孕中期血清AFP、uE3和fβ-hCG水平与子痫前期的关系研究 [中文引用][英文引用]

目的 利用现有产前筛查资源，探讨孕中期母体甲胎蛋白（AFP）、游离雌三醇（uE3）和游离人绒毛膜促性腺激素β亚基（fβ-hCG）血清水平与子痫前期发生的关系。方法 回顾性分析2014年1月至2015年12月期间于本院行孕中期母体血清学产前筛查的孕妇临床数据，通过病历资料与电话随访明确其妊娠并发症和结局。经排除子宫肌瘤、输卵管囊肿等其他合并症病例后，共186例在后期妊娠中发生子痫前期的孕妇纳入研究，其中发生轻度子痫前期119例，发生重度子痫前期67例。另选择同期行产前筛查经随访确定为正常结局的孕妇，根据年龄和孕周相近原则（年龄相差1岁，孕周相差1周）按1:1随机匹配作为病例对照，收集两组孕妇产前筛查及相关的临床资料。采用EmpowerStats统计软件进行统计分析，组间比较根据资料分布类型分别采用t检验或Kruskal-Wallis秩和检验，子痫前期发病危险因素采用条件logistic回归模型分析。结果 与正常孕妇组相比，后期妊娠发生子痫前期的孕妇孕中期血清uE₃（6.46±2.19 vs 7.13±2.30，P=0.002）显著降低；AFP和fβ-hCG则无统计差异。在调整年龄、孕周等其他因素后，血清uE₃是子痫前期发生的独立保护因素（uE₃：OR=0.80，95% CI：0.70~0.91，P=0.0008），孕妇血清uE₃每升高1 nmol/L，发生子痫前期的风险降低20%。结论 发生子痫前期的孕妇在孕15~20周时血清uE₃低于未发生子痫前期的孕妇，血清uE₃是子痫前期的独立保护因素。

Objective By analyze the available data of second-trimester(gestational age between 15 and 20 weeks) maternal serum prenatal screening, to evaluate the relationship between preeclampsia and serum markers, alpha-fetoprotein(AFP), unconjugated estriol(uE3), and free beta-human chorionic gonadotropin (fβ-hCG). Method Retrospective analysis the data of pregnant women who had been evaluated with second-trimester maternal serum prenatal screening performed at Changzhou Maternal and Child Health Care Hospital from 2014 through 2015. 186 pregnant women were diagnosed with preeclampsia after 20 weeks of gestation, included 119 mild cases and 67 severe cases. The cases combine with hysteromyoma, cystic salpinx were exclude in the study. Each case with preeclampsia was matched one control participant by computerized algorithm as the ratio 1:1. The control participants were produced from the healthy pregnant women who received maternal serum prenatal screening at the same period. The clinical data, include maternal age, weight, gestational age at enrollment, gestational age at delivery and infant’s birth weight were recorded and compared, and the independent relationship between preeclampsia and serum maker were estimated by multiple regression analyses with an adjustment for potential confounders. Results The serum level of uE₃ in preeclampsia patients was lower than in controls, while there was no difference in AFP and fβ-hCG. After adjusted potential confounders, preeclampsia was associated with uE₃ with the OR= 0.80(95%CI: 0.70～0.91, P=0.0008). Conclusions In 15～20 gestational weeks, the serum level of uE₃ was reduce in pregnant women who later develop into preeclampsia, uE₃ was an independent protective factor for preeclampsia.