子痫前期患者血清AFP、D-二聚体、PLGF水平对母体及妊娠结局影响

目的:分析子痫前期(PE)患者血清甲胎蛋白(AFP)、D-二聚体(D-dimer)及胎盘生长因子(PLGF)水平对母体及妊娠结局的影响。方法:将本院2016年1月-2018年9月收治的330例PE患者分轻度PE组(n=117)、重度PE组(n=213),另选同期本院住院待产的正常妊娠产妇30例为对照组,检测各组孕妇血清AFP、D-dimer、PLGF水平,绘制受试者工作特征(ROC)曲线分析对PE的诊断预测效能;Spearman相关性分析各检测指标与病情的相关性;对PE患者妊娠结局的预测效能。结果:PE组与对照组AFP比较无差异(P>0.05),但D-dimer水平PE组高于对照组,PLGF低于对照组(P<0.05);D-dimer AUC值最高(387.51μg/L),预测PE的敏感度、特异度为80.6%、100.0%;PLGF AUC值次之(217.33pg/ml),预测PE的敏感度为96.7%,高于D-dimer。不同病情严重程度的PE患者血清AFP、PLGF水平未见差异(P>0.05),但D-dimer轻度PE组低于重度PE组(P<0.05)。AFP与PE病情程度未见相关性(r=0.093,P=0.078),D-dimer与PE病情程度正相关(r=0.796,P=0.000),PLGF与PE病情程度负相关(r=0.114,P=0.031)。PE患者中,母体发生并发症、胎儿结局不良者血清D-dimer水平高于无并发症、胎儿结局良好者(P<0.05),AFP、PLGF未见差异(P>0.05);D-dimer对PE患者并发症可发挥一定预测效能,以579.53μg/L为cut-off,预测PE患者并发症的敏感度、特异度为80.9%、61.9%,另两项血清指标对妊娠结局的预测效能不佳。结论:血清AFP、D-dimer、PLGF3个指标中,D-dimer对PE的预测价值及其与PE病情的相关性最为显著,用于预测PE患者母体并发症具有一定敏感度,但特异度不佳。

Influence of serum alpha-fetoprotein,D-dimer,and placental growth factor levels on pregnancy outcomes of women with preeclampsia

Objective:To analyze the influence of serum levels of alpha-fetoprotein(AFP),D-dimer and placenta growth factor(PLGF)on pregnancy outcomes of women with preeclampsia(PE).Methods:330 women with PE were divided into group A(117 women with mild PE)and group B(213 women with severe PE)from January 2016 to September 2018.30 normal pregnant women were selected in group C during the same period.The levels of serum AFP,D-dimer and PLGF of women in the three groups were detected,and ROC curve were drawn to analyze the efficacy of the levels of serum AFP,D-dimer and PLGF for predicting PE.Spearman correlation analysis was used to study the correlation between the levels of serum AFP,D-dimer and PLGF and disease condition,and to analyze the efficacy of serum AFP,D-dimer and PLGF levels for predicting the pregnancy outcomes of women with PE.Results:There was no significant difference in AFP level of women between women with and without PE(P>0.05).The D-dimer level of women in group A and B was significant higher than that of women in group C,while PLGF level of women in group A and B was significant lower(P<0.05).The AUC value of D-dimer level for predicting PE was the highest(387.51μg/L),which’s sensitivity and specificity were 80.6%and 100.0%,respectively.The AUC value of PLGF level for predicting the pregnancy outcomes was the second highest(217.33pg/ml),which’s sensitivity(96.7%)was significant higher than that of D-dimer level.There were no significant different in serum AFP and PLGF levels of women with different severity PE(P>0.05),but the level of D-dimer of women in group A was significant lower than that of women in group B(P<0.05).There was no correlation between AFP level and PE severity(r=0.093,P=0.078),D-dimer level was positively correlated with PE severity(r=0.796,P=0.000),and PLGF level was negatively correlated with PE severity(r=0.114,P=0.031).In the group A and B,the serum D-dimer level of women with complications or fetal adverse outcomes was significant higher than that of women without complications or fetal adverse outcomes(P<0.05),and there were no significant differences in AFP and PLGF levels between the women with and without complications or fetal adverse outcomes(P>0.05).D-dimer level had value for predicting the complications of women with PE.When the cut-off value of D-dimer level was 579.53μg/L,the sensitivity and the specificity of D-dimer level for predicting the complications of women with PE were 80.9%and 61.9%,respectively.The levels of AFP and PLGF had no value for predicting pregnancy outcomes of women with PE.Conclusion:Among the serum AFP,D-dimer and PLGF levels,D-dimer level has the most significant value for predicting PE and is closest correlation with PE.The sensitivity of D-dimer level for predicting PE is high,but its specificity is low.