动脉压（MAP）、子宫动脉搏动指数（UtAPI）、妊娠相关血浆蛋白A（PAPP - A）和胎盘生长因子（PlGF）对先兆子痫和妊娠期高血压进行预测的情况。该研究针对的是挪威一个既往发生妊娠高血压疾病风险为中到高的斯堪的纳维亚人群，纳入了579名未生育过或有先兆子痫或妊娠期高血压病史的女性。方法是在妊娠11（+0）至13（+6）周对这些女性进行检查，询问母亲特征并测量MAP、UtAPI、PAPP - A和PlGF。这些检测分别以及在联合模型中通过受试者工作特征（ROC）曲线进行评估。主要观察指标为先兆子痫、重度先兆子痫和妊娠期高血压的预测情况。结果显示，预测重度先兆子痫的最佳模型（MAP + UtAPI + PlGF + PAPP - A）的ROC曲线下面积为0.866 [95%置信区间（95%CI）0.756 - 0.976]。预测先兆子痫的最佳模型（MAP + UtAPI + 年龄）的ROC曲线下面积为0.738（0.634 - 0.841），妊娠期高血压（MAP）为0.820（0.727 - 0.913），妊娠高血压疾病总体（MAP + PlGF + 年龄）为0.783（0.709 - 0.856）。使用最佳模型，在固定10%假阳性率的情况下，我们能够识别出61.5%（95%CI 31.6 - 86.1）的重度先兆子痫、38.5%（95%CI 20.2 - 59.4）的先兆子痫和42.9%（95%CI 21.8 - 66）的妊娠期高血压。结论是，母亲特征、MAP、UtAPI、PAPP - A和PlGF作为筛查检测手段价值有限。在斯堪的纳维亚将妊娠早期高血压疾病筛查纳入产前保健之前，需要对生化和生物物理检测以及结合这些参数的算法进行进一步研究。
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