Prediktivna vrednost izuzetno niskih nivoa PAPP-A, slobodnog βhCG i izuzetno visokog srednjeg pulzatornog indeksa uterinih arterija u prvom trimestru trudnoće u proceni nastanka intrauterusnog zastoja u rastu ploda

  • Relja Lukić University of Belgrade, Faculty of Medicine, Clinic for Gynecology and Obstetric „Narodni Front“, Belgrade, Serbia
  • Nataša Karadžov-Orlić University of Belgrade, Faculty of Medicine, Clinic for Gynecology and Obstetric „Narodni Front“, Belgrade, Serbia
  • Amira Egić University of Belgrade, Faculty of Medicine, Clinic for Gynecology and Obstetric „Narodni Front“, Belgrade, Serbia
  • Barbara Damnjanović-Pažin University of Belgrade, Faculty of Medicine, Clinic for Gynecology and Obstetric „Narodni Front“, Belgrade, Serbia
  • Željko Miković University of Belgrade, Faculty of Medicine, Clinic for Gynecology and Obstetric „Narodni Front“, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP180109070L
Ključne reči: trudnoća, prvi trimestar, fetus, zaostajanje u rastu, ultrasonografija, dopler kolor, plazma, protein a, udružen sa trudnoćom, horionski gonadotropin, beta subjedinica, humani

Sažetak


Uvod/Cilj. Neželjeni ishodi trudnoće kao što su pre­ek­lampsija, abrupcija placente i zaostajanje rasta fetusa i mrtvorođenost mogu biti prepoznati u okvirima pre­natalnog skrininga. Cilj ove studije bio je ispitati mogućnost predviđanja pojave intrauterusnog zastoja u rastu ploda (IUGR) pojedinačnom i kombinovanom upotrebom izu­zetno niskih vrednosti plazma proteina A povezanog sa trudnoćom (PAPP-A), izuzetno niskih vrednosti slobodne beta subjedinice humanog horionskog gonadotropina (free βhCG), kao i ekstremno visokih srednjih vrednosti dop­lerskog pulsatilnog indeksa (PI) uterinih arterija u prvom trimestru trudnoće. Metode. Prospektivnom studijom analizirane su jednoplodne trudnoće starosti 11–13+6 nedelja gestacije u okviru rutinskog skrininga na Daunov sindrom. Studija je rađena na Odeljenju za visoko rizične trudnoće, univerzitetske Ginekološko-akušerske klinike „Narodni front“ u Beogradu, Srbija. Skrining prvog trimestra je obuhvatao analizu: PAPP-A, free βhCG i PI kod normotenzivnih nulipara, kod kojih su zabeležene ekstremno niske vrednosti PAPP-A (PAPP-A ≤ 0,52 unit multiple of median – MoM) i/ili ekstremno niske vrednosti free βhCG (free βhCG ≤ 0,56 MoM) i/ili ekstremno visoke vrednosti PI (PI ≥ 2,52). Resultati. Kod 85 trudnica uključenih u konačnu analizu, kod njih 14 (16,5 %) je zabeležena pojava IUGR ploda. PAPP-A ≤ 0,52 MoM i PI ≥ 2,52, kao pojedinačne kategorijske varijable, su prepoznate kao varijable sa visokim prediktivnim značajem za pojavu IUGR (odds ratio – OR = 3,064, 95% confidence interval – CI = 0,634 – 14,810, p = 0,046 i OR = 2,129, 95% CI = 0,449 – 10,713, p = 0,021). Daljom analizom, receiver operating characteristic (ROC) – kriva je identifikovala PAPP-A i PI, kao kontinualne varijable, koje su značajni prediktori za pojavu IUGR ploda (area under the curve – AUC = 0,671, 95% CI = 0,521 – 0,820, p = 0,045 i AUC = 0,744, 95% CI = 0,587 – 0,902, p = 0,004). Zaključak. Ova studija sugeriše da u prvom trimestru trudnoće ekstremno niske vrednosti PAPP-A i ekstremno visoke srednje vrednosti Doppler-PI uterinih arterija mogu biti značajni parametri za predviđanje pojave IUGR ploda. Opisani model bi mogao da se primeni u svakodnevnoj kliničkoj praksi u zemljama sa ograničenim mogućnostima, kada ostali parametri za predviđanje pojave IUGR ploda nisu dostupni.

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Objavljeno
2021/08/04
Broj časopisa
Vol. 77 Br. 3 (2020): Vojnosanitetski pregled
Rubrika
Originalni članak