Study On The Relationship Between Plasma D-Dimer,Inflammatory Factors,Uterine Artery Pulsation Index And Early Onset Preeclampsia In The First Trimester Of Pregnancy

Objective:Preeclampsia（PE）is a serious pregnancy complication that seriously threatens the health of mother and child.Research has found that early onset preeclampsia（EOPE）shows more adverse pregnancy outcomes than late onset preeclampsia（LOPE）.This study compared the plasma D-dimer（D-D）,inflammatory factors and Uterine artery pulse index（Ut A-PI）of patients with EOPE and normal pregnant women in the first trimester of pregnancy（11-13 weeks of pregnancy）to explore the correlation between the above indicators and the incidence of EOPE and its predictive value for EOPE,so as to improve the predictive value and predictive rate of EOPE in the first trimester of pregnancy,and then implement individualized management,Avoid the occurrence of EOPE and try to reduce the adverse pregnancy outcome of pregnant women.Methods:1 Select 213 EOPE patients who were registered for prenatal examination and hospitalized for delivery at the Obstetrics Clinic of the First Affiliated Hospital of Hebei North University from December 2020 to December 2022.After screening according to the inclusion and exclusion criteria,the remaining 75 patients met the selection criteria and were included in the case group.In addition,859 pregnant women with normal blood pressure and no comorbidities during pregnancy who underwent prenatal examination and delivery in our hospital were randomly selected and included in the control group using a random number table method.Clinical data of two groups of pregnant women were collected:age,pre pregnancy height,and weight to calculate pre pregnancy body mass index（BMI）,gestational age,parity,systolic blood pressure,diastolic blood pressure,heart rate,smoking history,and other indicators.Plasma D-D was measured at 11-13 weeks of pregnancy Inflammatory factors and Ut A-PI（bilateral mean）,including interleukin-6（IL-6）,C-reactive protein（CRP）,and neutrophils/lymphocytes（NLR）,were retrospectively studied.2 SPSS26.0 software was used for statistical analysis.The measurement data were expressed by mean±standard deviation（（?）±s）.The t-test was used for inter group comparison.The counting data were expressed by percentage.The inter group comparison was performed by X² test.The multifactor logistic regression was used to analyze the related risk factors before early onset eclampsia.The receiver operating characteristic（ROC）curve was compiled,the area under the curve（AUC）was analyzed,and the plasma D-dimer,IL-6 The difference between independent prediction and joint prediction of CRP,NLR and uterine artery pulsation index,and the clinical predictive value of the above indicators for early onset preeclampsia.Result:1 Comparison of serological indicators:（1）Age,pre-pregnancy BMI and the proportion of primiparas in EOPE group were higher than those in control group,the differences were statistically significant（P<0.05）.Systolic blood pressure,diastolic blood pressure,heart rate and smoking history were not statistically significant between the two groups（P>0.05）.（2）D-D,IL-6,NLR,Ut A-PI of pregnant women in EOPE group were higher than those in the control group,and the difference was statistically significant（P<0.05）.The CRP level of pregnant women in EOPE group was not statistically significant（P>0.05）.2 Multi factor Logistic regression analysis:2.1 The age of pregnant women is an independent risk factor for EOPE:Age of pregnant women（OR=1.566,95%CI=1.065～2.304,P=0.023）2.2 D-D,IL-6,NLR and Ut A-PI are independent risk factors of EOPE in early pregnancy:（1）IL-6 level in early pregnancy（OR=2.107,95%CI=1.131～3.926,P=0.019）.（2）NLR level in early pregnancy（OR=2.495,95%CI=1.177～5.290,P=0.017）.（3）D-D level in early pregnancy（OR=1.019,95%CI=1.006～1.032,P=0.005）.（4）Ut A-PI level in early pregnancy（OR=14.379,95%CI=2.868-72.084,P=0.001）3.A EOPE prediction model was constructed based on the levels of D-D,IL-6,NLR and Ut A-PI in the first trimester of pregnancy.The ROC curve of a single indicator was analyzed as follows:（1）The AUC of IL-6 predicting EOPE in the first trimester of pregnancy was 0.894,the sensitivity was 83%,the specificity was 65%,the Yoden index was 0.481,and the corresponding cut-off value was7.6mg·L^-1;（2）The AUC of NLR predicting EOPE in early pregnancy was 0.789,the sensitivity was 79%,the specificity was 49%,the Yoden index was0.281,and the corresponding cutoff value was 4.63;（3）The AUC of D-D predicting EOPE in early pregnancy was 0.922,the sensitivity was 85%,the specificity was 79%,the Yoden index was0.639,and the corresponding cut-off value was 371.15ug·L^-1;（4）The AUC of Ut A-PI for predicting EOPE in the first trimester of pregnancy was 0.964,the sensitivity was 93%,the specificity was 85%,the Yoden index was 0.786,and the corresponding cut-off value was 1.31.（5）The largest AUC among IL-6,D-D,NLR and Ut A PI in early pregnancy was 0.964,indicating that Ut A PI in a single index had relatively high predictive value for EOPE.4 The ROC curve of the joint prediction of multi factor indicators is analyzed as follows:（1）The AUC of EOPE predicted by IL-6 and NLR in the first trimester was 0.924.When the cut-off value was 0.411,the Yoden index was 0.760,the sensitivity was 88%,and the specificity was 88%.（2）The AUC of EOPE predicted by IL-6,NLR and D-D in the first trimester was 0.970.When the cut-off value was 0.501,the Yoden index was 0.893,the sensitivity was 93%,and the specificity was 96%.（3）The AUC of EOPE predicted by IL-6,NLR,D-D and Ut A-PI in the first trimester was 0.985.When the cut-off value was 0.491,the Yoden index was 0.847,the sensitivity was 96%,and the specificity was 95%.（4）The combined predictive value of D-D,IL-6,NLR,Ut A PI for EOPE in early pregnancy was significantly higher than that of single index（P<0.05）.Conclusion:1 The age of pregnant women,pre pregnancy BMI and primipara are related to the occurrence of EOPE,among which age is an independent risk factor for the occurrence of EOPE.2 In clinical indicators,levels of D-D,IL-6,NLR,and Ut A-PI in early pregnancy are independent risk factors for the onset of EOPE,and are correlated with the onset of EOPE,all of which are positively correlated.3 The combined predictive value of D-D,IL-6,NLR,and Ut A-PI in early pregnancy for EOPE is significantly higher than the predictive value of individual indicators.