妊娠早中期孕妇血清中甲胎蛋白、游离雌三醇、抑制素A及子宫动脉搏动指数预测子痫前期的价值

目的探讨妊娠早中期孕妇血清中甲胎蛋白（AFP）、游离雌三醇（uE3）、抑制素A（InhA）及子宫动脉搏动指数（PI）单独和联合预测子痫前期的价值。方法选择产检的单胎初孕产妇1 000例，其中随访至产后3个月的有945例。将945例孕妇中诊断为子痫前期的孕妇作为病例组，在未发生子痫前期的孕妇中按1∶4的比例为病例组匹配对照组。检测并记录妊娠早中期孕妇血清中的AFP、uE3、InhA和PI。结果945例孕妇子痫前期的发病率为3.5%（33/945）。病例组和对照组孕妇AFP差异无统计学意义（P>0.05），病例组孕妇InhA和PI高于对照组孕妇，uE3低于对照组孕妇，差异均有统计学意义（P<0.05~P<0.01）。InhA、uE3和PI预测子痫前期的灵敏度分别为48.4%、72.7%和57.6%，InhA、uE3和PI预测子痫前期的特异度分别为78.0%、69.7%和84.8%；联合指标预测子痫前期的灵敏度和特异度分别为75.8%和76.5%；ROC曲线下面积为0.825，大于InhA、uE3和PI值3个单项指标的ROC曲线下面积（P<0.01）。结论妊娠早中期孕妇血清中的uE3、InhA和PI联合预测和诊断子痫前期的价值相对单个指标较好。

The value of the levels of alpha-fetoprotein,free estriol,inhibin A and uterine arterial pulse index in predicting preeclampsia of pregnant women in the first and second trimesters of pregnancy

ObjectiveTo analyze the value of the individual and combined the levels of alpha-fetoprotein(AFP), free estriol(uE3), inhibin A(InhA) and uterine arterial pulse index(PI) in predicting preeclampsia of pregnant women in the first and second trimesters of pregnancy.MethodsA total of 1 000 singleton primiparas were selected, 945 pregnant women diagnosed by preeclampsia were set as the case group, and the case group was matched to the control group in a ratio of 1:4 among pregnant women without preeclampsia.The serim levels of AFP, uE3 and InhA, and PI were detected and recorded.ResultsThe incidence rate of preeclampsia in 945 pregnant women was 3.5%(33/945).There was no statistical significance in the AFP level between two group(P>0.05).The value of InhA and PI in case group were higher than those in control group, and the uE3 value in case group was lower than that in control group(P<0.05 to P<0.01).The sensitivities of InhA, uE3 and PI in predicting preeclampsia of pregnant women were 48.4%, 72.7% and 57.6%, respectively.The specificities of InhA, uE3 and PI in predicting preeclampsia of pregnant women were 78.0%, 69.7% and 84.8%, respectively.The sensitivity and specificity of the combined index for predicting preeclampsia were 75.8% and 76.5%, respectively.The area under the ROC curve of the combined data in predicting preeclampsia was 0.825, which was significantly higher than that of InhA, uE3 and PI, respectively(P<0.05).ConclusionsThe combined value of uE3, InhA and PI in predicting preeclampsia is better than that of single parameter in the first and second trimesters of pregnancy.