Kumar Manisha, Sharma Karuna, Singh Ritu, Singh Shalini, Ravi V, Singh Kamlesh, Gupta Usha, Bhattacharya J
a Department of Obstetrics and Gynecology , Lady Hardinge Medical College , New Delhi , India.
b Department of Biochemistry , Lady Hardinge Medical College , New Delhi , India.
Hypertens Pregnancy. 2016 Aug;35(3):382-93. doi: 10.3109/10641955.2016.1161766. Epub 2016 May 2.
To determine the predictive value of biochemical markers, uterine artery Doppler, and maternal factors in predicting early-onset (EO) and late-onset (LO) pregnancy hypertension.
All singleton pregnancies between 11 and 13 weeks and 6 days gestation underwent estimation of body mass index (BMI), mean arterial pressure (MAP), uterine artery Doppler pulsatality index (PI, and resistance index), biomarker PAPP-A, and free β-hCG. Women who developed hypertension were treated as cases and normotensives were taken as controls. The cases were further divided into EO and LO hypertension. The comparison was undertaken by appropriate statistical analysis.
Pregnancy hypertension was seen in 399 (13.2%) women. EO hypertension was seen in 153 (38.3%), whereas LO was observed in 246 (61.7%). The significant markers for predicting hypertension in pregnancy were maternal age, BMI, MAP, uterine artery Doppler PI, and PAPP-A. A combination of MAP and BMI was a better predictor (sensitivity and specificity 80% and 52%, respectively) than PAPP-A and Doppler combined (sensitivity and specificity 62% and 52%, respectively). When all the above markers were combined, the sensitivity and specificity of the test was 73% and 70%, respectively. EO hypertension was better predicted compared with LO. The negative predictive value (NPV) of the test was above 90%, suggesting that if a woman had the marker below the cutoff, there was more than 90% chance that she would not develop hypertension later in pregnancy.
A combination of variables increased the sensitivity and specificity of the test for hypertension in pregnancy. The markers examined were a predictor of EO hypertension, with a high NPV, making it a good screening test.
确定生化标志物、子宫动脉多普勒及母体因素在预测早发型（EO）和晚发型（LO）妊娠高血压中的预测价值。
对所有妊娠11周零0天至13周零6天的单胎妊娠孕妇进行体重指数（BMI）、平均动脉压（MAP）、子宫动脉多普勒搏动指数（PI）和阻力指数、生物标志物妊娠相关血浆蛋白A（PAPP-A）及游离β-人绒毛膜促性腺激素（β-hCG）的评估。发生高血压的女性作为病例组，血压正常者作为对照组。病例组进一步分为早发型和晚发型高血压组。通过适当的统计分析进行比较。
399名（13.2%）女性出现妊娠高血压。其中早发型高血压153名（38.3%），晚发型高血压246名（61.7%）。预测妊娠高血压的显著标志物包括产妇年龄、BMI、MAP、子宫动脉多普勒PI及PAPP-A。MAP与BMI联合预测效果（敏感性和特异性分别为80%和52%）优于PAPP-A与多普勒联合（敏感性和特异性分别为62%和52%）。当上述所有标志物联合使用时，检测的敏感性和特异性分别为73%和70%。与晚发型高血压相比，早发型高血压的预测效果更好。该检测的阴性预测值（NPV）高于90%，表明如果一名女性的标志物低于临界值，那么她在妊娠后期发生高血压的可能性低于10%。
多种变量联合可提高妊娠高血压检测的敏感性和特异性。所检测的标志物是早发型高血压的预测指标，NPV较高，使其成为一种良好的筛查检测方法。
