孕母早期血清学指标预测分娩足月小于胎龄儿的价值

Value of early maternal serological indicators in predicting delivery of full-term small-for-gestational-age infants

  • 摘要:
    目的 探讨产妇早期血清学指标预测分娩足月小于胎龄儿(SGA)的价值。
    方法 选取2023年8月—2024年8月在北京市通州区妇幼保健院分娩的产妇的临床资料, 将分娩足月SGA的180例产妇纳入病例组,另选取同期分娩足月适于胎龄儿的180例产妇纳入对照组。比较2组妊娠早期(孕11~13周+ 6)血清妊娠相关蛋白A(PAPP-A)、胎盘生长因子(PLGF)、可溶性血管内皮生长因子受体-1(sFlt-1)水平。采用受试者工作特征曲线(ROC)分析产妇早期PAPP-A、PLGF、sFlt-1对分娩足月SGA的预测价值。
    结果 病例组孕早期血清PAPP-A、PLGF水平低于对照组, sFlt-1水平高于对照组,差异均有统计学意义(P<0.05)。孕早期血清PAPP-A、PLGF、sFlt-1水平联合检测预测分娩足月SGA的ROC的曲线下面积为0.823, 大于各指标单独检测的曲线下面积(0.738、0.720、0.724), 差异有统计学意义(P<0.05)。
    结论 产妇早期PAPP-A、PLGF、sFlt-1水平检测可反映宫内胎儿生长状态,三者联合检测对产妇分娩足月SGA具有更高的预测价值。

     

    Abstract:
    Objective To investigate the value of early maternal serological indicators in predicting the delivery of full-term small-for-gestational-age (SGA) infants.
    Methods The clinical data of pregnant women who delivered at Beijing Tongzhou District Maternal and Child Health Hospital from August 2023 to August 2024 were analyzed. A total of 180 pregnant women who delivered full-term SGA infants were included in case group, and 180 pregnant women who delivered full-term appropriate-for-gestational-age (AGA) infants during the same period were included in control group. The levels of serum pregnancy-associated plasma protein A (PAPP-A), placenta growth factor (PLGF), and soluble fms-like tyrosine kinase-1 (sFlt-1) in the first trimester(11 to 13 weeks +6 days of gestation) of the two groups were compared. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of early maternal serological indicators for the delivery of full-term SGA infants.
    Results The levels of serum PAPP-A and PLGF in the first trimester of the case group were lower than those in the control group, while the level of sFlt-1 was higher (P < 0.05). The area under the ROC curve (AUC) for the combined detection of serum PAPP-A, PLGF, and sFlt-1 levels in the first trimester in predicting the delivery of full-term SGA infants was 0.823, which was higher than the AUCs for detection of each indicator (0.738, 0.720, 0.724) (P < 0.05).
    Conclusion The detection of early maternal PAPP-A, PLGF, and sFlt-1 levels can reflect the fetal growth status in utero. The combined detection of these three indicators has a higher predictive value for the delivery of full-term SGA infants by pregnant women, which is helpful for clinicians to take intervention measures in advance.

     

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