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目的评价在不同孕周联合应用抑制素A、激活素A水平及子宫动脉搏动指数(UAPI)3个指标对子痫前期(PE)的预测价值。方法选择2014年7月—2015年9月在浙江省人民医院产检的孕9~16周单胎初孕产妇400人作为研究对象,采用酶联免疫吸附试验(ELISA)检测抑制素A、激活素A,经多普勒超声检测UAPI值,绘制受试者工作特征曲线(ROC)计算联合检测的特异度和灵敏度。结果本研究失访23人,失访率为5.75%。孕9~12周组PE 10例,PE发生率为5.35%;孕13~16周组PE 9例,PE发生率为4.74%。孕9~12周和孕13~16周的PE组血清抑制素A、激活素A浓度及UAPI值均高于孕9~12周和孕13~16周的正常组(P<0.05);经ROC曲线分析,孕9~12周3个指标联合应用后曲线下面积(AUC)=0.836,特异度为72%,灵敏度是83%;孕13~16周联合应用AUC=0.912,特异度是87%,灵敏度是86%。结论孕13~16周时联合应用外周血抑制素A、激活素A及UAPI预测PE的特异度和灵敏度高于孕9~12周。
Objective To evaluate the predictive value of three indexes of inhibin A, activin-A and uterine arterial pulse index (UAPI) at different gestational weeks in predicting preeclampsia (PE). METHODS: From July 2014 to September 2015, 400 maternal singleton pregnancies at 9 to 16 weeks pregnant in Zhejiang Provincial People’s Hospital were enrolled in this study. Enzyme-linked immunosorbent assay (ELISA) was used to detect the expression of inhibin A, A. Detect the UAPI by Doppler ultrasound and plot the receiver operating characteristic curve (ROC) to calculate the specificity and sensitivity of the combined detection. Results The study lost 23 people, the rate of loss was 5.75%. In the 9th to 12th week of pregnancy, 10 cases were treated with PE and the incidence of PE was 5.35%. In the 13th to 16th week of pregnancy, there were 9 cases of PE and the incidence of PE was 4.74%. The levels of serum inhibin A, activin A and UAPI in PE 9-12 weeks and 13-16 weeks pregnant were higher than those in normal group (P <0.05) ROC curve analysis showed that the area under the curve (AUC) = 0.836, the specificity of 72% and the sensitivity of 83% after the combination of three indexes from 9 weeks to 12 weeks of gestation; AUC = 0.912 and specificity of 87 %, The sensitivity is 86%. Conclusions The combined use of peripheral blood inhibin A, activin A and UAPI at 13 to 16 weeks of pregnancy predicts the specificity and sensitivity of PE higher than that of 9 to 12 weeks of pregnancy.