孕早期血清PAPP-A水平与妊娠和围产结局的关系

目的:探讨孕早期血清妊娠相关蛋白-A(pregnancy associatied plasma protein A,PAPP-A)水平对妊娠和围产结局的预测价值。方法:对664例孕4~14周初产妇采用酶联免疫法检测血清PAPP-A水平,并随访该人群至妊娠终止或分娩,分析孕早期血清PAPP-A水平与妊娠和围产结局的关系。结果:①664例初产妇女中,随访到妊娠结局的420例,其中异常妊娠(自然流产、胚胎停止发育)35例(8.33%),建立苏州市围产保健册并成功分娩的385例(91.67%)。②早孕妇女血清PAPP-A水平随孕周的增加而升高。③妊娠结局为异常妊娠的妇女其孕早期血清PAPP-A的中位数倍数值(multiples of the respective normal median,MOM值)水平低于成功分娩者(P<0.05)。④成功分娩孕妇的孕早期血清PAPP-A的MOM值与其早孕期体质量、体质量指数(body mass index,BMI)呈负相关(分别为-0.156,-0.159),与年龄、身高无相关性(P>0.05)。⑤孕早期血清PAPP-A的MOM值与其胎儿性别、出生体质量和分娩方式等无相关性(P>0.05)。结论:孕早期血清PAPP-A水平低常预示早期不良妊娠结局;成功分娩妇女早孕血清PAPP-A水平与其早孕期体质量、BMI呈负相关,但不能预测围产结局。

Relationships between the Level of Serum Pregnancy Associatied Plasma Protein A in the First Trimester and the Pregnant Outcomes

Objective: To explore the value of pregnancy associatied plasma protein A(PAPP-A) in predicting pregnant and perinatal outcome.Methods: Maternal serum levels of PAPP-A were detected by ELISA at 4-14 weeks gestation.Results: 1) Totally 664 women who were primiparas in the first trimester were enrolled,among them 385 were nomal pregnancy,35 were abnomal pregnancy such as missed abortion,embryo development ceasing.2) The level of serum PAPP-A increased along with the week of pregnancy.3) The MOM of PAPP-A in nomal pregnancy was higher than that in abnomal pregnancy with unfavourable outcome(P<0.000 1).4) In normal pregnany,the MOM of PAPP-A had no relationship with age,height of early pregnancy(P>0.05),but it was related to weight,body mass index(P>0.05).5) There was no correlation between the MOM of PAPP-A and the way of delivery,weight,sex of infant(P>0.05).Conclusion: Lower level of serum PAPP-A in the first trimester usually predict unfavourable early pregnant outcome,but has no correlation with perinatal outcomes.