| [Background]Preeclampsia is a potentially dangerous complication of pregnancy,parturiti-on or early after delivery.It can complicate up to 8%of pregnancies,and is a major cause of maternal and fetal death and morbidity.It accounts for 10-15%of maternal deaths and up to 60,000 maternal deaths worldwide each yeardue to preeclampsia.A growing body of evidence suggests that preeclamps-ia may be a marker of long-term health risk,with an incidence of 3-7%in primipara and 1-3%in pluripara.Preeclampsia was defined as the occurrence ofsystolic blood pressure?140mmHg and/or diastolic blood pressure?90mmHgafter 20 weeks of gestation,accompanied by urinary protein>0.3g/24h,or ran-dom urinary protein(-).By this time,the diagnosis of preeclampsia is in themiddle and third trimester of pregnancy,and preeclampsia existing treatment meas-ures(e.g.spasmolysis,decompression)were unable to prevent disease progressi-on,it can only be a temporary maintenance,termination of pregnancy is the only effective treatments by far,however,premature termination of pregnancy leads to the emergence of a large number of premature babies and babies withlow birth weight,and the increase of perinatal morbidity and infant disability rate,which leads to a large amount of expenditure of family,society and healthcosts.Therefore,it is of clinical significance to establish an early screening model to screen the occurrence of preeclampsia and apply it in clinical work,so as to achieve early detection and early intervention to reduce the occurrence of preeclampsia and reduce the expenditure of family,social and health costs.[Research objectives]This study discussed the value of serological indicators of down syndrome and glucose metabolism index in the screening of preeclampsia,in order to find the relationship between them and the incidence of preeclampsia,so as to provide a basis for the early screening of preeclampsia and its pathogenesis in clinical work.[Research methods]1.In this study,a total of 1,406 cases of pregnant women with pre-eclampsia who were examined and delivered in shenzhen maternal and child health care hospital on January 1,2014(solstice,January 1,2019)were selected through retrospective analysis.The risk factors including twins or multiple births,essential hypertension,nephropathy and medical diseases related to the onset of preeclampsia were excluded,about 754 cases of preeclampsia were left,then,the pregnant women with incomplete data were excluded,a total of 181 pregnant women with preeclampsia who met the conditions were collected as the experimental group,and 181 normal pregnant women were randomly selected as the control group according to the ratio of 1:1 in the experimental group and the control group.2.For all pregnant women in the study,collect the general clinical data of pregnant women(age,pregestational weight and BMI),serology of down syndrome screening index(PAPP-A,hCG,AFP,uE3)and glucose metabolism index(the fasting plasma glucose of the early pregnancy,three blood glucose values of OGTT),to assess the index value of preeclampsia screening alone,and two screening models were established,namely,the general condition of pregnant women combined with the serological screening indicators in early pregnancy and the general condition of pregnant women combined with the serological screening indicators in mid-pregnancy.Then,the indicators with good screening value were selected to conduct the combined screening and evaluate the value of the combined screening for preeclampsia.[Research results]1.Comparison of general information:The average age,pre-pregnancy weight and pre-pregnancy BMI of pregnant women in the preeclampsia group were higher than those in the normal pregnant women group,and the difference between the two groups was statistically significant(P<0.05).2.Comparison of serological screening indicators in early pregnancy:PAPP-A of serological indicators of down syndrome in early pregnancy was smaller than that in the normal pregnant women group,while fasting blood glucose and hCG in early pregnancy were higher than that in the normal pregnant women group,and the difference between the two groups was statistically significant(P<0.05).3.Comparison of screening indicators of serology in the second trimester:UE3 in the preeclampsia group was smaller than that in the normal pregnant women group,the blood glucose values of OGTT at 0 h,1 h and 2 h were all higher than those of the normal pregnant women group,and the difference between the two groups was statistically significant(P<0.05).4.The value of screening for preeclampsia alone for pregnant women in general:The AUC of preeclampsia screening was 0.730,0.733 and 0.754 respectively(P<0.05).5.The value of early pregnancy serological markers for screening for preeclampsia alone:The AUC of fasting blood glucose and hCG in early pregnancy were 0.739 and 0.708 respectively(P<0.05),while PAPP-A had no screening value for preeclampsia(AUC<0.5,P>0.05).6.The value of serologic markers in the second trimester for screening for preeclampsia alone:The AUC of preeclampsia was 0.666,0.711,0.684 and 0.753 respectively(P<0.05)for AFP and OGTT at 0 h,1 h and 2 h in the pregnant women in the second trimester,UE3 had no screening value for preeclampsia(AUC<0.5,P>0.05).7.General conditions of pregnant women combined with serological indicators in early pregnancy:the ROC curve(AUC)of the general condition of pregnant women combined with the serological indicators of early pregnancy screening for preeclampsia was 0.763,and the P value was 0.000.When the maximum index of the combined screening factor was 0.742,the optimal cut-off value of the combined screening factor was 87.315,the sensitivity was 87.1%,and the specificity was 80.6%8.General conditions of pregnant women combined with maternal mid pregnancy serological indicators:the ROC curve(AUC)of the general condition of pregnant women combined with the screening of preeclampsia with the mid-pregnancy serological index was 0.782,and the P value was 0.000.When the maximum index of the combined screening factor was 0.645,the optimal cut-off value of the combined screening factor was 76.9224,the sensitivity was 83.9%,and the specificity was 80.5%.9.Combined prediction:The ROC area under the ROC curve(AUC)of preeclampsia screening was 0.787 and the P value was 0.000.When the maximum index of the combined screening factor was 0.678,the optimal cut-off value of the combined screening factor was 85.3411,the sensitivity was 87.1%,and the specificity was 80.6%.[Conclusion]1.The general condition of pregnant women combined with the level of fasting blood glucose and hCG in early pregnancy can improve the screening value of preeclampsia2.The combination of AFP,OGTT 0 h,1 h,and 2 h blood glucose levels during the second trimester of pregnancy may enhance the value of screening for preeclampsia.3.The combination of fasting glucose and hCG levels in early pregnancy and OGTT 0 h and 2 h levels in mid pregnancy may enhance the value of screening for preeclampsia. |
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