| Background:Preeclampsia is a unique disease of pregnancy,mainly characterized by hypertension,proteinuria and edema,accompanied by damage to multiple organs and organs of the whole body.In severe cases,it causes convulsions,coma,intracerebral hemorrhage,placental abruption,disseminated intravascular coagulation and even death,which seriously threatens the health of mothers and infants and is one of the main causes of illness and death of pregnant women and perinatal infants.Therefore,Strengthening the early diagnosis and screening of patients with preeclampsia is of great significance for taking effective clinical intervention measures.At present,its pathogenesis has not been fully clarified.Environmental,immune and genetic factors can play a role in the pathogenesis of preeclampsia.It is generally recognized as the two-stage theory of preeclampsia,which may be related to vascular endothelial cells At present,there is no independent and reliable method to predict preeclampsia,so it is difficult to take preventive measures in advance.This paper retrospectively analyzes the clinical data of 132 pregnant women in early pregnancy,and discusses the screening effect of multi index combined detection to predict and evaluate the occurrence of preeclampsia.Objective:To explore the screening,prevention and treatment strategies of pregnancy associated plasma protein A(PAPP-A),placental growth factor(Pl GF),uterine artery pulsatility index(utpi)and 25 hydroxyvitamin D in early pregnancy..Methods: :132 pregnant women in early pregnancy from March 2019 to March 2020 were selected retrospectively and divided into two groups.There were 102 cases in the control group and 30 cases in the eclampsia group.The patients in the eclampsia group met the diagnostic criteria of preeclampsia in obstetrics and Gynecology of the ninth edition,which means that after 20 weeks of pregnancy,systolic blood pressure is greater than or equal to 140 mm Hg and / or diastolic blood pressure is greater than or equal to 90 mm Hg,accompanied by urinary protein is greater than or equal to 0.3g/24 h,or random urinary protein(+),or no proteinuria,However,if any of the following items are combined: 1 Thrombocytopenia(platelets less than100)× 10~9/L)2.Liver function damage(serum transaminase level is more than twice the normal value)3Impairment of renal function(serum creatinine level greater than 1.1mg/dl or more than twice the normal value)4 Pulmonary edema 5 New central nervous system abnormalities or visual impairment.The levels of PAPP-A,PLGF,utpi and 25 hydroxyvitamin D were measured at(11-13 + 4)weeks in 132 pregnant women in early pregnancy.The differences of index data between the control group and the eclampsia group were compared and analyzed.According to the occurrence of preeclampsia as the dependent variable,the values of PAPP-A,PLGF,utpi and 25 hydroxyvitamin D were used as the independent variable for logistic analysis,To evaluate whether each index is an independent predictor of preeclampsia;Draw the ROC curve,analyze the efficacy(sensitivity and specificity)of PAPP-A,PLGF,utpi and 25 hydroxyvitamin D in preeclampsia screening,compare the single index and the area under the ROC curve(AUC)to evaluate the predictive value of individual and combined application of each index for preeclampsia,and find out the cut-off value(cut-off value),sensitivity and specificity of the corresponding index when the yoden index is the largest through the ROC curve.For those with high risk of multi index joint detection,corresponding prevention and control strategies can be adopted.All data in this study were collected by spss25 0 for data processing and statistical analysis.The measurement data shall be tested for normal distribution first.Those in line with normal distribution shall be expressed by mean ± standard deviation((?) ± s).T-test shall be used for comparison between groups.The test level is a = 0.05,and the difference is statistically significant with P < 0.05.Results:1.The levels of serum PAPP-A(3613.94 ± 1014.84),PLGF(43.02 ± 8.65)and 25 hydroxyvitamin D(13.43 ± 2.74)in the eclampsia group were significantly lower than those in the control group(4912.21 ±1182.79),(50.84 ± 6.44),(18.15 ± 2.32)(P < 0.001);2.The level of utpi in early pregnancy in eclampsia group(0.79 ± 0.16)was significantly higher than that in control group(0.43 ± 0.08)(P < 0.001);3.PAPP-A,PLGF,utpi and 25 hydroxyvitamin D were independent predictors of preeclampsia(P < 0.05)4 The areas under the curve of PAPP-A,PLGF,utpi and 25 hydroxyvitamin D alone in predicting preeclampsia were0.793,0.786,0.969 and 0.847,respectively;The area under the curve of four indexes combined to predict preeclampsia was 0.998.Conclusion:1.The levels of PAPP-A,PLGF,utpi and 25 hydroxyvitamin D in pregnant women with preeclampsia are significantly different from those in normal pregnant women,which is statistically significant.It can be used as early screening markers of preeclampsia and has good screening efficiency.For early pregnant women,PAPP-A,PLGF,utpi and 25 hydroxyvitamin D can be used as independent predictors of preeclampsia.2.The combined detection of PAPP-A,PLGF,utpi and 25 hydroxyvitamin D levels in pregnant women can predict the occurrence of preeclampsia,which is higher than the single factor prediction value,and can better find the high-risk population;3.For the high-risk population with PAPP-A,PLGF,utpi and 25 hydroxyvitamin D levels,corresponding prevention and treatment strategies should be taken to reduce the incidence of preeclampsia. |
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