血浆血栓烷B2不同孕期对子痫前期的预测价值

目的:研究孕妇血浆TXB2在子痫前期以及正常妊娠中的变化并探讨不同孕期对子痫前期的预测价值。方法:采用前瞻性、双盲的研究方法,对180例孕前血压正常的孕妇,在妊娠10+0~14+6、20+0~24+6、30+0~34+6周3个时间段母体血浆中的TXB2水平进行测定,观察孕妇孕期病情变化并随访妊娠结局。结果:①180例孕妇发展为子痫前期10例(子痫前期组),其中4例重度子痫前期、6例轻度子痫前期;170例妊娠结局正常(正常妊娠组)。②180例孕妇血浆中TXB2的水平随着妊娠的进展,进行自身配对比较均逐渐上升,不同阶段之间比较,差异有显著性意义(P=0.000<0.01)。③在妊娠10+0~14+6周子痫前期组母体血浆TXB2水平与正常妊娠比较,差异有上升的趋势,但差异无统计学意义(P=0.486>0.05);20+0~24+6、30+0~34+6子痫前期母体血浆TXB2与正常妊娠组比较,其值均明显上升(P=0.016、0.002,P均<0.05)。④母体血浆中TXB2水平在妊娠20+0~24+6、30+0~34+6周2个阶段对子痫前期均有预测价值,ROC曲线下面积分别为0.724(95%CI0.617~0.830)和0.797(95%CI0.674~0.920),应用ROC曲线计算2个阶段的最佳切入值分别为3 750 ng/ml和4 400 ng/ml,它们预测子痫前期的敏感性、特异性、阳性预测值、阴性预测值、比数积(OR)分别为80%、69.5%、13.3%、98.33%、9.11和90%、68.82%、13.84%、99.13%、19.86。结论:子痫前期母体血浆TXB2水平在临床症状出现前很长一段时间就异常升高,20+0~24+6、30+0~34+6周母体血浆TXB2水平对子痫前期有早期预测价值,妊娠30+0~34+6周的预测价值优于妊娠20+0~24+6周。

The predictive value of maternal blood plasma thromboxane B2 for preeclampsia during different durations of pregnancy

Objective:To determine maternal blood plasma levels of TXB2 in normotensive and preeclamptic pregnant women,explore the predictive value of TXB2 for preeclampsia during different durations of pregnancy.Methods:180 pregnant women with previously normal during their progestation were included in the study by prospective and double-blind study methods.Peripheral venous blood samples were obtained during 10+0～14+6,20+0～24+6,30+0～34+6 weeks of gestation.Maternal plasma levels of TXB2 were measured by enzyme-linked immunoassay.The pathogenetic condition and pregnancy outcomes of those cases were observed.Results:①Among 180 previously normotensive women,10 developed into preeclampsia(preeclampsia group),including 4 severity and 6 mild preeclampsia.170 remained normal till the end of pregnancy(normal group).②With the development of pregnancy,the levels of 180 cases whose maternal plasma levels of TXB2 were gradually ascended through Wilcoxon Signed Ranks Test.Maternal TXB2 levels between two different gestational stages had significant difference(P<0.01).③The levels of maternal plasma TXB2 were slight higher in preeclampsia group than that in normal group during 10+0～14+6 gestational weeks,without significant difference(P>0.05);The levels of TXB2 were significantly higher in preeclampsia group than that in normal group during 20+0～24+6 and 30+0～34+6 weeks of gestation(P<0.05 respectively).④The index of maternal plasma TXB2 had predictive value for preeclampsia during 20+0～24+6 and 30+0～34+6 weeks of gestation respectively through receiver operating characteristic curve(ROC),the area under curve was 0.724(95%CI:0.617～0.830)and 0.797(95%CI:0.674～0.920).The best cut off values of maternal TXB2 were 3 750 ng/ml and 4 400 ng/ml during the two gestational stages by ROC,and the sensitivity,specificity,positive predictive value,negative predictive value and odd radio of TXB2 in predicting preeclampsia were 80%,69.5%,13.3%,98.33%,9.11 and 90%,68.82%,13.84%,99.13%,19.86 respectively.Conclusion:Higher levels of maternal plasma TXB2 are detected a long time before clinical symptom emerged.The maternal plasma TXB2 have predictive value during 20+0～24+6 and 30+0～34+6 weeks of gestation,and the index at 30+0～34+6 surpassed at 20+0～24+6 gestational weeks.