Khanam Zeba, Mittal Pratima, Suri Jyotsna
Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
J Obstet Gynaecol India. 2021 Jun;71(3):226-234. doi: 10.1007/s13224-020-01420-7. Epub 2021 Jan 21.
To study the role of uterine artery Doppler pulsatility index (UtA-PI), serum pregnancy-associated plasma protein-A (PAPP-A) and free beta human chorionic gonadotropin (f-hCG) levels, individually and in combination with each other, at 11-14 weeks of gestation for prediction of preeclampsia (PE).
In a prospective observational study, a total of 100 low-risk gravid females were recruited at 11-14-weeks of gestation. UtA-PI, PAPP-A and f-hCG levels were estimated. These women were followed up until delivery for the development of PE and gestational hypertension (GH).
The best individual marker for screening PE and GH was UtA-PI with ROC AUC (± standard error) = 0.934 ± 0.028, < 0.0001. UtA-PI at a cutoff value of ≥ 2.8 (95th percentile) had 77.8% sensitivity, 98.9% specificity, 97.8% NPV and 87.5% PPV in detecting PE. PAPP-A (MoM) at a cutoff value of ≤ 0.27 (5th percentile) demonstrated 44.4% sensitivity, 95.6% specificity, 94.5% NPV and 50% PPV. f-hCG (MoM) at a cutoff value of ≤ 0.5 (5th percentile) had a specificity of 94.5%. Among the combined markers, UtA-PI along with PAPP-A estimation served best with a sensitivity and specificity of 44% and 100%, respectively. Addition of f-hCG to either UtA-PI or PAPP-A levels was not found sensitive for detecting PE but yielded 100% specificity and 96% NPV.
UtA-PI as a stand-alone test was found most useful for the prediction of PE. Addition of either or both of PAPP-A and f-hCG to UtA-PI did not improve the sensitivity of combined test with only a slight improvement in specificity and NPV. Their routine addition to UtA-PI studies is not recommended for prediction of PE at 11-14 weeks of gestation in low- and lower-middle-income countries (LMIC).
研究妊娠11 - 14周时子宫动脉多普勒搏动指数（UtA - PI）、血清妊娠相关血浆蛋白A（PAPP - A）和游离β人绒毛膜促性腺激素（f - hCG）水平单独及相互联合用于预测子痫前期（PE）的作用。
在一项前瞻性观察性研究中，共招募了100名妊娠11 - 14周的低风险孕妇。对其UtA - PI、PAPP - A和f - hCG水平进行评估。对这些女性进行随访直至分娩，观察子痫前期（PE）和妊娠期高血压（GH）的发生情况。
筛查PE和GH的最佳单项指标是UtA - PI，其ROC曲线下面积（±标准误）= 0.934 ± 0.028，P < 0.0001。UtA - PI临界值≥2.8（第95百分位数）时，检测PE的灵敏度为77.8%，特异度为98.9%，阴性预测值为97.8%，阳性预测值为87.5%。PAPP - A（中位数倍数）临界值≤0.27（第5百分位数）时，灵敏度为44.4%，特异度为95.6%，阴性预测值为94.5%，阳性预测值为50%。f - hCG（中位数倍数）临界值≤0.5（第5百分位数）时，特异度为94.5%。在联合指标中，UtA - PI联合PAPP - A评估效果最佳，灵敏度和特异度分别为44%和100%。在UtA - PI或PAPP - A水平上加入f - hCG对检测PE不敏感，但特异度为100%，阴性预测值为96%。
发现UtA - PI作为单独检测指标对预测PE最有用。在UtA - PI基础上加入PAPP - A和f - hCG中的一个或两个，联合检测的灵敏度并未提高，仅特异度和阴性预测值略有改善。在低收入和中低收入国家（LMIC），不建议在妊娠11 - 14周预测PE的UtA - PI研究中常规加入它们。
