Chiriac Evelina, Popa Zoran L, Gorun Florin I, Vilceanu Narcis, Oros Razvan, Buhas Liana-Camelia, Dumitrescu Patrick, Citu Cosmin, Tivadar Katalin Midia, Csep Andrei, Buhas Bogdan Adrian
Doctoral School, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, ROU.
Department of Obstetrics-Gynecology and Neonatology, Faculty of Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, ROU.
Cureus. 2024 Dec 2;16(12):e74996. doi: 10.7759/cureus.74996. eCollection 2024 Dec.
Despite improvements in pregnancy care, preterm birth remains a major cause of neonatal morbidity and mortality worldwide, particularly in developing countries. Maternal inflammation has been recognized as a factor that may induce preterm birth, with various inflammatory markers associated with its pathogenesis. The aim of this study is to evaluate the value of maternal serum amyloid A(SAA) level as a predictive marker for preterm delivery in a Romanian cohort.
This observational study was carried out at a Romanian tertiary care hospital between April 2023 and March 2024. We enrolled 136 pregnant women and divided them into two groups depending on the beginning of labor: preterm (before 37 weeks, n=70) and term (after 37 weeks, n=66). Maternal blood samples were taken upon admission and analyzed using the Atellica® NEPH 630 System (Siemens Healthineers, Erlangen, Germany) to determine SAA levels. The best cut-off value for SAA was determined using receiver operating characteristic (ROC) curve analysis with the Youden index. Logistic regression models were then applied to assess the association between elevated SAA levels and preterm birth, adjusting for potential confounders such as maternal age and history of preterm birth.
The median SAA levels were significantly higher in the preterm group (22 mg/L) compared to the term group (7 mg/L) (p<0.001). The ROC curve analysis yielded a moderate predictive value of SAA for preterm birth, with the area under the ROC curve (AUC) being 0.690. The threshold at 15 mg/L was the best cut-off value, achieving a sensitivity of 89% and a specificity of 85%. Elevated SAA levels were associated with a 27.89-fold increased risk of preterm delivery. Further, after adjusting for maternal age, medical conditions during pregnancy, and prior preterm birth, elevated SAA remained a significant predictor of preterm birth (adjusted odds ratio (aOR)=28.966; p=0.001).
Maternal SAA proved to be a strong independent risk factor for preterm birth. This biomarker further narrows the population of pregnant women at higher risk of preterm delivery and opens new perspectives for its clinical role in preterm birth prevention.
尽管孕期护理有所改善，但早产仍是全球新生儿发病和死亡的主要原因，在发展中国家尤为如此。母体炎症已被认为是可能诱发早产的一个因素，多种炎症标志物与其发病机制相关。本研究的目的是评估母体血清淀粉样蛋白A（SAA）水平作为罗马尼亚队列中早产预测标志物的价值。
这项观察性研究于2023年4月至2024年3月在罗马尼亚一家三级护理医院进行。我们招募了136名孕妇，并根据分娩开始时间将她们分为两组：早产组（37周前，n = 70）和足月组（37周后，n = 66）。入院时采集母体血样，使用Atellica® NEPH 630系统（西门子医疗，德国埃尔朗根）进行分析以确定SAA水平。使用受试者工作特征（ROC）曲线分析和尤登指数确定SAA的最佳临界值。然后应用逻辑回归模型评估SAA水平升高与早产之间的关联，并对潜在混杂因素如产妇年龄和早产史进行校正。
早产组的SAA中位数水平（22 mg/L）显著高于足月组（7 mg/L）（p < 0.001）。ROC曲线分析得出SAA对早产具有中等预测价值，ROC曲线下面积（AUC）为0.690。15 mg/L的阈值是最佳临界值，灵敏度为89%，特异性为85%。SAA水平升高与早产风险增加27.89倍相关。此外，在对产妇年龄、孕期医疗状况和既往早产史进行校正后，SAA水平升高仍然是早产的显著预测因素（校正比值比（aOR）= 28.966；p = 0.001）。
母体SAA被证明是早产的一个强有力的独立危险因素。这种生物标志物进一步缩小了早产风险较高的孕妇群体范围，并为其在预防早产中的临床作用开辟了新的前景。
