血小板参数对先兆子痫的预测价值：一项大型前瞻性队列研究的结果。
Incremental predictive value of platelet parameters for preeclampsia: results from a large prospective cohort study.
机构信息
Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.
Department of Women and Child Health Care, Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.
出版信息
BMC Pregnancy Childbirth. 2023 May 26;23(1):387. doi: 10.1186/s12884-023-05661-y.
BACKGROUND
Platelet parameters during pregnancy were associated with the risk of preeclampsia (PE), but the predictive value of these parameters for PE remained unclear. Our aim was to clarify the individual and incremental predictive value of platelet parameters, including platelet count (PC), mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW) for PE.
METHODS
This study was based on the Born in Guangzhou Cohort Study in China. Data on platelet parameters were extracted from medical records of routine prenatal examinations. Receiver operating characteristic (ROC) curve was performed to analyze the predictive ability of platelet parameters for PE. Maternal characteristic factors proposed by NICE and ACOG were used to develop the base model. Detection rate (DR), integrated discrimination improvement (IDI) and continuous net reclassification improvement (NRI) were calculated compared with the base model to assess the incremental predictive value of platelet parameters.
RESULTS
A total of 30,401 pregnancies were included in this study, of which 376 (1.24%) were diagnosed with PE. Higher levels of PC and PCT were observed at 12-19 gestational weeks in women who developed PE later. However, no platelet parameters before 20 weeks of gestation reliably distinguished between PE complicated pregnancy and non-PE complicated pregnancy, with all values of the areas under the ROC curves (AUC) below 0.70. The addition of platelet parameters at 16-19 gestational weeks to the base model increased the DR for preterm PE from 22.9 to 31.4% at a fixed false positive rate of 5%, improved the AUC from 0.775 to 0.849 (p = 0.015), and yielded a NRI of 0.793 (p < 0.001), and an IDI of 0.0069 (p = 0.035). Less but significant improvement in prediction performance was also observed for term PE and total PE when all the four platelet parameters were added to the base model.
CONCLUSIONS
Although no single platelet parameter at the early stage of pregnancy identified PE with high accuracy, the addition of platelet parameters to known independent risk factors could improve the prediction of PE.
背景
怀孕期间的血小板参数与子痫前期（PE）的风险相关，但这些参数对 PE 的预测价值仍不清楚。我们的目的是阐明血小板参数（包括血小板计数（PC）、平均血小板体积（MPV）、血小板压积（PCT）和血小板分布宽度（PDW））对 PE 的个体和增量预测价值。
方法
本研究基于中国广州出生队列研究。从常规产前检查的病历中提取血小板参数数据。采用受试者工作特征（ROC）曲线分析血小板参数预测 PE 的能力。采用 NICE 和 ACOG 提出的母体特征因素构建基础模型。与基础模型相比，计算检测率（DR）、综合判别改善（IDI）和连续净重新分类改善（NRI），以评估血小板参数的增量预测价值。
结果
本研究共纳入 30401 例妊娠，其中 376 例（1.24%）诊断为 PE。在以后发生 PE 的女性中，12-19 孕周时 PC 和 PCT 水平较高。然而，在 20 孕周之前，没有任何血小板参数能够可靠地区分 PE 合并妊娠和非 PE 合并妊娠，所有 ROC 曲线下面积（AUC）值均低于 0.70。在固定假阳性率为 5%的情况下，将 16-19 孕周的血小板参数添加到基础模型中，可将早产 PE 的 DR 从 22.9%提高到 31.4%，AUC 从 0.775 提高到 0.849（p=0.015），NRI 为 0.793（p<0.001），IDI 为 0.0069（p=0.035）。当将所有四个血小板参数添加到基础模型中时，对足月 PE 和总 PE 的预测性能也有较小但有统计学意义的改善。
结论
尽管在妊娠早期没有单一的血小板参数能够准确识别 PE，但将血小板参数添加到已知的独立危险因素中可以提高 PE 的预测能力。
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