摘要
目的评价联合检测妊娠相关蛋白A (PAPP-A)、同型半胱氨酸(HCY)、超敏C反应蛋白(hsCRP)和补体C1q(C1q)水平在子痫前期孕妇患者中的早期诊断价值。方法采用前瞻性的研究方法,选取2013年4月至2015年2月在山西医科大学第一医院门诊行常规产前检查并在我院分娩的孕妇共117例,根据随访结果将其分为健康对照组、重度子痫前期组和慢性高血压合并子痫前期组。采用酶联免疫吸附试验定量法检测血清中PAPP-A水平、酶循环法检测HCY水平、免疫比浊法检测hsCRP和C1q,对血清指标和部分妊娠结局的相关性进行分析。结果①117例孕妇中未发生妊娠期高血压疾病42例(健康对照组),重度子痫前期56例(病例A组),慢性高血压合并子痫前期19例(病例B组)。②使用SPSS 22.0软件对数据进行分析,数据不符合正态分布,采用M(QR)进行统计描述,健康对照组孕妇血清中PAPP-A值、HCY值、hsCRP值和C1q值分别是1 504(4 027)ng/ml、6.80(3.25)μmol/L、3(2.70)mg/L、194(26)mg/L;重度子痫前期组分别是1 764(4 167)ng/ml、11.70 (6.60)μmol/L、5.90 (4.24)mg/L、191 (40.50)mg/L;慢性高血压合并子痫前期组分别是1 715 (5 047)ng/ml、9.60 (8.85)μmol/L、5.98(6.43)mg/L、207(52)mg/L;健康对照组产妇血清中PAPP-A值、HCY值hsCRP值和C1q分别是11.16(22.32)ng/ml、9.60(4.45)μmol/L、1.56(2.47)mg/L和206(38.50)mg/L;病例A组产后分别是7.56(26.91)ng/ml、10.60 (6)μmol/L、1.99 (2.78)mg/L和206 (41)mg/L;病例B组产后分别是9.36 (20.52)ng/ml、9.70(5.95)μmol/L、2.75(3.01)mg/L和221(57)mg/L。③经配对计量资料比较的Wilcoxon秩和检验,健康组PAPP-A、HCY、hsCRP和C1q产前产后比较,差异有统计学意义(P<0.05);病例A组PAPP-A、HCY、hsCRP和C1q产前产后比较,差异有统计学意义(P<0.05);病例B组PAPP-A产前产后比较,差异有统计学意义(P<0.05),HCY、hsCRP和C1q产前产后比较,差异均无统计学意义(P>0.05)。④经多个独立样本两两比较的Mann-Whitney U检验,3组孕妇血清PAPP-A分别两两比较,差异均无统计学意义(P>0.05);3组孕妇血清HCY分别两两比较,健康组与病例A组、正常组与病例B组,差异均有统计学意义(P<0.05),病例A组与病例B组,差异均无统计学意义(P>0.05);3组孕妇血清hsCRP分别两两比较,健康组与病例A组、健康组与病例B组,差异均有统计学意义(P<0.05),病例A组与病例B组,差异均无统计学意义(P>0.05);3组孕妇血清C1q分别两两比较,差异均无统计学意义(P>0.05)。3组产妇血清PAPP-A、HCY、hsCRP和C1q分别两两比较,差异均无统计学意义(P>0.05)。结论PAPP-A、HCY、hsCRP和C1q对子痫前期的发病有一定的预测价值。
Objective To evaluate the value of combined determination of pregnancy-associated plasma protein-A(PAPP-A), homocysteine(HCY), hypersensitive C-reactive protein(hsCRP) and complement C1 q levels in the early diagnosis of preeclampsia. Methods A total of 117 pregnant women, who underwent routine prenatal examination and deliveredin the Outpatient Department of the First Hospital of Shanxi Medical University between April 2013 and February 2015 were prospectively included in the study. According to the follow-up outcomes, the pregnant women were divided into the health control group, severe preeclampsia group and chronic hypertension combined with preeclampsia group.The serum level of PAPP-A was measured by enzyme-linked immunosorbent assay(ELISA). HCY level was measured by enzymatic cycling method. hsCRP and C1 q levels were determined by latex immunoturbidime-try.The correlation between the serum indicators and partial pregnancy outcomes was analyzed. Results ①Among the 117 pregnant women, there were 42 cases without gestational hypertension(health control group), 56 of severe preeclampsia(group A), and 19 of chronic hypertension combined with preeclampsia(group B).② SPSS22.0 was used to analyze the data, and the data did not conform to the normal distribution. M(QR)was used for statistical description, and theprenatalserum levels of PAPP-A, HCY, hsCRP and C1 q were 1 504(4 027)ng/ml, 6.80(3.25)μmol/L, 3(2.70)mg/L,and 194(26)mg/L in the health control group;1 764(4167)ng/ml, 11.70(6.60)μmol/L, 5.90(4.24)mg/L, and 191(40.50)mg/L in group A;1 715(5 047)ng/ml, 9.60(8.85)μmol/L, 5.98(6.43)mg/L, and 207(52)mg/L in group B, respec-tively.The postnatal serum levels of PAPP-A, HCY, hsCRP and C1 q were 11.16(22.32)ng/ml,9.60(4.45)μmol/L,1.56(2.47)mg/L and 206(38.50)mg/L in the health control group;7.56(26.91)ng/ml,10.60(6)μmol/L,1.99(2.78)mg/L and 206(41)mg/L in group A;9.36(20.52)ng/ml,9.70(5.95)μmol/L,2.75(3.01)mg/L and 221(57)mg/L in group B, respectively.③According to the Wilcoxon rank sum test for paired data, there were statistically significant differences in prenatal and postnatal serum levels of PAPP-A, HCY, hsCRP and C1 q in the control group(P<0.05);there were statistically signif-icant differ-ence in prenatal and postnatal serum levels of PAPP-A, HCY, hsCRP and C1 q in group A(P<0.05);There was statisti-cally significant difference in prenatal and postnatal serumlevel of PAPP-A in group B(P<0.05), whereas there were no statistically significant difference in prenatal and postnatal serum levels of HCY, hsCRP and C1 q(P>0.05).④Mann-Whitney U tests was used forpairwise comparison of multiple independent samples, there was no statistically signifi-cant difference in the prenatal serum level of PAPP-A among the three groups(P>0.05). There was statistically significant difference inthe prenatal serum level of HCY between the normal control group and group A, and between the health control group and group B(P<0.05), whereas there was no statistically significant difference in the prenatal serum level of HCY between group A and group B(P>0.05). There was statistically significant difference in the prenatal serum level of hsCRP between the normal control group and group A, and between the health control group and group B(P<0.05), whereas there was no statistically significant difference in the prenatal serum level of hsCRP be-tween group A and group B(P>0.05). There was no statistically significant difference in the prenatal serum level of C1 q among the three groups(P>0.05). There were no statistically significant differences in the postnatal serum levels of PAPP-A, HCY, hsCRP and C1 q among the three groups(P>0.05). Conclusion PAPP-A, HCY, hsCRP and C1 q may be predictive for the onset of preeclampsia.
作者
杨泽华
胡敏
许建萍
窦水秀
丁琳茹
赵晓宇
Yang Zehua;Hu Min;Xu Jianping;Dou Shuixiu;Ding Linru;Zhao Xiaoyu(Department of Laboratory Medicine, First Hospital of Shanxi Medical University, Taiyuan 030001, China)
出处
《中国药物与临床》
CAS
2019年第12期1952-1956,共5页
Chinese Remedies & Clinics
基金
山西省科技攻关项目(社会发展)(20130313016-10)
关键词
子痫前期
妊娠相关蛋白A
同型半胱氨酸
超敏C反应蛋白
补体C1Q
Preeclampsia
Pregnancy-associated plasma protein-A
Homocysteine
Hypersensitive C-reactive protein
Complement C1q
作者简介
通信作者:许建萍,Email:xujp1972@163.com.
