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Predictive Value of Maternal Serum Factors and Uterine Pulse Index in Pre-eclampsia

Author: BianZheng
Tutor: DuanTao
School: Fudan University
Course: Obstetrics and Gynaecology
Keywords: Preeclampsia Placental Growth Factor PGF Angiogenesis inhibitor sFlt-1 Asymmetric dimethyl arginine ADMA Uterine artery pulsatility index (PI) Forecast Screening
CLC: R714.2
Type: Master's thesis
Year: 2010
Downloads: 22
Quote: 0
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Abstract


Chinese Abstract Objective: pre-eclampsia is a pregnancy-specific diseases, so far unknown etiology. Currently, there is lack of an effective factor can be used to predict preeclampsia. This study by the detection pregnant 12-16 weeks and 20-24 weeks of gestation maternal serum PGF, the ADMA and sFIt-1, the average joint second trimester uterine artery pulsatility index PI to evaluate joint prediction of preeclampsia value trying to establish an early screening model. Methods: The study design nested case - control study and their own before and after comparison research methods, first select qualified in Shanghai First Maternity and Infant Health Hospital, regular check-ups for pregnant women at 12-16 weeks pregnant 20-24 weeks pregnant when blood was collected separately, extracted serum stored at -80 ℃ to prepare for testing. Outcome based on pregnancy outcomes, subjects were divided into a group of pre-eclampsia and normal pregnancy group. ELISA was used to detect the two groups before and after the PGF concentration of ADMA and sFIt-1. All pregnant women in pregnant 20-24 Zhou Hangzi Palace artery Doppler examination was measured PI values. The difference between the groups as well as the ROC curve four index results are converted to the the MOM value, the use of statistical methods compare four indicators to evaluate the joint predictive value, the establishment of a joint screening model. Results: The results showed that pre-eclampsia number of new cases to 44 cases, an incidence rate of 5.8%, including severe preeclampsia, 13 cases of early-onset preeclampsia four cases (before 34 weeks of pregnancy, childbirth), minimum gestational age 32 weeks; premature birth 17 cases; FGR in 4 cases in the control group of 100 patients. The case group and control group average PI MOM value were 1.122 ± 0.229 and 0.817 ± 0.314 (P lt; 0.01), AUC to 0.836 (95% Cl: 0.771 ~ 0.902). Case and control groups sFIt-1 the average the MOM value (12-16 weeks gestation) 0.328 ± 0.025 and 0.318 ± 0.019 (P = 0.042), (20-24 weeks gestation) 0.368 ± 0.03 and 0.320 ± 0.022 (P lt ; 0.01). ADMA average the MOM value (12-16 weeks of gestation) 0.84 ± 0.205 and 0.67 ± 0.199 (P lt; 0.01), (20-24 weeks gestation) and 1.34 ± 0.55 and 0.79 ± 0.20 (P lt; 0.01). PGF average the MOM value (12-16 weeks of gestation) 115.86 ± 59.1 and 210 ± 63.13 (P lt; 0.01), (20-24 weeks gestation) 156.33 ± 67.13 and 253.35 ± 45.15 (P lt; 0.01). And make the two groups before and after the three serum factor ROC curve and uterine artery PI ROC curve. Derived by statistical analysis of risk factors, and then drawn after Logistic analysis PGF of ADMA and PI early prediction of preeclampsia significantly related. Draw after the establishment of a joint predictors model ROC curve, the AUC was 0.964 (95% Cl: 0.938 ~ 0.991)), a specificity of 80%, a sensitivity of 90%, compared with a separate PI predict preeclampsia had significantly improved . In addition, in order to minimize excessive intervention patients can be screened in the first trimester, so as to rule out the true negative patients, this study attempts to early detection of blood markers to initial screening of patients at high risk of preeclampsia in the second trimester of preliminary PI detection screening of high-risk patients, the positive predictive value. Logistic regression analysis (excluding PI), the establishment of a joint screening model, the formation of screening high-risk patients, PI values ??detection, the positive predictive value of 80.9%, detection than individual PI, a positive predictive value of 61.5%, on the rise. Conclusion: In pregnant as early as the mid-maternal serum ADMA, sFlt-1, PGF and PI were changed with gestational age are subject to change. The ADMA, PGF and PI preeclampsia have some predictive value. The joint several factors can significantly improve the predictive value.

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CLC: > Medicine, health > Obstetrics and Gynaecology > Obstetrics > Pathological pregnancy ( abnormal pregnancy )
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