Litwińska Ewelina, Litwińska Magdalena, Oszukowski Przemysław, Szaflik Krzysztof, Kaczmarek Piotr
Perinatology and Gynecology Department, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland.
Department of Gynecology, Fertility and Fetal Therapy, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland.
Adv Clin Exp Med. 2017 May-Jun;26(3):439-448. doi: 10.17219/acem/62214.
Pre-eclampsia is a systemic disease connected with high maternal and fetal morbidity and mortality. Despite significant progress achieved in perinatal medicine, pre-eclampsia is still one of the most significant current problems in obstetrics.
The aim of the study was to establish diagnostic algorithms for early and late pre-eclampsia (PE) and intrauterine growth restriction (IUGR).
A total of 320 pregnant women between 11 + 0 and 13 + 6 weeks of gestation were recruited for a case-control study. The study group consisted of 22 patients with early PE, 29 patients with late PE and 269 unaffected controls. The following parameters were recorded: maternal history, mean arterial pressure (MAP), mean uterine artery pulsatility index (UtA-PI), and the concentrations of placental growth factor (PlGF), pregnancy-associated plasma protein A (PAPP-A) and free beta-human chorionic gonadotropin (free β-hCG).
A multivariable stepwise logistic regression analysis indicated that the best screening model for the prediction of early PE is based on a combined analysis of maternal risk factors, UtA-PI and PlGF levels (sensitivity: 91%; specificity: 84%). The best screening model for the prediction of late PE is based on a combined analysis of maternal risk factors, UtA-PI and MAP (sensitivity: 85%; specificity: 83%). The most effective screening model for the prediction of IUGR is based on a combined analysis of maternal risk factors, UtA-PI and PlGF concentrations (sensitivity: 91%; specificity: 83%).
The integrated model of screening established in this study can be a valuable method to identify patients at increased risk of developing pre-eclampsia and related complications. The ability to predict the occurrence of pre-eclampsia in early pregnancy would enable maternal and fetal morbidity to be reduced through the introduction of strict obstetric surveillance as well as planned delivery in a reference center.
子痫前期是一种与孕产妇和胎儿高发病率及死亡率相关的全身性疾病。尽管围产医学取得了显著进展，但子痫前期仍是当前产科最重要的问题之一。
本研究的目的是建立早发型和晚发型子痫前期（PE）及胎儿生长受限（IUGR）的诊断算法。
共招募了320名妊娠11 + 0至13 + 6周的孕妇进行病例对照研究。研究组包括22例早发型PE患者、29例晚发型PE患者和269例未受影响的对照组。记录了以下参数：孕产妇病史、平均动脉压（MAP）、子宫动脉平均搏动指数（UtA-PI）以及胎盘生长因子（PlGF）、妊娠相关血浆蛋白A（PAPP-A）和游离β-人绒毛膜促性腺激素（游离β-hCG）的浓度。
多变量逐步逻辑回归分析表明，预测早发型PE的最佳筛查模型基于孕产妇危险因素、UtA-PI和PlGF水平的综合分析（敏感性：91%；特异性：84%）。预测晚发型PE的最佳筛查模型基于孕产妇危险因素、UtA-PI和MAP的综合分析（敏感性：85%；特异性：83%）。预测IUGR最有效的筛查模型基于孕产妇危险因素、UtA-PI和PlGF浓度的综合分析（敏感性：91%；特异性：83%）。
本研究建立的综合筛查模型可能是识别子痫前期及相关并发症发生风险增加患者的有价值方法。在妊娠早期预测子痫前期发生的能力将通过引入严格的产科监测以及在参考中心进行计划分娩来降低母婴发病率。
