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目的:研究孕妇血浆TXB2在子痫前期以及正常妊娠中的变化并探讨不同孕期对子痫前期的预测价值。方法:采用前瞻性、双盲的研究方法,对180例孕前血压正常的孕妇,在妊娠10+0~14+6、20+0~24+6、30+0~34+6周3个时间段母体血浆中的TXB2水平进行测定,观察孕妇孕期病情变化并随访妊娠结局。结果:①180例孕妇发展为子痫前期10例(子痫前期组),其中4例重度子痫前期、6例轻度子痫前期;170例妊娠结局正常(正常妊娠组)。②180例孕妇血浆中TXB2的水平随着妊娠的进展,进行自身配对比较均逐渐上升,不同阶段之间比较,差异有显著性意义(P=0.000<0.01)。③在妊娠10+0~14+6周子痫前期组母体血浆TXB2水平与正常妊娠比较,差异有上升的趋势,但差异无统计学意义(P=0.486>0.05);20+0~24+6、30+0~34+6子痫前期母体血浆TXB2与正常妊娠组比较,其值均明显上升(P=0.016、0.002,P均<0.05)。④母体血浆中TXB2水平在妊娠20+0~24+6、30+0~34+6周2个阶段对子痫前期均有预测价值,ROC曲线下面积分别为0.724(95%CI0.617~0.830)和0.797(95%CI0.674~0.920),应用ROC曲线计算2个阶段的最佳切入值分别为3 750 ng/ml和4 400 ng/ml,它们预测子痫前期的敏感性、特异性、阳性预测值、阴性预测值、比数积(OR)分别为80%、69.5%、13.3%、98.33%、9.11和90%、68.82%、13.84%、99.13%、19.86。结论:子痫前期母体血浆TXB2水平在临床症状出现前很长一段时间就异常升高,20+0~24+6、30+0~34+6周母体血浆TXB2水平对子痫前期有早期预测价值,妊娠30+0~34+6周的预测价值优于妊娠20+0~24+6周。
Objective: To study the change of plasma TXB2 levels in preeclampsia and normal pregnancy and to explore the predictive value of TXB2 in different pregnant women. Methods: A prospective, double-blind study was performed on 180 pregnant women with normal blood pressure before pregnancy at 3 times of pregnancy at 10 + 0-14 + 6,20 + 0-24 + 6,30 + 0-34 + 6 weeks TXB2 levels in maternal plasma were measured to observe the changes of pregnant women during pregnancy and follow-up of pregnancy outcomes. Results: ①80 pregnant women developed 10 cases of preeclampsia (preeclampsia group), 4 cases of severe preeclampsia, 6 cases of mild preeclampsia; 170 cases of normal pregnancy outcome (normal pregnancy group). ② The level of TXB2 in plasma of 180 pregnant women increased gradually with the progress of pregnancy, and their pairing increased gradually. The difference was significant between different stages (P = 0.000 <0.01). (3) Compared with normal pregnancy, the level of TXB2 in maternal serum of preeclampsia group at 10 + 0-14 + 6 weeks of gestation had a trend of increase, but the difference was not statistically significant (P = 0.486> 0.05); 20 + 0-24 + 6 (P = 0.016,0.002, P <0.05). Compared with the normal pregnancy group, the levels of TXB2 in preeclampsia maternal serum of 30 + 0 ~ 34 + 6 were significantly increased. The levels of TXB2 in maternal plasma had predictive value for preeclampsia in two stages of pregnancy (20 + 0-24 + 6,30 + 0-34 + 6 weeks). The area under ROC curve was 0.724 (95% CI 0.617 ~ 0.830), and 0.797 (95% CI 0.674-0.920). The best cut-off values calculated by ROC curve at 2 stages were 3 750 ng / ml and 4 400 ng / ml, respectively, which predicted the sensitivity of preeclampsia The positive predictive value, negative predictive value and OR were 80%, 69.5%, 13.3%, 98.33%, 9.11 and 90%, 68.82%, 13.84%, 99.13% and 19.86, respectively. Conclusion: TXB2 levels in maternal plasma from preeclampsia were abnormally elevated for a long time before the onset of clinical symptoms. TXB2 level in maternal plasma from 20 + 0-24 + 6,30 + 0-34 + 6 weeks had an early prediction of preeclampsia The predictive value of 30 + 0 ~ 34 + 6 weeks of gestation was better than that of 20 + 0-24 + 6 weeks of gestation.