PAPP-A、sFlt-1、TTR在妊娠期高血压疾病诊断中的价值

目的探讨妊娠相关蛋白A(PAPP-A)、可溶性血管内皮生长因子(sFlt-1)、中转甲状腺素蛋白(TTR)联合检测对于鉴别诊断妊娠期高血压疾病的临床价值。方法选取2018年1月至2019年12月在徐州医科大学附属沭阳医院确诊的妊娠期高血压疾病孕妇88例作为病例组,选取同期正常妊娠的孕妇120例作为对照组,检测两组孕妇于孕24~28周的PAPP-A、sFlt-1、TTR水平,并按照患者病情将病例组分为妊娠期高血压组、轻度子痫前期组、重度子痫前期组,采用受试者工作特征曲线(ROC)分析3项指标单独和联合检测鉴别诊断妊娠期高血压疾病的价值。结果病例组的PAPP-A水平显著高于对照组(t=2.254,P<0.05),病例组的sFlt-1、TTR水平显著低于对照组(t值分别为-3.226、-17.907,均P<0.05);妊娠期高血压组、轻度子痫前期组、重度子痫前期组患者的PAPP-A、sFlt-1、TTR水平比较差异均有统计学意义(F值分别为3.624、3.525、7.037,均P<0.05);PAPP-A、sFlt-1、TTR联合检测诊断妊娠期高血压疾病的灵敏度为97.15%、特异度为86.49%、漏诊率为2.85%、误诊率为13.51%,ROC曲线下面积AUC值为0.935。结论PAPP-A、sFlt-1、TTR这3项指标联合检测鉴别诊断妊娠期高血压疾病具有重要的临床价值。

Diagnostic value of combined detedtion of PAPP-A,sFlt-1 and TTR for hypertensive disorder complicating pregnancy

Objective To explore clinical value of combined detection of pregnancy-associated plasma protein A(PAPP-A),soluble fms-like tyrosine kinase receptor 1(sFlt-1)(soluble vascular endothelial growth factor 1)and transthyretin(TTR)(a kind of thyroxine transport protein)in differential diagnosis of hypertensive disorder complicating pregnancy(HDCP).Methods 88 pregnant women with HDCP diagnozed in The Affiliated Muyang Hospital of Xuzhou Medical University were selected and divided into case group and 120 normal pregnant women in the same period were included in control group.The serum levels of PAPP-A,sFlt-1 and TTR of the pregnant women in the two groups were detected at 24~28 weeks of gestational age.The pregnant women in the case group were stratified into HDCP subgroup,mild pre-eclampsia subgroup and severe pre-eclampsia subgroup according to the patient’s condition,and the values of single detection and combined detection of the three indices for differential diagnosis of HDCP were analyzed by receiver’s operation curve(ROC).Results The serum level of PAPP-A of the pregnant women in the case group was significantly higher than that in the control group(t=2.254,P<0.05),while the serum levels of sFlt-1 and TTR of the pregnant women in the case group were significantly lower than those in the control group(t=-3.226 and-17.907 respectively,both P<0.05).There were statistically significant differences in serum levels of PAPP-A,sFlt-1 and TTR among the three subgroups(F=3.624,3.525 and 7.037 respectively,all P<0.05).The sensitivity,specificity,missed diagnosis rate,misdiagnosis rate and AUC value under ROC curve of PAPP-A,sFlt-1 and TTR combined detection were 97.15%,86.49%,2.85%,13.51%and 0.935 respectively.Conclusion The combined detection of PAPP-A,sFlt-1 and TTR has important clinical value in differential diagnosis of HDCP.