血清Ang2、uE3、PAPP-A对子痫前期患者胎盘早剥的预测价值

Predictive value of serum Ang2, uE3, and PAPP-A for placental abruption in patients with preeclampsia

摘要:

目的 探讨血清血管生成素-2（Ang2）、游离雌三醇（uE3）联合血清妊娠相关蛋白A（APAPP-A）对子痫前期患者胎盘早剥的预测价值。方法 回顾性分析2021年12月—2023年6月西北妇女儿童医院收治的84例子痫前期孕妇作为研究组，另取同期该院孕检结果正常的84例孕妇为对照组。根据子痫前期孕妇胎盘早剥情况分为早剥组（23例）和非早剥组（61例）。检测各组血清Ang2、uE3、PAPP-A表达水平并比较患者临床资料，通过多因素一般Logistic回归模型分析影响子痫前期患者发生胎盘早剥的影响因素，并通过受试者工作特征（ROC）曲线评估Ang2、uE3、PAPP-A及其联合预测子痫前期患者发生胎盘早剥的价值。结果 研究组收缩压（SBP）、舒张压（DBP）、尿酸、白蛋白、和PAPP-A水平均高于对照组（P <0.05），Ang2、uE3水平均低于对照组（P <0.05）。早剥组SBP、尿酸、PAPP-A水平均高于对照组（P <0.05），Ang2、uE3、水平均低于对照组（P <0.05）。多因素一般Logistic回归分析结果显示：SBP升高［O^R=1.232（95% CI：1.165，1.302）］、尿酸升高［O^R=1.010（95% CI：1.006，1.014）］、Ang2降低［O^R=0.593（95% CI：0.423，0.830）］、uE3降低［O^R=0.001（95% CI：0.000，0.006）］和PAPP-A升高［O^R=0.998（95% CI：0.996，1.000）］均是子痫前期患者发生胎盘早剥的危险因素（P <0.05）。ROC曲线结果显示，Ang2、uE3、PAPP-A单独预测子痫前期孕妇发生胎盘早剥的敏感性分别为82.6%、82.6%、73.9%，特异性分别为59.0%、93.4%、78.7%，曲线下面积（AUC）分别为0.730、0.893、0.768，3者联合检测的敏感性、特异性、AUC分别为91.3%、91.8%、0.919。结论 子痫前期合并胎盘早剥患者血清Ang2、uE3水平异常低表达，PAPP-A水平异常高表达，3者联合预测胎盘早剥的效能较高，有一定临床应用价值。

Abstract:

Objective To explore the predictive value of serum angiopoietin-2 (Ang2), unconjugated estriol (uE3), and pregnancy-associated plasma protein-A (PAPP-A) for placental abruption in patients with preeclampsia.Methods A retrospective study was conducted on 84 pregnant women with preeclampsia treated in the Northwest Women's and Children's Hospital from December 2021 to June 2023. Additionally, 84 pregnant women with normal prenatal examination results were selected as the control group. Those with preeclampsia were further divided into the placental abruption group (23 cases) and the non-abruption group (61 cases). Serum levels of Ang2, uE3, and PAPP-A were measured, and these indicators and clinical characteristics of patients were compared among the groups. Multivariable logistic regression was used to analyze factors influencing placental abruption in patients with preeclampsia, and the diagnostic value of Ang2, uE3, PAPP-A and their combination for placental abruption was assessed using receiver operating characteristic (ROC) curves.Results SBP, DBP, and levels of uric acid, albumin, and PAPP-A were significantly higher in the study group compared to the control group (P < 0.05), whereas Ang2 and uE3 levels were significantly lower in the study group (P < 0.05). The placental abruption group had higher SBP and levels of uric acid and PAPP-A, but lower levels of Ang2 and uE3, compared to the non-abruption group (P < 0.05). The multivariable logistic regression analysis demonstrated that elevated SBP [O^R = 1.232 (95% CI: 1.165, 1.302) ], increased levels of uric acid [O^R = 1.010 (95% CI: 1.006, 1.014) ], decreased levels of Ang2 [O^R = 0.593 (95% CI: 0.423, 0.830) ], decreased levels of uE3 [O^R = 0.001 (95% CI: 0.000, 0.006) ], and increased levels of PAPP-A [O^R = 0.998 (95% CI: 0.996, 1.000) ] were all independent risk factors associated with the occurrence of placental abruption in patients with preeclampsia (P < 0.05). ROC curve analysis showed that the sensitivities of Ang2, uE3, and PAPP-A for predicting placental abruption in patients with preeclampsia were 82.6%, 82.6%, and 73.9%, with the specificities being 59.0%, 93.4%, and 78.7%, and areas under the curves (AUCs) being 0.730, 0.893, and 0.768. The combination of these indicators yielded a sensitivity of 91.3%, with a specificity of 91.8%, and an AUC of 0.919.Conclusion Patients with preeclampsia complicated by placental abruption exhibit abnormally low serum levels of Ang2 and uE3, and abnormally high levels of PAPP-A. The combination of these markers demonstrates high predictive efficacy for placental abruption and holds significant clinical utility.