血清γ-谷氨酰转肽酶与血小板比值可预测HELLP综合征。
The serum gamma-glutamyl transpeptidase-to-platelet ratio predicts HELLP syndrome.
作者信息
Chen Jiaying, Gu Hao, Wu Hongqin, Jiang Minhui, Gu Ying, Feng Yaling
机构信息
Department of Women Health Care, Wuxi School of Medicine, Wuxi Maternal and Child Health Hospital, Jiangnan University, Wuxi, 214002, Jiangsu Province, PR China.
Department of Obstetrics, Wuxi School of Medicine, Wuxi Maternal and Child Health Hospital, Jiangnan University, Wuxi, 214002, Jiangsu Province, PR China.
出版信息
BMC Pregnancy Childbirth. 2025 Mar 15;25(1):292. doi: 10.1186/s12884-025-07431-4.
BACKGROUND
HELLP (Hemolysis, elevated liver enzymes, and low platelets) syndrome is a dangerous obstetric condition that is in great need of simple and inexpensive non-invasive early predictors, but it has been poorly studied. This study was conducted to investigate the predictive role of serum gamma-glutamyl transpeptidase to platelet ratio (GPR) during pregnancy in HELLP syndrome and its adverse pregnancy outcomes.
METHODS
This was a retrospective study in a tertiary hospital. One hundred parturients were allocated into two groups: HELLP group (n = 50) and control group (n = 50).
RESULTS
① In the HELLP group, the maternal GPR levels showed a continuous upward trend from middle pregnancy to before-delivery, with significantly higher values observed in late pregnancy and before-delivery compared to the control group (P < 0.05). ② A comparison was made between the counts of platelets (PLT), plasma fibrinogen (FIB), alanine transaminase (ALT), aspartate transaminase (AST), uric acid (UA), γ-glutamyl transferase (GGT), and GPR in two groups of the pregnant women during their late pregnancy and before-delivery to the hospital, all of which showed statistically significant differences (P < 0.05). ③Multivariate logistic regression analysis showed that higher GPR, ALT, and UA were independent risk factors for the development of HELLP syndrome (OR = 23.382, 1.169,1.016, P < 0.05), while higher FIB was a protective factor (OR = 0.057, P < 0.05). ④ Spearman correlation analysis indicated that the abnormal elevation of GPR in late pregnancy and before-delivery was correlated with preterm birth (r = 0.510, 0.450, P < 0.05). ⑤ROC curve analysis revealed that the predictive efficacy of GPR in late pregnancy (AUC = 0.8441) was higher than AST (AUC = 0.7960), ALT (AUC = 0.7952), and PLT (AUC = 0.7691) in late pregnancy, with an AUC of 0.8656 for GPR before delivery When GPR values were 0.22 and 0.27 in late pregnancy and before-delivery, the sensitivity for predicting HELLP syndrome was 77.6% and 78%, and the specificity was 85% and 90%.
CONCLUSIONS
The abnormal increase of GPR during pregnancy has a certain predictive effect on HELLP syndrome and its adverse pregnancy outcomes.
背景
HELLP（溶血、肝酶升高和血小板减少）综合征是一种危险的产科疾病，迫切需要简单且廉价的非侵入性早期预测指标，但对此研究较少。本研究旨在探讨孕期血清γ-谷氨酰转肽酶与血小板比值（GPR）对HELLP综合征及其不良妊娠结局的预测作用。
方法
这是一项在三级医院开展的回顾性研究。100例产妇被分为两组：HELLP组（n = 50）和对照组（n = 50）。
结果
①在HELLP组中，孕妇GPR水平从孕中期到分娩前呈持续上升趋势，孕晚期和分娩前的值显著高于对照组（P < 0.05）。②对两组孕妇孕晚期及入院分娩前的血小板（PLT）计数、血浆纤维蛋白原（FIB）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、尿酸（UA）、γ-谷氨酰转肽酶（GGT）和GPR进行比较，差异均有统计学意义（P < 0.05）。③多因素logistic回归分析显示，较高的GPR、ALT和UA是发生HELLP综合征的独立危险因素（OR = 23.382、1.169、1.016，P < 0.05），而较高的FIB是保护因素（OR = 0.057，P < 0.05）。④Spearman相关性分析表明，孕晚期和分娩前GPR异常升高与早产相关（r = 0.510、0.450，P < 0.05）。⑤ROC曲线分析显示，孕晚期GPR的预测效能（AUC = 0.8441）高于孕晚期的AST（AUC = 0.7960）、ALT（AUC = 0.7952）和PLT（AUC = 0.7691），分娩前GPR的AUC为0.8656。当孕晚期和分娩前GPR值分别为0.22和0.27时，预测HELLP综合征的敏感度分别为77.6%和78%，特异度分别为85%和90%。
结论
孕期GPR异常升高对HELLP综合征及其不良妊娠结局有一定的预测作用。
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