中孕期血清AFP和free β-HCG水平与子痫前期的相关性

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1420 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的：了解中孕期孕妇血清甲胎蛋白（AFP）和游离人绒毛膜促性腺激素β亚基（free β-HCG）水平与子痫前期的相关性。方法：分析2015年1月至2016年8月在杭州市妇产科医院接受中孕期（妊娠15～20+6周）血清学产前筛查检测、妊娠晚期住院分娩的孕妇，根据子痫前期发病程度，将研究对象分为子痫前期组（n=55）和重度子痫前期组（n=36），同时期正常分娩孕妇中随机抽取100例作为对照组（n=100），检测孕妇血清标本AFP和free β-HCG水平，并比较其浓度分布情况。子痫前期和重度子痫前期与孕妇年龄、孕期、体质量、AFP和free β-HCG的关系采用非条件logistic回归分析。采用ROC曲线评价AFP和freeβ-HCG的筛查效能。结果：子痫前期组、重度子痫前期组AFP（MoM）水平均高于对照组，差异有统计学意义（P＜0.01）。经非条件logistic回归分析，孕妇血清AFP是子痫前期、重度子痫前期发病的主要危险因素（P＜0.05），但其检测灵敏度偏低。结论：中孕期妇女血清高水平AFP（MoM）是妊娠子痫前期的危险因素，可预测晚期孕妇发生子痫前期可能，但其检测灵敏度偏低，单独筛查子痫前期价值有限，需要与其他标志物联合应用。

	服务
	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	陈益明
	卢莎
	何佩
	顾琳媛
	张艳珍
	褚雪莲
	连结静
	张敏

关键词 ：甲胎蛋白类, 绒毛膜促性腺激素, &beta, 亚单位, 人, 先兆子痫

Abstract：Objective: To determine if second-trimester maternal serum alpha-fetoprotein (AFP) level and free β-HCG level can predict preeclampsia. Methods: Second-trimester maternal serum levels of AFP and β-HCG in pregnancies who delivered in Hangzhou Women’s Hospital from January 2015 to August 2016 were analyzed. A prospective case-control study included 55 mild preeclampsia patients, 36 severe preeclampsia patients and 100 control pregnant women. AFP and free β-HCG among groups were compared. The correlation of age, weight, gestational age, AFP, free β-HCG and preeclampsia, severe preeclampsia were analyzed by unconditional logistic regression analysis. The diagnostic efficacy of AFP and free β-HCG were evaluated by ROC curves. Results: AFP of mild preeclampsia group and severe preeclampsia group was significantly higher than control group (P<0.01). Logistic regression analysis showed that AFP was independent factor of mild and severe preeclampsia (P<0.05), but it has lower sensitivity. Conclusion: Higher second trimester maternal serum AFP level is a risk factor for preeclampsia. It can serve as a screening test for preeclampsia. However, single detection of AFP test is limited as the lower sensitivity. Combining other markers will make it more sufficient and reliable.

Key words： alpha-fetoproteins chorionic gonadotropin, beta subunit, human pre-eclampsia

收稿日期: 2017-06-01

基金资助:浙江省医药卫生学科平台项目（临床研究-2018ZD036）；杭州市余杭区医疗卫生科研项目（2014-医疗卫生-20）。

通讯作者: 何佩，主任医师，Email：hehepei2012@163.com。

作者简介: 陈益明（1969-），男，浙江苍南人，主任技师。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I2/115

[1] 孔红芳, 常亚清, 王芳, 等. HtrA与子痫前期相关性的研究进展[J]. 国际妇产科学杂志, 2017, 44(1): 56-59.
[2] SPAGGIARI E, RUAS M, DREUX S, et al. Management strategy in pregnancies with elevated second-trimester maternal serum alpha-fetoprotein based on a second assay[J].Am J Obstet Gynecol, 2013, 208(4): 303.e1-7.
[3] OLSEN RN, WOELKERS D, DUNSMOOR-SU R, et al. Abnormal second-trimester serum analytes are more predictive of preterm preeclampsia[J]. Am J Obstet Gynecol, 2012. 207(3): 228.e1-7.
[4] 中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南(2015)[J]. 中华妇产科杂志, 2015, 50(10): 721-728.
[5] 谢幸, 苟文丽. 妇产科学[M]. 8版. 北京: 人民卫生出版社, 2013: 64-70.
[6] DEHGHANI-FIROUZABADI R, TAYEBI N, GHASEMI N,
et al. The association between second-trimester maternal serum alpha-fetoprotein in 14-22 weeks and adverse pregnancy outcome[J]. Acta Med Iran, 2010, 48(4): 234-238.
[7] TACHE V, BAER R J, CURRIER R J, et al. Population-based biomarker screening and the development of severe preeclampsia in California[J]. Am J Obstet Gynecol, 2014, 211
(4): 377.e1-8.
[8] BREDAKI F E, MATALIOTAKIS M, WRIGHT A, et al. Maternal serum alpha-fetoprotein at 12, 22 and 32 weeks’ gestation in screening for pre-eclampsia[J]. Ultrasound Obstet Gynecol, 2016, 47(4): 466-471.
[9] SHENHAV S, GEMER O, VOLODARSKY M, et al. Midtrimester triple test levels in women with severe preeclampsia and HELLP syndrome[J]. Acta Obstet Gynecol Scand, 2003, 82(10): 912-915.
[10] DAVIDSON E J, RILEY S C, ROBERTS S A, et al. Maternal serum activin, inhibin, human chorionic gonadotrophin and alpha-fetoprotein as second trimester predictors of pre-eclampsia[J]. BJOG, 2003, 110(1): 46-52.
[11] MORSSINK L P, HERINGA M P, BEEKHUIS J R, et al. The association between hypertensive disorders of pregnancy and abnormal second-trimester maternal serum levels of HCG and alpha-fetoprotein[J]. Obstet Gynecol, 1997, 89(5): 666-670.
[12] CNOSSEN J S,TER RIET G, MOL B W, et al. Are tests for predicting pre-eclampsia good enough to make screening viable? A review of reviews and critical appraisal[J]. Acta Obstet Gynecol Scand, 2009, 88(7): 758-765.
[13] WALLER D K, LUSTIG L S,CUNNINGHAM G C, et al. The association between maternal serum alpha-fetoprotein and preterm birth, small for gestational age infants, preeclampsia, and placental complications[J]. Obstet Gynecol, 1996, 88(5): 816-822.