孕早期测量孕妇血清胎盘生长因子和妊娠相关血浆蛋白A作为预测子痫前期和小于胎龄儿的指标：一项前瞻性观察研究。
Maternal serum placental growth factor and pregnancy-associated plasma protein A measured in the first trimester as parameters of subsequent pre-eclampsia and small-for-gestational-age infants: A prospective observational study.
作者信息
Sung Kyung Uk, Roh Jeong A, Eoh Kyung Jin, Kim Eui Hyeok
机构信息
Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
出版信息
Obstet Gynecol Sci. 2017 Mar;60(2):154-162. doi: 10.5468/ogs.2017.60.2.154. Epub 2017 Mar 16.
OBJECTIVE
To examine the first-trimester maternal serum placental growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A) levels in pregnancies associated with pre-eclampsia (PE) or small-for-gestational-age (SGA) infants, and determine the predictive accuracy of PlGF and of PAPP-A for either PE or SGA infants.
METHODS
This prospective, observational study included 175 pregnant women, and of these women, due to participant withdrawal or loss to follow-up, delivery data were collected from the medical records of 155 women, including 4 who had twin pregnancies. The women's maternal history was recorded, and the PlGF and PAPP-A levels at 11 to 13 gestational weeks were measured. During the second trimester, the maternal uterine artery's systolic/diastolic ratio was measured. Multiples of the median (MoM) of PlGF and PAPP-A were determined, and the associations of these values with the risk factors of SGA and PE were evaluated. Logistic regression analysis was used to determine whether PlGF and PAPP-A are useful markers for predicting SGA infants.
RESULTS
The PAPP-A MoM level was significantly lower in women with advanced maternal age, multipara women, and women with gestational diabetes than in their counterparts. The PlGF and PAPP-A MoM levels were higher in women with a twin pregnancy than in those with a singleton pregnancy. There was a significant relationship between the maternal serum PAPP-A MoM level in the first trimester and the uterine artery systolic/diastolic ratio in the second trimester. Results of logistic regression analysis showed that low PlGF and PAPP-A MoM levels were predictors of SGA infants (odds ratio, 0.143; 95% confidence interval, 0.025 to 0.806; odds ratio, 0.191; 95% confidence interval, 0.051 to 0.718, respectively).
CONCLUSION
PlGF and PAPP-A are potentially useful as first-trimester markers for SGA infants and some hypertensive disorders of pregnancy.
目的
检测子痫前期（PE）或小于胎龄儿（SGA）妊娠孕妇孕早期血清胎盘生长因子（PlGF）和妊娠相关血浆蛋白A（PAPP-A）水平，并确定PlGF和PAPP-A对PE或SGA婴儿的预测准确性。
方法
这项前瞻性观察性研究纳入了175名孕妇，其中，由于参与者退出或失访，从155名妇女的病历中收集了分娩数据，包括4名怀有双胎妊娠的妇女。记录了这些妇女的孕产史，并测量了孕11至13周时的PlGF和PAPP-A水平。在孕中期，测量孕妇子宫动脉的收缩/舒张比。确定了PlGF和PAPP-A的中位数倍数（MoM），并评估了这些值与SGA和PE危险因素的关联。采用逻辑回归分析确定PlGF和PAPP-A是否为预测SGA婴儿的有用标志物。
结果
高龄孕妇、经产妇和妊娠期糖尿病孕妇的PAPP-A MoM水平显著低于相应对照组。双胎妊娠妇女的PlGF和PAPP-A MoM水平高于单胎妊娠妇女。孕早期孕妇血清PAPP-A MoM水平与孕中期子宫动脉收缩/舒张比之间存在显著关系。逻辑回归分析结果显示，低PlGF和PAPP-A MoM水平是SGA婴儿的预测指标（优势比分别为0.143；95%置信区间为0.025至0.806；优势比为0.191；95%置信区间为0.051至0.718）。
结论
PlGF和PAPP-A作为孕早期SGA婴儿和某些妊娠高血压疾病的标志物可能有用。
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