妊娠中期测定孕妇血清β-HCG、AFP及UE3水平对预测妊高征的意义(精)

妊娠中期测定孕妇血清β-HCG、AFP及UE3水平对

预测妊高征的意义

[ 10-04-19 13:08:00 ] 作者：王爱娟，左万

兴编辑：studa20

【摘要】目的探讨测定中期妊娠孕妇血清β-HCG、AFP及UE3水平及测定MAP对预测妊高征的关系。方法对2 363例中期妊娠孕妇抽取血标本测定血

β-HCG、AFP及UE3值，同时测量MAP，并随访至分娩，观察上述指标与妊高征的关系。结果有177例因各种原因除外后，余2 186例随访至分娩，发生妊高征179例，占8.2%。妊高征组血β-HCG、AFP值分别为（61.75±9.78）IU/L

及（328.3±41.52）μg/L，显著高于正常孕妇组的（20.65±7.61）IU/L及（151.96±36.06）μg/L，P<0.01。UE3为（53.7±20.11）ng/L，显著低于正常组的（81.45±34.36）ng/L，P<0.05。当血β-HCG升高≥2 MOM，AFP值升

高≥2.5 MOM时，预测妊高征发生率分别为39.8%（45/125）及29.8%

（42/141），显著高于对照组的6.3%（134/2 090）及6.4%（137/2 045）。UE3下降≤0.5 MOM时预测妊高征发生率为29.8%（42/141），显著高于对照组的6.7%（137/2 045）。当MAP>12 kPa时，预测妊高征发生率为26.4%

（112/425）。在179例妊高征患者中有40例上述四种指标均明显高于预示值水平，且大多为重度子痫前期患者。结论测定中期妊娠孕妇血清β-HCG、AFP 及UE3及MAP对预示妊高征发生均有一定价值。当应用多指标联合监测可显著提高阳性预测率。

【关键词】中期妊娠；β-HCG；AFP；UE3；MAP；妊娠高血压综合征；预示

［Abstract］ Objective To investigate the relationship between predicting PIH and determing serum β-HCG，AFP and UE3 levels in mid trimester of pregnancy as well as determing the

MAP.Methods In this study 2 363 gravidas in mid trimester of pregnancy were included，subjected to MAP measure and followed up to accouchement.Their serum specimens were collected to detect β-HCG，AFP and UE3 and we observed the relationship between the occurance of PIH and the above-mentioned targets.Results Except 177 cases for various reasons，the remainder 2 186 cases were followed up to delivery，among which PIH occurred in 179 cases，accounting for

8.2%.In the PIH group，serum β-HCG and AFP values were

（61.75±9.78）IU/L and（328.3±41.52）μg/L respectively，significantly higher than the normal group of pregnant women

（20.65±7.61）IU/L and（151.96±36.06）μg/ L，P<0.01.UE3 value was （53.7±20.11）ng/L，significantly lower than the normal group of （81.45±34.36）ng/L，P<0.05.When the serum β-HCG rose≥2 MOM，AFP value increased≥2.5 MOM，prediction of the incidences of PIH was 39.8%（45/125）and 29.8%（42/141）that were significantly higher than the 6.3%（134/2 090）and 6.4%（137/2 045）of the control group.When

UE3 dropped≤0.5 MOM，the prediction of PIH was 29.8%（42/141），significantly higher than 6.7%（137/2 045）in control group.While MAP>12 kPA，the prediction of PIH was 26.4%（112/425）.Among the 179 cases of PIH，there were 40 cases which the whole 4 indexes above-mentioned were significantly higher than predictive value，and patients were almost severe pre-eclampsia.Conclusion It’s valuable to determine β-HCG,AFP,UE3 and MAP of mid-pregnancy maternal serum to predicate PIH.It could significantly increase the positive predictive rate by jointing detection with the multiple indexes.

［Key words］ mid trimester of pregnanc y;β-

HCG;AFP;UE3;MAP;pregnancy hypertension;indiction

近年来，测定中期妊娠孕妇血清绒毛膜促性腺激素（β-HCG）、甲胎蛋白（AFP）及游离雌三醇（UE3）来预测妊高征，但结果各有不同。本文测定妊娠中期孕妇上述血清生化指标，以探讨其在预测妊高征的意义，并与翻身试验及平均动脉压（MAP）预测法进行对照比较。

1 资料与方法

1.1 研究对象与标本采集 2002年7月至2005年12月对初次来上海市第一人民医院宝山分院妇产科做产前检查的2 363例孕妇抽取血清测定血β-HCG、AFP及UE3，并定期产前检查直至分娩，并收集其临床资料进行分析。孕妇平均年龄（25.8±3.2）岁，初诊孕周25～32周，平均（29.9±

2.6）周，除了363例为经产妇外均为初产妇，2 363例孕妇均无慢性高血压、心肝肾疾

病及糖尿病病史。

1.2 诊断标准妊娠期高血压疾病诊断标准参照乐杰主编的《妇产科》第6版教科书。

1.3 试剂及测定方法所有标本均由本院中心实验室专人采用放射免疫方法检测，β-HCG药盒为上海生物制品研究所提供，单位IU/L；AFP及

UE3药盒均由北京北方生物技术研究所提供，单位分别为：μg/L及ng/ml，测定仪由合肥众成机电技术公司生产的DFM-96型γ放射免疫计数仪测定。

1.4 翻身试验及平均动脉压测定翻身试验时孕妇取左侧卧位，测左臂血压至平稳不变，翻身仰卧再测血压，平卧后舒张压上升≥2 kPa为阳性

预示值，平均动脉压用burton公式=（收缩压+舒张压×3）/2-2 计算，以平均动脉压≥12 kPa为阳性预示值。

1.5 统计学处理采用t检验及χ2检验进行统计学处理，P<0.05为差异有统计学意义。

2 结果