早发型重度子痫前期与孕早期妊娠相关血浆蛋白A及人绒毛膜促性腺激素总量的关系
Early-onset severe preeclampsia by first trimester pregnancy-associated plasma protein A and total human chorionic gonadotropin.
作者信息
Jelliffe-Pawlowski Laura L, Baer Rebecca J, Currier Robert J, Lyell Deirdre J, Blumenfeld Yair J, El-Sayed Yasser Y, Shaw Gary M, Druzin Maurie L
机构信息
Genetic Disease Screening Program, California Department of Public Health, Richmond, California.
Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
出版信息
Am J Perinatol. 2015 Jun;32(7):703-12. doi: 10.1055/s-0034-1396697. Epub 2014 Dec 17.
OBJECTIVE
This study aims to evaluate the relationship between early-onset severe preeclampsia and first trimester serum levels of pregnancy-associated plasma protein A (PAPP-A) and total human chorionic gonadotropin (hCG).
STUDY DESIGN
The association between early-onset severe preeclampsia and abnormal levels of first trimester PAPP-A and total hCG in maternal serum were measured in a sample of singleton pregnancies without chromosomal defects that had integrated prenatal serum screening in 2009 and 2010 (n = 129,488). Logistic binomial regression was used to estimate the relative risk (RR) of early-onset severe preeclampsia in pregnancies with abnormal levels of first trimester PAPP-A or total hCG as compared with controls.
RESULTS
Regardless of parity, women with low first trimester PAPP-A or high total hCG were at increased risk for early-onset severe preeclampsia. Women with low PAPP-A (multiple of the median [MoM] ≤ the 10th percentile in nulliparous or ≤ the 5th percentile in multiparous) or high total hCG (MoM ≥ the 90th percentile in nulliparous or ≥ the 95th percentile in multiparous) were at more than a threefold increased risk for early-onset severe preeclampsia (RR, 4.2; 95% confidence interval [CI], 3.0-5.9 and RR, 3.3; 95% CI, 2.1-5.2, respectively).
CONCLUSION
Routinely collected first trimester measurements of PAPP-A and total hCG provide unique risk information for early-onset severe preeclampsia.
目的
本研究旨在评估早发型重度子痫前期与孕早期血清妊娠相关血浆蛋白A（PAPP-A）及人绒毛膜促性腺激素（hCG）总水平之间的关系。
研究设计
在2009年和2010年进行了整合产前血清筛查的单胎妊娠样本（n = 129,488）中，测量早发型重度子痫前期与孕早期母体血清中PAPP-A及hCG总水平异常之间的关联。采用逻辑二项回归来估计孕早期PAPP-A或hCG总水平异常的妊娠与对照组相比发生早发型重度子痫前期的相对风险（RR）。
结果
无论产次如何，孕早期PAPP-A水平低或hCG总水平高的女性发生早发型重度子痫前期的风险增加。PAPP-A水平低（未产妇中位数倍数[MoM]≤第10百分位数或经产妇≤第5百分位数）或hCG总水平高（未产妇MoM≥第90百分位数或经产妇≥第95百分位数）的女性发生早发型重度子痫前期的风险增加三倍以上（RR分别为4.2；95%置信区间[CI]为3.0 - 5.9和RR为3.3；95% CI为2.1 - 5.2）。
结论
常规收集的孕早期PAPP-A和hCG总水平测量可为早发型重度子痫前期提供独特的风险信息。
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