Li Lijie, Zheng Yanmei, Zhu Ying, Li Jianchun
Department of Obstetrics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China.
Department of Ultrasonic Diagnosis, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China.
Exp Ther Med. 2016 Oct;12(4):2515-2520. doi: 10.3892/etm.2016.3625. Epub 2016 Aug 29.
First-trimester screening may be a major advantage over a second-trimester approach since it opens prospects for early and more efficient interventions. The aim of the current study was to evaluate whether the measurement of maternal serum inhibin A, activin A and placental growth factor (PlGF) at three to four months gestation with the second-trimester uterine artery pulsatility index (PI) are useful in predicting preeclampsia in a group of nulliparous women. All the patients also underwent uterine artery Doppler examination to measure the PI at 22-24 weeks gestation. Inhibin A, activin A and PlGF were measured using an ELISA by an examiner who was blinded to the pregnancy outcome. Thirty-eight cases with preeclampsia and 100 controls were analyzed. Second-trimester uterine artery PI and marker levels were expressed as multiples of the median (MoM). The uterine artery PI was increased in pregnancies with preeclampsia compared with controls. In pregnancies that developed preeclampsia, the uterine artery PI was increased (1.61±0.047 vs. 1.02±0.049, P<0.001), as was the level of inhibin A (1.72±0.023 vs. 1.03±0.063, P<0.001) and the level of activin A (1.68±0.38 vs. 1.06±0.42, P<0.001) compared with the controls. In contrast, the level of PlGF was decreased in pregnancies that developed preeclampsia compared with the controls (0.69±0.23 vs. 1.00±0.26, P<0.001). A combination of activin A, PlGF and uterine artery PI gave an AUC of 0.915 (95% CI, 0.812-0.928; P<0.001) with a sensitivity of 91% at a specificity of 82%. In our study, we demonstrated that both serum inhibin A and activin A levels were increased, while the PlGF level was decreased in the early second-trimester in women who developed preeclampsia.
孕早期筛查可能比孕中期筛查具有更大优势，因为它为早期且更有效的干预开辟了前景。本研究的目的是评估在妊娠三到四个月时测量孕妇血清抑制素A、激活素A和胎盘生长因子（PlGF），以及孕中期子宫动脉搏动指数（PI）是否有助于预测一组未生育过的女性患先兆子痫的风险。所有患者还在妊娠22 - 24周时接受了子宫动脉多普勒检查以测量PI。由对妊娠结局不知情的检查人员使用酶联免疫吸附测定法（ELISA）测量抑制素A、激活素A和PlGF。分析了38例先兆子痫病例和100例对照。孕中期子宫动脉PI和标志物水平以中位数倍数（MoM）表示。与对照组相比，先兆子痫妊娠的子宫动脉PI升高。在发生先兆子痫的妊娠中，子宫动脉PI升高（1.61±0.047对1.02±0.049，P<0.001），抑制素A水平也升高（1.72±0.023对1.03±0.063，P<0.001），激活素A水平同样升高（1.68±0.38对1.06±0.42，P<0.001）。相比之下，发生先兆子痫的妊娠中PlGF水平低于对照组（0.69±0.23对1.00±0.26，P<0.001）。激活素A、PlGF和子宫动脉PI联合检测的曲线下面积（AUC）为0.915（95%可信区间，0.812 - 0.928；P<0.001），敏感性为91%，特异性为82%。在我们的研究中，我们证明了发生先兆子痫的女性在孕中期早期血清抑制素A和激活素A水平升高，而PlGF水平降低。
