孕期子宫动脉超声参数、血清PIGF水平与子痫前期风险的相关性研究

李敏; 郑淑敏; 张红霞; 戴呈呈; 刘超; 于鹏

doi:10.16766/j.cnki.issn.1674-4152.003880

孕期子宫动脉超声参数、血清PIGF水平与子痫前期风险的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.003880

李敏¹,
郑淑敏^1, ,,
张红霞¹,
戴呈呈¹,
刘超²,
于鹏¹

1.
山东大学齐鲁医院德州医院妇产科，山东德州 253000
2.
山东大学齐鲁医院德州医院麻醉手术科

基金项目:

山东省医药卫生科技发展计划项目 2019WS019

详细信息

通讯作者:
郑淑敏，E-mail：18678367103@163.com

中图分类号: R714.244
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- 文章访问数: 12
- HTML全文浏览量: 4
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-05-21
- 网络出版日期: 2025-03-27

The correlation between uterine artery ultrasound parameters, serum PIGF level and the risk of preeclampsia during pregnancy

1.
Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University Dezhou Hospital Shandong University, Dezhou, Shandong 253000, China

摘要

摘要: 目的分析在子痫前期患者中子宫动脉超声参数、血清胎盘生长因子(PIGF)水平变化的意义。方法纳入2022年1月-2023年12月山东大学齐鲁医院德州医院收治的80例子痫前期孕妇为观察组, 分为轻度/重度子痫前期亚组, 同期30例健康孕妇为对照组。比较各组子宫动脉超声参数[阻力指数(RI)、搏动指数(PI)、血流收缩期与舒张期流速比(S/D)]、血清PIGF; 采用logistic回归分析研究子宫动脉超声参数、PIGF与子痫前期的相关性; 采用ROC曲线评估子宫动脉超声参数、PIGF对预测子痫前期严重程度的价值。结果观察组RI (0.62±0.12)、PI (1.64±0.32)、S/D (0.58±0.18)高于对照组(0.56±0.10、1.30±0.17、0.46±0.18), 血清PIGF[(33.24±7.36) pg/mL]低于对照组[(50.12±10.10) pg/mL, P < 0.05];RI、PI、S/D升高是子痫前期的危险因素, PIGF升高是保护因素(P < 0.05);观察组轻度25例, 重度55例, 重度子痫前期亚组RI、PI、S/D较高, PIGF较低(P < 0.05);RI、PI评估子痫前期严重程度的AUC为0.565、0.568(P>0.05), S/D、PIGF、联合检测的AUC为0.685、0.648、0.774(P < 0.05)。结论子痫前期孕妇RI、PI、S/D升高, 血清PIGF降低, 均与子痫前期的发病相关, 联合检测可评估子痫前期严重程度。
- 子痫前期 /
- 子宫动脉 /
- 超声 /
- 胎盘生长因子
Abstract: Objective To analisis significance of uterine artery ultrasound parameters and serum placental growth factor (PIGF) levels in preeclampsia patients. Methods A total of 80 pregnant women with preeclampsia admitted to Dezhou Hospital of Qilu Hospital of Shandong University from January 2022 to December 2023 were included as the observation group and were divided into mild/severe preeclampsia subgroup, and 30 healthy pregnant women during the same period were included as the control group.The ultrasonic parameters of uterine artery[resistance index (RI), pulse index (PI), systolic to diastolic flow velocity ratio (S/D)]and serum PIGF levels were compared; The correlation between uterine artery ultrasound parameters, PIGF, and preeclampsia was analyzed by logistic regression; The receiver operating characteristic curve (ROC) were used to evaluate the value of uterine artery ultrasound parameters and PIGF in the severity of preeclampsia. Results RI (0.62±0.12), PI (1.64±0.32) and S/D (0.58±0.18) in the observation group were higher than those in control group (0.56±0.10, 1.30±0.17, 0.46±0.18), but serum PIGF[(33.24±7.36) pg/mL]was lower (P < 0.05);RI, PI, and S/D were risk factors for preeclampsia, and PIGF was a protective factor (P < 0.05).There were 25 mild cases and 55 severe cases in the observation group.RI, PI, and S/D in the severe preeclampsia subgroup were significantly higher, and PIGF was significantly lower (P < 0.05);The area under the curve (AUC) of RI and PI in evaluating the severity of preeclampsia were 0.565 and 0.568(P>0.05), and those of S/D, PIGF, and combined detection were 0.685, 0.648, and 0.774, respectively (P < 0.05). Conclusion RI, PI, and S/D in pregnant women with preeclampsia increase, but serum PIGF levels decrease, which is associated with the onset of preeclampsia, and the combined detection can assess the severity of preeclampsia.
- Preeclampsia /
- Uterine artery /
- Ultrasound /
- Placental growth factor

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图 1 子宫动脉超声参数、血清PIGF评估子痫前期严重程度的ROC曲线

Figure 1. ROC curve for assessing the severity of preeclampsia using uterine artery ultrasonic parameters and serum PIGF

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表 1 子痫前期孕妇和正常孕妇临床资料比较

Table 1. Comparison of clinical data between preeclampsia pregnant women and normal pregnant women

组别	例数	年龄 (x±s，岁)	BMI (x±s)	孕周 (x±s，周)	经产妇 [例(%)]	子宫动脉超声参数(x±s)			PIGF (x±s，pg/mL)
组别	例数	年龄 (x±s，岁)	BMI (x±s)	孕周 (x±s，周)	经产妇 [例(%)]	RI	PI	S/D	PIGF (x±s，pg/mL)
观察组	80	30.28±2.72	25.35±1.54	31.21±1.65	36(45.00)	0.62±0.12	1.64±0.32	0.58±0.18	33.24±7.36
对照组	30	29.63±2.58	25.03±1.51	30.97±1.59	12(40.00)	0.56±0.10	1.30±0.17	0.46±0.18	50.12±10.10
统计量		1.132^a	0.976^a	0.686^a	0.222^b	2.438^a	5.524^a	3.114^a	9.631^a
P值		0.260	0.331	0.494	0.638	0.016	＜0.001	0.002	＜0.001
注：^a为t值，^b为χ²值。

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表 2 子宫动脉超声参数、血清PIGF在子痫前期发生的logistic回归分析

Table 2. Logistic regression analysis of uterine artery ultrasound parameters and serum PIGF in the occurrence of preeclampsia

变量	B	SE	Waldχ²	P值	OR值	95% CI
RI	0.959	0.415	5.340	0.021	2.609	1.157~5.885
PI	1.058	0.424	6.226	0.013	2.881	1.255~6.613
S/D	1.260	0.551	5.229	0.023	3.525	1.197~10.381
PIGF	1.331	0.452	8.671	0.003	3.785	1.561~9.179
注：RI、PI、S/D、PIGF以实际值赋值。

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表 3 轻度和重度子痫前期孕妇子宫动脉超声参数、血清PIGF水平比较(x±s)

Table 3. Comparison of uterine artery ultrasound parameters and serum PIGF levels in pregnant women with mild and severe preeclampsia(x±s)

组别	例数	RI	PI	S/D	PIGF(pg/mL)
重度子痫前期亚组	25	0.67±0.12	1.80±0.35	0.65±0.19	30.14±7.07
轻度子痫前期亚组	55	0.60±0.14	1.57±0.31	0.55±0.17	34.65±7.42
t值		2.163	2.954	2.350	2.556
P值		0.034	0.004	0.021	0.013

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表 4 子宫动脉超声参数、血清PIGF评估子痫前期严重程度的ROC曲线分析

Table 4. ROC curve analysis for assessing the severity of preeclampsia using uterine artery ultrasonic parameters and serum PIGF

指标	最佳截断值	约登指数	灵敏度(%)	特异度(%)	AUC	SE	95% CI	P值
RI	0.74	0.149	23.75	91.25	0.565	0.071	0.449~0.675	0.358
PI	1.81	0.160	36.25	80.00	0.568	0.071	0.453~0.679	0.337
S/D	0.66	0.400	60.00	80.00	0.685	0.066	0.572~0.785	0.005
PIGF	33.29 pg/mL	0.320	72.50	60.00	0.648	0.068	0.533~0.751	0.030
联合检测		0.538	72.50	81.25	0.774	0.060	0.667~0.860	＜0.001

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参考文献(20)

[1]	肖燕璇, 张立力, 黎嘉琪, 等. 单胎子痫前期孕妇产前体质量指数与母婴结局关系探讨[J]. 实用医学杂志, 2023, 39(18): 2357-2361. XIAO Y X, ZHANG L L, LI J Q, et al. Relationship between prenatal body mass index and pregnancy outcomes in singleton pregnant women with preeclampsia[J]. The J Pract Med, 2023, 39(18): 2357-2361.
[2]	石莉, 符小艳, 王丽, 等. 不同绒毛膜性质双胎与子痫前期的临床研究[J]. 新医学, 2021, 52(9): 709-712. SHI L, FU X Y, WANG L, WU D C. Clinical study of the association between preeclampsia and chorionicity of twin pregnancies[J]. New Med, 2021, 52(9): 709-712.
[3]	王霞, 王群华, 吴明珠, 等. 基于生化指标的重度子痫前期辅助诊断模型构建[J]. 实用妇产科杂志, 2023, 39(8): 603-608. WANG X, WANG Q H, WU M Z, et al. Construction of Assistant Diagnostic Model for Severe Preeclampsia in Pregnancy Based on Biochemical Indicators[J]. The J Pract Obstet Gynecol, 2023, 39(8): 603-608.
[4]	KIFLE M M, DAHAL P, VATISH M, et al. The prognostic utility of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PIGF) biomarkers for predicting preeclampsia: a secondary analysis of data from the INSPIRE trial[J]. BMC Pregnancy Childbirth, 2022, 22(1): 520. doi: 10.1186/s12884-022-04817-6
[5]	乐杰. 妇产科学[M]. 7版. 北京: 人民卫生出版社, 2008: 92-103. YUE J. Obstetrics and gynecology[M]. 7th Ed. Beijing: People' s Medical Publishing House, 2008: 92-103.
[6]	张霞, 徐晓敏. 子痫前期孕妇子宫动脉SD、THBS1与凝血功能障碍的相关性[J]. 中华全科医学, 2023, 21(12): 2074-2076. doi: 10.16766/j.cnki.issn.1674-4152.003293 ZHANG X, XU X M. Correlation between uterine artery SD, THBS1 and coagulation dysfunction in pregnant women with preeclampsia[J]. Chinese Journal of General Practice, 2023, 21(12): 2074-2076. doi: 10.16766/j.cnki.issn.1674-4152.003293
[7]	莫蕾, 钟萍. 孕早中期孕妇肠道菌群差异与子痫前期发病关系的研究[J]. 中国全科医学, 2022, 25(20): 2489-2492. MO L, ZHONG P. Study on the Relationship between Intestinal Microflora Differences and the Incidence of Preeclampsia in Pregnant Women in the Early and Middle Stages of Pregnancy[J]. Chinese General Practice, 2022, 25(20): 2489-2492.
[8]	樊海霞, 杨瑞敏, 尹佳园, 等. 多血流参数联合预测子痫前期患者胎儿不良妊娠结局的临床价值[J]. 河北北方学院学报: 自然科学版, 2021, 37(12): 15-18. FAN H X, YANG R M, YIN J Y, et al. Clinical Value of Multiple Blood Flow Parameters in Predicting Fetal Adverse Pregnancy Outcome in Patients with Preeclampsia[J]. Journal of Hebei North University (Natural Science Edition), 2021, 37(12): 15-18.
[9]	庄万祝, 戚怀钻, 张果, 等. 早发重度子痫前期患者子宫动脉血流动态监测对胎儿生长受限的预测效能[J]. 中国妇产科临床杂志, 2023, 24(5): 526-527. ZHUANG W Z, QI H Z, ZHANG G, et al. Predictive efficacy of uterine artery flow dynamics monitoring in fetal growth restriction in patients with early onset severe preeclampsia[J]. Chin Clini J Obstet Gynecol, 2023, 24(5): 526-527.
[10]	黄杨, 孟琳, 吕慧, 等. 血清PIGF、sFlt-1及PLGF水平对妊娠期高血压的预测效能及与子痫前期发病的关系[J]. 广东医学, 2023, 44(3): 284-287. HUANG Y, MENG L, LV H, et al. Correlation analysis of serum PIGF, sFlt-1 and PLGF in early pregnancy with preeclampsia[J]. Guangdong Medical Journal, 2023, 44(3): 284-287.
[11]	徐小芬, 徐彬彬. 血清可溶性类fms酪氨酸激酶-1血管内皮生长因子胎盘生长因子在高危子痫前期产妇中的表达及其与病情严重程度的相关性[J]. 中国妇幼保健, 2022, 37(5): 895-897. XU X F, XU B B. Expression of serum soluble fms tyrosine kinase-1 vascular endothelial growth factor and placental growth factor in high-risk preeclampsia women and its correlation with the severity of the disease[J]. Maternal & Child Health Care of China, 2022, 37(5): 895-897.
[12]	储华, 陆艳, 刘明松. 孕期子宫动脉超声参数动态分析与子痫前期风险的相关性研究[J]. 中华全科医学, 2022, 20(9): 1545-1547. doi: 10.16766/j.cnki.issn.1674-4152.002645 CHU H, LU Y, LIU M S. The correlation between the dynamic analysis of uterine artery ultrasound parameters during pregnancy and the risk of preeclampsia[J]. Chinese Journal of General Practice, 2022, 20(9): 1545-1547. doi: 10.16766/j.cnki.issn.1674-4152.002645
[13]	PANDA S, JANTE V, DAS A, et al. Unveiling preeclampsia prognosis: uterine artery doppler indices in low-risk pregnancies[J]. Cureus, 2023, 15(9): e46060. DOI: 10.7759/cureus.46060.
[14]	王媛, 闫国珍, 李一凡, 等. 妊娠8~10^(+6)周平均子宫动脉搏动指数对低危人群不良妊娠结局的预测价值[J]. 中国超声医学杂志, 2023, 39(8): 922-926. WANG Y, YAN G Z, LI Y F, et al. Predictive value of mean uterine artery pulsation index at 8 to 10^(+6) weeks gestation for adverse pregnancy outcomes in low-risk population[J]. Chin J Ultra Med, 2023, 39(8): 922-926.
[15]	钟敏, 肖慧彬, 朱艳宾, 等. sEng和ADMA联合子宫动脉PI对早发型子痫前期的预测[J]. 中国妇产科临床杂志, 2020, 21(5): 486-488. ZHONG M, XIAO H B, ZHU Y B, et al. The combined application of ADMA, sEng and uterine artery doppler pulsatility index in the prediction of early-onset preeclampsia[J]. Chin Clini J Obstet Gynecol, 2020, 21(5): 486-488.
[16]	方婕, 何洁, 吴侠霏, 等. 基于生物信息学筛选的CEBPA在子痫前期胎盘组织的表达及对滋养细胞上皮间质转化的影响[J]. 实用妇产科杂志, 2022, 38(5): 358-363. FANG J, HE J, WU X F, et al. Expression of CEBPA in Preeclampsia Placenta and Its Effect on Trophoblast Epithelial-Mesenchymal Transition Based on Bioinformatics Analysis[J]. The J Pract Obstet Gynecol, 2022, 38(5): 358-363.
[17]	孙文苑, 马利娟, 吴思沂, 等. 孕中期血清sFlt-1、PIGF和补体系统激活因子对子痫前期危险因素孕妇发生子痫前期的预测价值[J]. 中国妇产科临床杂志, 2020, 21(5): 489-491. SUN W Y, MA L J, WU S Y, et al. Predictive value of serum sFlt-1, PIGF and complement system activators for preeclampsia in the second trimester pregnant women with preeclampsia risk factors[J]. Chin Clini J Obstet Gynecol, 2020, 21(5): 489-491.
[18]	CHEN Y, PAN X, XIANG G, et al. More need to optimize the prediction model of sFlt-1/PIGF ratio and ambulatory blood pressure monitoring in preeclampsia[J]. Hypertens Res, 2024, 47(5): 1438-1439.
[19]	玉娟, 贾音, 王慧丽, 等. 单胎妊娠孕妇子痫前期的影响因素分析[J]. 北京医学, 2023, 45(6): 521-524. ZHANG L H, LI X H, FENG K D, et al. Changes and Diagnostic Efficacy of NfL and PLGF in Patients with Preeclampsia[J]. Beijing Medical Journal, 2023, 45(6): 521-524.
[20]	CICIU E, PAȘATU-CORNEA A M, DUMITRU S, et al. Utility of sFtl-1 and placental growth factor ratio for adequate preeclampsia management[J]. Healthcare (Basel), 2023, 11(3): 381.