Borovkov V A, Igitova M B, Korenovskiy Y V, Dudareva Y A
Altai Regional Clinical Center for Maternity and Child Welfare Surveillance, Barnaul, Russian Federation.
Altai State Medical University, Barnaul, Russian Federation.
Klin Lab Diagn. 2020;65(6):353-357. doi: 10.18821/0869-2084-2020-65-6-353-357.
Comparative analysis of serum concentrations of chorionic gonadotropin (hCG) associated with the pregnancy of plasma protein A (PAPP-A) and alpha-fetoprotein (AFP), based on the results of a survey of women as part of a standard screening program (the results were expressed as a MoM - multiply of the median), found a significant increase in the performance of all the studied specific pregnancy proteins in women with a scar on the uterus and placenta acctera (75 patients) compared with the data of the group of pregnant women without scar on the uterus and without abnormalities of attachment of the placenta (150 women). AFP indices were 1.68 ± 0.76 and 1.19 ± 0.43 MoM (p = 0.0018), hCG - 1.62 ± 1.48 and 1.23 ± 0.76 MoM (p = 0, 0112), PAPP-A - 1.93 ± 1.24 and 1.23 ± 0.67 MoM (p <0.0001). Using the ROC analysis, the diagnostic thresholds for the concentrations of AFP, hCG and PAPP-A were calculated. The risk of placenta accreta in women with a scar on the uterus in cases of exceeding the diagnostic threshold of AFP concentration (1.64 MoM) increased 2.5 times (RR = 2.5; 95% CI 1.17-5.36, p = 0, 0185), hCG (1.41 MoM) - 1.6 times (RR = 1.59; 95% CI 1.09-2.32, p = 0.0147), PAPP-A (1.41 MoM) - 2.65 times (RR = 2.65; 95% CI 1.76-3.99, p <0.0001). Determination of the level of specific pregnancy proteins can be used in the system of complex prediction of placental growth in pregnant women with a scar on the uterus as an addition to the assessment of clinical and anamnestic risk factors.
基于一项作为标准筛查项目一部分的女性调查结果，对与妊娠相关的绒毛膜促性腺激素（hCG）、血浆蛋白A（PAPP - A）和甲胎蛋白（AFP）的血清浓度进行比较分析（结果以MoM - 中位数倍数表示），发现有子宫瘢痕和胎盘植入的女性（75例患者）中，所有研究的特定妊娠蛋白的表现与无子宫瘢痕且无胎盘附着异常的孕妇组（150例女性）的数据相比有显著增加。AFP指数分别为1.68±0.76和1.19±0.43 MoM（p = 0.0018），hCG分别为1.62±1.48和1.23±0.76 MoM（p = 0.0112），PAPP - A分别为1.93±1.24和1.23±0.67 MoM（p <0.0001）。使用ROC分析，计算了AFP、hCG和PAPP - A浓度的诊断阈值。在子宫有瘢痕的女性中，AFP浓度超过诊断阈值（1.64 MoM）时，胎盘植入风险增加2.5倍（RR = 2.5；95% CI 1.17 - 5.36，p = 0.0185），hCG（1.41 MoM）时增加1.6倍（RR = 1.59；95% CI 1.09 - 2.32，p = 0.0147），PAPP - A（1.41 MoM）时增加2.65倍（RR = 2.65；95% CI 1.76 - 3.99，p <0.0001）。特定妊娠蛋白水平的测定可用于子宫有瘢痕的孕妇胎盘生长的综合预测系统，作为对临床和既往风险因素评估的补充。
