中国妇幼保健

目的 探讨子宫动脉(UtA)血流参数联合血清糖类抗原125(CA125)、甲胎蛋白(AFP)对子痫前期(PE)患者不良妊娠结局的预测价值。方法 选取2022年1月—2024年12月浙江大学医学院附属邵逸夫医院龙游分院收治的50例PE患者为研究对象(PE组),另选择同期产检的40例健康孕妇作为对照(NC组);酶联免疫吸附测定(ELISA)检测血清CA125、 AFP水平;测定Ut A血流参数;评价PE患者的病情程度,分为重度PE(Ⅱ组,n=17)和轻度PE(Ⅰ组,n=33);随访PE患者的妊娠结局,分为不良妊娠结局(不良组,n=13)和妊娠结局良好(良好组,n=37);采用比值比分析PE患者妊娠结局的影响因素;受试者工作特征曲线(ROC)分析CA125、 AFP、 PI、 RI及S/D对妊娠结局的预测价值。结果 PE组较NC组PI、 RI、 S/D及血清CA125、 AFP水平均升高(P<0.05); Ⅱ组较Ⅰ组PI、 RI、 S/D及血清CA125、 AFP水平均升高(P<0.05);不良组较良好组PI、 RI、 S/D及血清CA125、 AFP水平均升高(P<0.05); CA125高水平、 AFP高水平、 PI高水平、 RI高水平、 S/D高水平患者发生不良妊娠结局的风险分别是CA125低水平、 AFP低水平、 PI低水平、 RI低水平及S/D低水平患者的3.333倍(95%CI:1.040～10.687)、 3.333倍(95%CI:1.040～10.687)、 5.500倍(95%CI:1.355～22.325)、 3.611倍(95%CI:1.127～11.575)、 12.000倍(95%CI:1.685～85.470); CA125、 AFP、 PI、 RI、 S/D单独及联合预测不良妊娠结局的曲线下面积(AUC)分别为0.834、 0.712、 0.711、 0.861、 0.650、 0.969,联合预测价值显著高于单独预测(Z=2.424、 2.615、2.839、 2.236、 3.374,均P<0.05)。结论 PE患者血清Ut A血流参数PI、 RI、 S/D及血清AFP、 CA125水平均升高,联合检测对患者妊娠结局有良好的预测价值。

Objective To explore the predictive value of uterine artery(UtA) flow parameters combined with serum carbohydrate antigen 125(CA125) and alpha-fetoprotein(AFP) for adverse pregnancy outcomes in patients with preeclampsia(PE).Methods Totally 50 patients with PE who were admitted to our hospital from January 2022 to December 2024 were included in the study(PE group), and 40 healthy pregnant women who underwent prenatal check ups in our hospital during the same period were selected as the control group(NC group). Enzyme-linked immunosorbent assay(ELISA) was used to detect the levels of serum CA125 and AFP. Ut A blood flow parameters were measured. The severity of PE patients was evaluated, and they were assigned into severe PE(group Ⅱ, n= 17) and mild PE(group I, n= 33). The pregnancy outcomes of the follow-up patients with PE were classified as adverse pregnancy outcomes(adverse group, n= 13) and good pregnancy outcomes(good group, n= 37). The odds ratio analysis was used to investigate the influencing factors of pregnancy outcomes in patients with PE; receiver operating characteristic curve(ROC) analysis was conducted to evaluate the predictive value of CA125, AFP, PI, RI, and S/D for pregnancy outcomes.Results The PI, RI, S/D values, as well as the levels of serum CA125 and AFP in the PE group were higher than those in the NC group(P<0. 05). The PI, RI, S/D, as well as levels of serum CA125 and AFP in group Ⅱ were higher than those in group I(P<0. 05). The PI, RI, S/D, as well as levels of serum CA125 and AFP in the adverse group were all higher than those in the good group(P<0. 05). The risk of adverse pregnancy outcomes for patients with high levels of CA125, AFP, PI, RI, and S/D was 3. 333 times(95%CI: 1. 040-10. 687), 3. 333 times(95%CI: 1. 040-10. 687), 5. 500 times(95%CI: 1. 355-22. 325), 3. 611 times(95%CI: 1. 127-11. 575), 12. 000 times(95%CI: 1. 685-85. 470) that of patients with low levels of CA125, AFP, PI, RI, and S/D, respectively. The area under the curve(AUC) values for CA125, AFP, PI, RI, S/D alone and in combination for predicting adverse pregnancy outcomes were 0. 834, 0. 712, 0. 711, 0. 861, 0. 650, and 0. 969, respectively. The combined prediction value was obviously higher than that of the individual predictions(Z= 2. 424, 2. 615, 2. 839, 2. 236, 3. 374, all P<0. 05).Conclusion The serum UtA flowparameters(PI,RI,SD)andthelevelsofserum AFP and CA125 in patients with PE are elevated. Inaddition,the combined detection has a good predictive value for the pregnancy outcome of the patients.