Combined Screening For Preeclampsia By Maternal Serum PAPP-A、PLGF And UtA-PI、MAP At Early Pregnancy

Background and ObjectivePreeclampsia(PE)is a kind of pregnancy-specific syndrome of new hypertension with multi-system involvement and damage after 20 weeks of gestation,it affects about 2～8%of pregnancie,witch can cause serious complications such as placental abruption,HELLP syndrome,acute kidney failure,iatrogenic preterm birth,and it is a significant cause of maternal and fetal mortality and morbidity,there is growing evidence that preeclampsia can increase the long-term risk of cardiovascular disease in patients.At present,the pathogenesis of preeclampsia is yet to be fully elucidated,and there is a lack of effective clinical prevention and treatment methods,early prediction and prevention of preeclampsia is especially important to improve maternal and fetal adverse pregnancy outcomes.The characteristics of multi-factor induction,multi-channel pathogenesis and individual heterogeneity determine that a single indicator cannot predict preeclampsia well.More and more studies tend to predict preeclampsia with multiple indicators in early pregnancy.Current strategies of scholars at home and abroad for first-trimester prediction of preeclampsia mainly are combinated mean arterial pressure(MAP),uterine arterial pulse index(UtA-PI),and maternal serum biochemical markers.Multiple studies have shown that low concentrations of pregnancy-associated plasma protein-a(PAPP-A)and placental growth factor(PLGF)in early pregnancy were significantly associated with preeclampsia.The aim of this study is to estimate the predictive value of first-trimester maternal serum PAPP-A,PLGF and UtA-PI and MAP alone or in combination for preeclampsia,and provides reference for further clinical exploration of prediction methods of preeclampsia.Materials and Methods1.MaterialsThis is a prospective nested case-control study,the data for this study were derived from pregnant women aged 20-35 who were registered in the obstetrical outpatient department of the second affiliated hospital of zhengzhou university from January 2019 to September 2019 were selected for examination,they all underwent early down’s serum screening,bilateral uterine arterial pulse index measurement(NT time measured)and dual-arm simultaneous blood pressure measurements at 11-13+6 weeks of gestation.Follow-up of pregnancy outcome,subject to the inclusion and exclusion criteria,49 pregnant women with preeclampsia were selected as the case group and 152 normal pregnant women were selected as the control group,the age,body mass index and gestational age of blood collection in the early pregnancy of the control group were similar to the case group.Diagnostic criteria of preeclampsia refer to obstetrics and gynecology(9th edition textbook).After the research objects of the control group and the preeclampsia group were identified,the serum thawed from the two groups of pregnant women collected in early pregnancy was tested for PLGF.Then,By using Pre-eclampsia PriedictorTM software to calculate the MOM values of PAPP-A,PLGF,UtA-PI and MAP.2.Statistieal methodsSPSS25.0 through statistical software for statistical processing and data analysis.Firstly,the normal distribution test is carried out on the measurement data,the normal distribution were expressed as mean ± standard deviation(x ± s),two groups of mean comparing with independent samples t test,Do not follow the normal distribution of direct logarithmic conversion.The receiver operating curve(ROC curve)of single indicator and combined indicator was drawn respectively,and the area under the ROC curve(AUC)was used to evaluate the diagnostic efficacy of each indicator applied alone and in combination in the diagnosis of preeclampsia,and when the jorden index is at its maximum,find the Cut-off value(Cut-off value),sensitivity and specificity of the indicator.Test level a=0.05,and P<0.05 was considered to be statistically significant.Results1.The serum PAPP-A MOM level(0.93±0.37)was significantly lower in the case group than in the control group(1.31±0.43),The serum PLGF MOM level(0.73±0.23)was significantly lower in the case group than in the control group(0.98±0.23),There were statistically significant differences between the normal pregnant women group and the preeclampsia group(P<0.001).2.The UtA-PI MOM level(1.29±0.25)was significantly higher in the case group than in the control group(1.08±0.21),The MAP MOM level(1.10±0.07)was significantly higher in the case group than in the control group(1.03±0.08),There were statistically significant differences between the normal pregnant women group and the preeclampsia group(P<0.001).3.The areas under the curve of preeclampsia predicted by serum PAPP-A,PLGF,UtA-PI and MAP were 0.745,0.773,0.750 and 0.741,respectively in early pregnancy.4.The area under the curve of preeclampsia was predicted by two indicators were 0.843,0.830,0.820,0.856,0.829,0.827,separately;The area under the curve of preeclampsia was predicted by three indicators were 0.886,0.872,0.874,0.881,respectively;The area under the curve of preeclampsia was predicted by four indicators were 0.897.Conclusions1.Serum levels of PAPP-A and PLGF in early pregnancy of preeclampsia patients were lower than that of normal pregnant women,The levels of UtA-PI and MAP in early pregnancy of preeclampsia patients were higher than that of normal pregnant women.2.The early pregnancy maternal serum PAPP-A,PLGF,and UtA-PI,MAP have certain predictive value for preeclampsia when applied alone.3.The four combinations of maternal serum PAPP-A,PLGF,and UtA-PI,MAP in early pregnancy have greater application value in the prediction of preeclampsia than single indicator,any two or three indicators.