摘要： 目的 探讨血清胎盘生长因子（PLGF）/可溶性血管内皮生长因子受体-1 （sFlt-1）联合胎盘三维能量多普勒指数（3D-PDI）对子痫前期（PE）的预测价值。方法 选取2021年1月至2022年12月于我院就诊且有PE高危因素的孕妇120例，随访至分娩后1周。于孕14~20周常规产检时检测血清PLGF和sFlt-1水平，并计算PLGF/sFlt-1比值，同时超声检测胎盘3D-PDI，包括血管化指数（VI）、血流指数（FI）、血管化-血流指数（VFI）。根据孕20周后是否发生PE，分为PE组（55例）和对照组（65例），根据病情轻重将PE组进一步分为非重度PE组（35例）和重度PE组（20例）。比较各组PLGF/sFlt-1及3D-PDI，并分析PLGF、sFlt-1与3D-PDI的相关性，绘制受试者操作特征（ROC）曲线，分析各指标单独或联合预测PE的价值。结果 2组孕妇年龄、检测孕周、妊娠高血压史及生育史等均无差异（P > 0.05）。PE组收缩压（SBP）、舒张压（DBP）、24 h尿蛋白水平、早产率、新生儿重症监护室入住率及孕前体质量指数均高于对照组（P < 0.05），新生儿体质量低于对照组（P < 0.05）。PE组血清PLGF/sFlt-1、3D-PDI均低于对照组，重度PE组血清PLGF/sFlt-1、3D-PDI均低于非重度PE组（均P < 0.05）。PLGF与VFI呈显著正相关（P < 0.01），sFlt-1与VFI呈显著负相关（P < 0.01）。ROC曲线分析显示，PLGF/sFlt-1、VI、FI、VFI对PE均有预测价值，VI、FI、VFI联合预测PE的价值高于各参数指标［曲线下面积（AUC）=0.951］，血清PLGF/sFlt-1、VI、FI、VFI四者联合预测价值最高（AUC=0.987）。结论 PE患者孕早期血清PLGF、sFlt-1与胎盘VFI均具有显著相关性，且孕早期血清PLGF/sFlt-1及胎盘VI、FI、VFI均减低，4种指标联合应用预测PE的效能最高，可为临床早期筛查或预测PE提供参考。

血清PLGF/sFlt-1联合胎盘3D-PDI对子痫前期的预测价值

田飞¹, 刘玉芳², 李保卫¹, 张金俏¹

1. 滨州医学院附属医院超声医学科, 山东 滨州 256603;
2. 滨州医学院附属医院妇产科, 山东 滨州 256603

收稿日期:2023-07-03出版日期:2024-02-28发布日期:2024-01-12
通讯作者:张金俏E-mail:superqiao2020@163.com
作者简介:田飞(1984-),女,主治医师,硕士.
基金资助:山东省自然科学基金面上项目（ZR2021MH247）；山东省医药卫生科技发展计划（202005020624）


关键词: 血清胎盘生长因子/可溶性血管内皮生长因子受体-1, 三维能量多普勒指数, 子痫前期, 超声诊断
Abstract: Objective To investigate the predictive value of serum placental growth factor (PLGF)/soluble fms-like tyrosine kinase-1 (sFlt-1), combined with the placental three-dimensional energy Doppler index (3D-PDI) in preeclampsia (PE). Methods From January 2021 to December 2022, 120 pregnant women with PE risk factors were selected and followed up until 1 week after delivery. Serum PLGF and sFlt-1 levels were measured at routine prenatal check-ups at 14 to 20 weeks gestation. The PLGF/sFlt-1 ratio was calculated, and placental 3D-PDI was detected by ultrasound, including the vascularization index (VI), blood flow index (FI), and vascularization-blood flow index (VFI). Based on whether PE occurred after 20 weeks of pregnancy, cases were divided into PE (55 cases) and control groups (65 cases). The PE group was further divided into mild PE (35 cases) and severe PE groups (20 cases) based on the severity of the disease. The differences in PLGF/sFlt-1 and 3D-PDI between the groups were compared in terms of a statistical analysis of the correlation between PLGF, sFlt-1, and 3D-PDI. The receiver operating characteristic curve (ROC) was plotted, and the predictive value of each index on PE alone or in combination was analyzed. Results The systolic blood pressure (SBP), diastolic blood pressure (DBP), 24 h proteinuria level, preterm birth rate, NICU admission rate, and preconception BMI in the PE group were higher than those in the control group (P < 0.05). The two groups had no differences in age, gestational age, pregnancy history, and fertility history (P > 0.05). The serum PLGF/sFlt-1 of the PE group was lower than that of the control group, and the serum PLGF/sFlt-1 of the severe group was lower than that of the mild group (P < 0.05). The 3D-PDI index of the PE group was lower than that of the control group, and the 3D-PDI index of the severe group was lower than that of the mild group (P < 0.05). Pearson's correlation analysis indicated that PLGF and VFI were significantly positively correlated (P < 0.01), and sFlt-1 was significantly negatively correlated with VFI (P < 0.01). ROC curve analysis showed that PLGF/sFlt-1, VI, FI, and VFI all had predictive value for PE and the value of VI, FI, and VFI jointly predicted PE, and was higher than that of various parameters (AUC=0.951). Serum PLGF/sFlt-1, VI, FI, and VFI combined predicted the highest value (AUC=0.987). Conclusion In patients with PE, serum PLGF, sFlt-1, and placental VFI are significantly correlated. Serum PLGF/sFlt-1, placenta VI, FI, and VFI are reduced in early pregnancy, and the combined application of the four indicators has the highest efficacy in predicting PE, providing a possible reference for the early clinical screening or prediction of PE.
Key words: serum placental growth factor/soluble fms-like tyrosine kinase-1, three-dimensional energy Doppler index, preeclampsia, ultrasonography
PDF全文下载地址:

https://journal.cmu.edu.cn/CN/article/downloadArticleFile.do?attachType=PDF&id=3364