孕早期母体PAPP-A水平与早产关系分析-现代医学

孕早期母体PAPP-A水平与早产关系分析

单位：1. 张家港市妇幼保健所妇女保健科, 江苏张家港 215600;
2. 张家港市第一人民医院妇产科, 江苏张家港 215600

分类号：R714.21

出版年·卷·期（页码）：2021·49·第八期（965-969）

摘要：

目的：探讨孕早期孕妇血清中妊娠相关蛋白A （PAPP-A）与早产的关系。方法：收集2019年1—12月在张家港市第一人民医院分娩的204例早产妇，分为早期早产组（28~33周）和晚期早产组（34~36周），随机抽取574例足月产为足月对照组，回顾性调查孕早期（11~13⁺⁶周）血清中PAPP-A中位数倍数（MoM）值及孕前BMI、年龄、文化程度等一般临床资料，采用Logistic回归分析PAPP-A与早产的关系。结果：（1）早期早产组PAPP-A MoM值明显低于晚期早产组和足月对照组，差异有统计学意义（P<0.05），晚期早产组PAPP-A MoM值与足月对照组差异无统计学意义（P>0.05）；（2） Logistic回归分析显示PAPP-A MoM值低，发生早期早产风险升高，孕妇文化程度低、多次流产、胎膜早破、妊娠期糖尿病、妊娠期高血压疾病和胎位异常是早期早产的危险因素。结论：PAPP-A MoM值是早期早产独立的危险因素，在孕期保健中，可以结合孕妇孕期情况尽早干预，改善母婴预后。

Objective: To explore the relationship between serum pregnancy-associated plasma protein-A(PAPP-A) in the first trimester and premature delivery.Methods: 204 cases of premature delivery who gave birth in Zhangjiagang First People's Hospital from January to December 2019 were recruited and were divided into early premature delivery group(gestational weeks 28-33) and late premature delivery group(gestational weeks 34-36); 574 subjects of full-term birth were enrolled as control group. The serum PAPP-A MoM value in the first trimester(gestational weeks 11-13⁺⁶), as well as the general clinical data of pregnant women including pre-pregnancy BMI, age, and education level, were collected. The relationship between serum PAPP-A and premature delivery was analyzed using Logistic regression.Results: (1) PAPP-A MoM value was significantly lower in the early premature delivery group than that in the late premature delivery group and the full-term birth group(P<0.05), and showed no statistically significant difference between the late premature delivery group and the full-term birth group(P>0.05). (2) Logistic regression showed that low PAPP-A MoM value was associated with higher risk of early premature delivery; low education level of pregnant woman, multiple abortions, premature rupture of membranes, gestational diabetes mellitus, gestational hypertension, and abnormal fetal position were all risk factors for early premature delivery. Conclusion: The serum PAPP-A MoM value presents an independent risk factor for early premature delivery; in pregnancy care, early intervention based on the condition of the pregnant woman could improve outcome for both mothers and babies.

参考文献：

[1] 谢幸.妇产科学[M].9版.北京:人民卫生出版社, 2018:95-98.
[2] TORCHIN H, ANCEL P Y.Épidémiologie et facteurs de risque de la prématurité (Epidemiology and risk factors of preterm birth)[J]. Gynecol Obstet Biol Reprod(Paris), 2016, 45(10):1213-1230.
[3] 肖笛, 王晨虹, 许燕滨, 等.早孕期母体血清中PAPP-A水平与妊娠期糖尿病的相关性及预测价值研究[J]. 实用妇产科杂志, 2017, 33(6):446-450.
[4] 王结珍, 梁培松, 王伟佳, 等.孕早期血清F-βHCG, PAPPA水平及BMI值的变化与不良妊娠结局的相关性[J]. 现代检验医学杂志, 2019, 34(4):151-153, 157.
[5] KARAASLAN O, SECKIN K D, KADIROGULLARI P, et al. The utility of pregnancy associated plasma protein-A MoM values in prediction of term respiratory distress syndrome[J]. Journal of Obstetrics and Gynaecology, 2019, 40:200-204.
[6] 贺艳.孕妇血清PAPP-A、IR与妊娠期糖尿病的临床相关性分析[J]. 广州医药, 2016, 47(5):31-33.
[7] 魏淑燕, 李彬.孕早期PAPPA水平在预测孕晚期不良妊娠结局中的意义[J]. 齐齐哈尔医学院学报, 2015, 36(31):4708-4710.
[8] BILAGI A, BURKED L, RILEY R D, et al. Association of maternal serum PAPP-A levels, nuchal translucency and crown-rump length in first trimester with adverse pregnancy outcomes:retrospective cohort study[J]. Prenat Diagn, 2017, 37(7):705-711.
[9] 马艳飞.孕妇血清PAPP-A、β-HCG水平与GDM、PE、FGR的相关性[D].郑州:郑州大学, 2019.
[10] 陈锐.影响晚期早产儿短期预后的危险因素分析[D].重庆:重庆医科大学, 2020.
[11] 陈敦金.降低中国单胎早产发生率任重道远[J]. 中华围产医学杂志, 2018, 21(6):362-366.
[12] 张晓慧, 初清, 刘秀梅, 等.不同胎龄及出生体质量早产儿293例临床分析[J]. 中国小儿急救医学, 2011, 18(4):351-353.
[13] 罗欣, 漆洪波.早产的诊治现状和面临的问题[J]. 中国实用妇科与产科杂志, 2020, 36(2):111-114.
[14] 江江, 颜芳, 吴云萍, 等.自发性早产孕妇血清妊娠相关蛋白-A和抑制素-A表达水平的研究[J]. 中国妇幼保健, 2014, 29(13):2041-2044.
[15] MIKKELSEN J H, RESCH Z T, KALRA B, et al. Indirect targeting of IGF receptor signaling in vivo by substrate-selective inhibition of PAPP-A proteolytic activity[J]. Oncotarget, 2014, 5(4):1014-1025.
[16] 夏杏玲.CRP、PAPP-A在先兆早产孕妇血清中表达的临床意义[D].遵义:遵义医学院, 2018.
[17] 何敏敏, 唐雅兵.妊娠10~13周母血PAPP-A及胎盘体积对胎儿生长受限的预测价值[J]. 中国生育健康杂志, 2019, 30(6):549-551.
[18] 何丽芸, 杜莉, 金辉, 等.上海市早产发生状况及危险因素研究[J]. 中国妇幼健康研究, 2020, 31(6):706-711.
[19] SUFF N, STORY L, SHENNAN A.The prediction of preterm delivery:what is new?[J]. Semin Fetal Neonatal Med, 2019, 24(1):27-32.
[20] 蒋芳, 高劲松, 钟逸锋, 等.北京协和医院25年早产状况的调查[J]. 中国医学科学院学报, 2016, 38(5):528-533.
[21] 陈凌, 孟阳, 朱玲玲.早产儿肺炎发病的相关因素分析[J]. 现代医学, 2016, 44(2):223-227.
[22] 方广东, 贾贝贝, 陈长春, 等.极低出生体重儿支气管肺发育不良的高危因素及防治[J]. 东南大学学报(医学版), 2020, 39(4):430-435.

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